Srebniak I. Modern approaches to diagnostic and treatment of patients with precholesteatoma status and temporal bone cholesteatoma

Thesis is directed for improving the efficiency of diagnosis and treatment of patients with precholesteatoma status (retraction pockets) and temporal bone cholesteatoma through addition of certain pathogenetic aspects based on clinical, enzymatic, ultrastuctural and radiological features, optimization of diagnostic tests and development of new treatment approaches. The material presented in this research composed of 259 patients with cholesteatoma (196 with acquired cholesteatoma, 27 – congenital cholesteatoma, 25 – intralabyrinth cholesteatoma, 11- external ear canal cholesteatoma) and 94 patients with precholesteatoma (retraction pockets). Due to research high enzymatic activity in cholesteatoma matrix, perimatrix and adjacent bone even in fixed retraction pockets (RP) and close to it underlying bone was established and predicted disease agressivity with bone destruction. Biochemical marker (high level of catepsin B) of cholesteatoma aggressivity was established in middle ear discharge. Polyfunctional proteolytic enzymes inhibitor (aprotinin) highly reduces cholesteatoma enzymatic activity in vitro study. These data permit to include polyfunctional proteinase inhibitor in the complex cholesteatoma treatment. Schemes of complex treatment the patients with cholesteatoma (surgery with aprotinin and interferon) were proposed and adopted in clinic to reduce the risk of residual cholesteatoma. After complex treatment residual cholesteatoma was found in 2,2 % in follow-up. Original surgical approach in patients with fixed RP (tympanoplasty with reinforced tympanic membrane with simultaneous subannular ventilation T-tube in inferioir external ear canal wall) demonstrated a high efficacy in follow-up. MRI DWI demonstrated a high specificity in 98 % to evaluate a residual cholesteatoma in follow up. MRI DWI with CT scan determined to detect residual cholesteatoma after different types of mastoidoplasty and avoid to perform a second-look procedures for check reason.