The dissertation work is devoted to improving the results of diagnostics and increasing the effectiveness of surgical treatment of chronic cholesteatomic otitis media in children by improving diagnostic and therapeutic tactics using modern methods of endoscopic examinations and closed variants of endoscopic and microsurgical functional-reconstructive operations on tympanoplasty.
It has been shown that an effective method for diagnosing ACOM in children with uncontrolled retraction and cholesteatome, as well as narrow and curved auditory canal is otoendoscopy using straight and angular endoscopes, which, unlike otoscopy and otomicroscopy, allows maximum visualization of the anatomical parts of the middle ear that are difficult to see.
The study found that the use of an endoscope during otoscopy significantly increases the efficiency of detecting cholesteatome in children from the age of 2 years, while the lack of optics leads to late (6-7 years and older) confirmation of the diagnosis. According to the results of a retrospective analysis of outpatient findings (n = 346) in 2016-2021 and a comprehensive examination of these children, it was found that when using endoscopy compared to conventional otoscopy, cholesteatomic forms of chronic otitis media were additionally detected in 22 out of 44 cases, that is, in 50.0 (95% CI 35.2 - 64.8) % of cases at p < 0.001. In particular, epitympanic perforation was additionally detected in 6 (26.1%) children out of 23 cases of CCOM (p < 0.05). No epidermal ingrowth due to mesotympanic perforation and congenital cholesteatome were diagnosed by otoscopy, which were detected in 6 and 7 children, respectively, at the hospital level (p < 0.01). Mesotympanic perforation was additionally detected in 2 children (4.3%) out of 46 cases, deep uncontrolled retraction of the tympanic membrane and retractive cholesteatome - in 3 out of 8 cases (37.5%). The leading symptoms of cholesteatome in children, according to our data, are recurrent otorrhea with ichorotic odor and hearing loss, which were noted in 69.2% and 58.5% of cases, respectively.
It has been proven that congenital cholesteatome localized in the tympanic cavity may be an indication for endaural endoscopic surgery. Endoscopic surgery can also be performed in "second look" operations in the remote period after previous tympanoplasty for cholesteatome otitis media. All other cholesteatome otitis media can be operated by combined endoscopic and microsurgical methods.
It has been shown that the use of otoendoscope during surgery improves visualization and diagnosis of cholesteatome in the hard-to-reach areas of the tympanic cavity. Thus, the use of an endoscope allowed to detect cholesteatome in the tympanic sinus in 21.9% of patients, whereas with traditional microscopy only in 3.0% of cases (p < 0.05), cholesteatome of the facial sinus - in 15.6% and 6.1%, respectively (p > 0.05), in general in the projection of the tympanic cavity - in 93.8% and 69.7% of patients (p < 0.05).
The proposed algorithm of endoscopic support of CCOM microsurgery in the closed variant with the use of endaural anthrodrainage, especially in childhood, is aimed at high-quality visualized sanitation and allows to control inflammation in the middle ear and perform painless antrum toilet, and if necessary - to administer medications. The indications for the use of this surgical technique are pronounced thickening of the middle ear mucosa and simultaneous adenotomy in case of hypertrophy of the lymphoid tissue of the nasopharynx of 2-3 stages.
Thus, in the combined surgery of cholesteatome otitis media with endoscopic support, endaural drainage of the antrum provides additional ventilation and drainage of the reconstructed middle ear cavities in the early postoperative period, in 3,4 times increases the number of primary grafts of the neotympanic membrane and reduces the percentage of residual perforations from 15.2% to 5.3%, 2.9 times reduces the number of residual cholesteatomes, and also allows to achieve a stable morphofunctional effect in the long term in 89.5% (p < 0.05) patients and reduces the number of reoperations by 3.5 times compared to the standard technique of ear microsurgery using an operating microscope (p < 0.05)
