The thesis is devoted to the optimization of treatment of patients who suffer from acute otitis media complicated by mastoiditis based on etiological factor and proposed and developed surgical methods such as early short term eardrum bypass, tunnel endoscopic anthrotomy and modified antromastoidotomy (Patent №0201187»). Analysis of morphological, immunological, lab investigations and clinical examinations was made. Patients with acute otitis media complicated by mastoiditis were divided into 2 subgroups.
173 patients with acute otitis media complicated by mastoiditis were involved in the investigation. 84 men and 89 women represented this group. The age of patients ranged from 19 to 65. All patients were divided into two groups.
The first (the main) group contains 81 patients who suffer from acute otitis media complicated by mastoiditis and they were treated based on modified protocol from 2013 to 2016. Both conservative and surgical methods of treatment were used. The group of patients was divided into two subgroups: («1а») and («1b»). Patients of the first subgroup received conservative traditional treatment with the use of local and systemic antiviral drug (inductor of interferon with immunotrophism), and early short term eardrum bypass. Tunnel anthrotomy and modified antromastoidotomy was done to patients of the subgroup «1b».
The second group (comparison) includes 92 patients with acute otitis media complicated by mastoiditis and patients were treated 2008 to 2012. Both conservative and surgical methods were used. Patients were divided into 2 subgroups («2а») and («2b»). The patients of the subgroup «2а» received conventional treatment and paracentesis of ear drum. Typical Schwartz antromastoidotomy was done to patients of the subgroup «2b».
Actual practical and scientific task of Otorhinolaryngology was determined in the thesis. The efficacy of treatment of patients who suffer from acute otitis media complicated by mastoiditis due to etiological and genetic use of antiviral drug with immunotropic action (systemically and locally), and also proposed surgeries such as early short term bypass, tunnel anthrotomy and modified antromastoidotomywas determined.
Done morphological investigations of mucous membrane of the ear drum and tissues of papillary process demonstrated that in patients with acute otitis media complicated by mastoiditis lymphocytes exceeded (during practical absence of granulocytes) and it can be one of the specific sign for viral invasion. Positive polymerase chain reactions on human herpes virus of the І-ІІ types, adenoviruses and Epstein-Barr virus in main part of patients with acute otitis media complicated by mastoiditis (67 %), and increase of lymphocytes in general blood analysis was demonstrated (p<0,05).
Polymerase chain reactions on human herpes virus of the І-ІІ types, adenoviruses and Epstein-Barr virus in main part of patients with acute otitis media complicated by mastoiditis (67 %) were positive and it can confirm the role of viruses in etiological pathogenesis of this disease. Based on morphological investigations, on polymerase chain reactions, general blood analysis, increased lymphocytosis was detected (p<0,05). Positive clinical investigations, computer tomography investigations (CT) were used during the first days of treatment in patients of the main group (they received antiviral drug), in comparison with control one, antiviral drug was proposed and used for patients with acute otitis media complicated by mastoiditis.
Developed methods of antromastoidotomy for surgical treatment of patients with acute otitis media complicated by mastoiditis with destructions of sockets of papillary process were used. It differs from traditional operation by maximal preservation of anatomical and physiological peculiarities of middle ear, double drainage of tympano-antromastoidal cavities by silicone chains and primary suturing. Proposed surgery improves functional results, assists in essential term reduction of patients’ hospital stay (comparison with control group, p<0,05).
So, proposed complex treatment for patients with acute otitis media such as the use of antiviral drug for systemic and local use and also developed surgeries (early short term ear drum by pass), endoscopic tunnel anthrotomy, modified antromastoidotomy significantly improve functional results and (p<0,05) these methods essentially reduce inpatient hospital stay from 12,5 to 8,8 (p<0,05), and decrease the number of reoperations (p<0,05), and allow controlling attico-antral connection and in short terms (9-14 days) return a patient to employment capacity.
