Cochlear implantation is a high-tech method of rehabilitation of persons with complete deafness. However, cochlear implantation in patients may be accompanied by a number of difficulties due to the peculiarities of the structure of the cochlea, the relative position of anatomical structures relative to it and the nature of the acquired pathology of the inner ear. The reaction of the facial nerve during stimulation of one of the electrodes of the cochlear implant system is a common complication that can lead to a deterioration in the patient’s quality of life due to significant discomfort and restrictions on the use of the cochlear implant system. The debut of twitching of facial muscles in patients after cochlear implantation can occur both at the stage of connecting the speech processor and at the stages of further rehabilitation, which according to world literature can reach an interval of 10 years from the moment of surgery. Anatomical features of the cochlea, its interposition with the facial nerve, changes in the bone labyrinth, further progression of remodeling or ossification of the cochlea play a significant role in the development of symptoms of facial nerve stimulation in patients with sensorineural hearing loss of the IV degree, including at the stage of subsequent settings of the speech processor. The frequency of occurrence of this complication in various literature sources varies from 1 to 14.9 %. The purpose of this work is to review the world literature on the etiology of facial nerve stimulation in users of cochlear implants, highlighting the main theories of the origin of non-auditory sensations in this category of patients, since the data conducted in various studies are variable, and with a certain etiology reaches 38 %.

Chronic polypous rhinosinusitis is a common pathology significantly impairing the life quality. The pathogenesis of polyps’ generation predisposes the combination of conservative and surgical treatment methods. Today, the gold standard is the chronic polypous rhinosinusitis therapy using topical glucocorticosteroids and the functional endoscopic rhinosurgery, if necessary. However, there exists another approach suggesting the use of intranasal spacers and implants. This review work provides information about the causes of occurrence, technical development and the most successful representatives of such devices. According to some information, the efficacy of intranasal spacers and implants is comparable to functional endoscopic surgery. However, a rare utilization of this method in everyday practice reduces the possibility of study and obtaining reliable information about it.

Over the past few decades, in the world scientific literature devoted to the problems of auditory-speech rehabilitation, there has been an increased interest in studying the etiological features of congenital deafness. A deep understanding of the etiology and mechanisms of deafness development helped optimize the various stages of cochlear implantation and, thereby, increase its effectiveness. Objective. To develop an algorithm for obtaining the earliest possible information about the causative factor of congenital deafness for timely planning of rehabilitation measures, reducing the cost of excessive diagnostic search, and achieving the most effective results in the auditory and speech development of children. Patients and methods. From 2018 to 2021, a study of the etiological spectrum as well as the characteristics of cochlear implantation in patients with various etiologies of congenital deafness was conducted at the Saint Petersburg Research Institute for Ear, Throat, Nose, and Speech. We examined 100 patients under the age of 3 years (mean age 2,15 ± 0,2 years), of which 58 were female, and 42 were male. All patients had congenital bilateral deafness on newborn audiological screening and were candidates for cochlear implantation. Results and discussion. According to the data obtained, 37 patients (16 boys, 21 girls, mean age 2,3 ± 0,3 years) had congenital cytomegalovirus infection as an etiological factor in deafness. The presence of signs of congenital deafness of genetic etiology was detected in 58 patients (24 boys, 34 girls, mean age 1,9 ± 0,2 years): 43 of them with nonsyndromic deafness and 15 patients with syndromic deafness (4 boys, 11 girls, mean age 2,1 ± 0,4 years). In 5 patients, the etiological factor of congenital deafness could not be established even at the present stage of diagnostic search.

At the present stage of medical development, cochlear implantation is the optimal method of auditory and speech rehabilitation for patients with binaural deafness. Congenital cytomegalovirus infection, according to Russian and international scientific literature, is one of the two most common causes of congenital deafness. At the same time, its relevance in cochlear implantation is due not only to its high incidence among patients, but also to the influence on surgical procedure and the final results of hearing and speech rehabilitation. The surgery stage of cochlear implantation in patients with cytomegalovirus infection, due to a number of circumstances, requires individual technical procedure. The most significant thing in this context is the phenomenon of frequent preservation of natural hearing residues at low frequencies, requiring careful and accurate preservation. Moreover, due to the pathogenetic effect of an infectious agent, such patients have a high risk of intraoperative bleeding. Therefore, the most important goal is to prevent the penetration of blood cells into the lumen of the cochlear spiral canal in order to prevent damage to the cochlear sensory structures. However, to date, all the proposed methods of performing surgery in such patients have a number of limitations and do not in all cases meet all the requirements of efficacy and safety. In this regard, on the basis of the St. Petersburg Research Institute of Ear, Throat, Nose and Speech, an original surgical technique was developed for cochlear implantation in patients with cytomegalovirus infection. This technique most significantly meets the requirements of hearing-safe surgical techniques when performing cochlear implantation.

Bilateral cochlear implantation is becoming an optimal method of hearing and speech rehabilitation in patients with bilateral sensorineural hearing loss. Therefore, today, general principles for selecting patients for this type of treatment are being developed all over the world, approaches are being formed to determine indications and contraindications. The key argument for determining indications for bilateral cochlear implantation is the patient’s rehabilitation potential, which in turn is formed from a combination of various factors. One of the most significant of them is the time factor—namely, the time interval between the onset of deafness and the performance of surgery. For patients with the first cochlear implantation, the prognosis of rehabilitation is inversely related to the duration of this time delay. And for patients who are planning to install a second cochlear implant with sequential binaural cochlear implantation, the influence of the time factor is still a matter of debate. In our work, we present a description of our successful experience in the rehabilitation of patients with bilateral sensorineural hearing loss of the IV degree (profound) with a large time range (more than 5 years) between successive surgical interventions—cochlear implantations.