Kravchenko S. Improving the efficiency of sanitizing operations in the middle ear using a combined mastoidoplasty (clinical and experimental investigation)

The thesis is devoted to the improvement of the efficiency of sanitizing operations in the middle ear using a combined mastoidoplasty in patients with chronic suppurative otitis media. The thesis is based on experimental studies and clinical observations of substitution reparative mechanisms of bone implant Tutoplast® and bioactive ceramic material "Sintekost" in the trephine cavities of mastoid processes after sanitizing operations as well as the assessment of the effectiveness of a three-layer combined mastoidoplasty using autologous bone and the above mentioned implants in the surgical treatment of patients with chronic suppurative otitis media. The experimental part of the study was performed on 72 clinically healthy guinea pigs. The features of reparative processes of bone implant Tutoplast® and bioactive ceramic material "Sintekost" in the tympanic bullae of guinea pigs were investigated using histological verification as well as the reactions of the inner ear to the materials which were replanted into the tympanic bullae of guinea pigs were assessed and compared. The experimental studies showed that the transformation of bone implant Tutoplast® was completed in all animals within 12 months with the formation of a homogeneous compact bone tissue, while the restructuring of bioactive ceramic material "Sintekost" in a period of 12 months continued with the presence of unchanged granules of implanted plastic material in the tympanic bullae. The results of experimental investigation have shown that the use of the aforementioned plastic materials had no pathologic effects on the structures of the inner ear of guinea pigs. The clinical part of the study is based on the examination and surgical treatment of 62 patients with chronic suppurative otitis media who underwent surgical treatment combined mastoidoplasty where 25 patients had a three-layer mastoidoplasty by using autologous bone and bioactive ceramic material "Sintekost" and 37 patients had a three-layer mastoidoplasty where autologous bone and bone implant Tutoplast® were used. In both groups has been achieved stable sanifying effect. According to the CT of the temporal bones, it was noted that after a three-layer combined mastoidoplasty where autologous bone and bone implant Tutoplast® were used complete healing of the trepanation cavity with formation of the bone tissue has been achieved in terms of up to 1 year, at the same time after the three-layer combined mastoidoplasty where bioactive ceramic material "Sintekost" with autologous bone were used in terms of 1.5 to 2 years in the newly formed bone there was still present the implanted granules of plastic material. Substantiated and introduced into clinical practice three-layer combined mastoidoplasty (patent model " Mastoidoplasty method in patients with chronic suppurative otitis media " МПК А61В 17/00 №87518 from 10. 02. 2014).