Острый риносинусит относится к числу наиболее распространенных заболеваний человека, и эта проблема с каждым годом становится все актуальнее. Это заболевание развивается, как правило, на фоне респираторной вирусной инфекции. Тем не менее выраженная клиническая картина острого синусита почти всегда обусловлена последующей бактериальной инвазией околоносовых пазух.

Despite the existing possibilities of using modern surgical equipment and modern diagnostic techniques, there is still a risk of damaging the facial nerve during otological surgery (1,2). This is caused by the anatomic proximity of the facial nerve to the structures of the middle and inner ear (3-5). The facial nerve becomes more vulnerable to injury during repeated (sanifying) surgery on the middle ear, with the presence of dehiscence in the Fallopian canal, during the removal of masses in the middle ear (2,6), in cases of malformation of the middle or inner ear (7,8).Many scientific works study the anatomy of the facial nerve (3-5). Most of them provide a general description of the microtopographic characteristics of the facial canal and, at the same time, lack information on the thickness of its bone walls.Intraoperative damage causes paresis (paralysis) of the facial muscles, which leads to a degradation of the patients' quality of life. According to literary sources, during original surgery, the risk of dysfunction of the facial nerve is 0.6-3.7% of cases (9, 10). During repeated invasive surgery, the risk rises up to 4-10% of cases (1,11,12).The appearance of intraoperative facial nerve monitoring allowed identifying the nerve throughout the entire surgery (13-15), since this method of studying the neuromuscular system registers fluctuation of the electric potential of muscles in response to nerve stimulation.Despite considerable success in the development of machines for intraoperative monitoring of the facial nerve, the most important restriction remained, which was related to the fact that the system could not warn surgeons if they were operating near the facial nerve, whi-

This article provides a brief literature review on congenital cholesteatoma of the temporal bone. Existing theories describing the development of this pathology are analysed. The diagnostic criteria of congenital cholesteatoma are presented, along with a comparative analysis of the characteristics of various instrumental research methods used in the verification of this disease. Issues involved with the surgical management of such patients are considered.A conclusion is made that, due to the rare occurrence of the congenital cholesteatoma of the temporal bone, diverse theories of its etiology, the lack of clear criteria for its diagnostics, this pathology requires further research to elucidate the nature of the disease and identify the risk groups of its occurrence.Conflict of interest: the authors declare no conflict of interest.

Objective. This study was conducted to increase effectiveness of anti-relapse therapy of chronic rhinosinusitis with polyps to create a stable long-term remission in the long-term postoperative period.Patients and research methods. 60 patients with total spread of polyposis process in the nasal cavity and paranasal sinuses were examined. All patients underwent endoscopic polysinusotomy and 3 weeks after surgery, basic anti-relapse therapy of PRS in the form Of nasonex intranasal spray of 400 mcg/day for 6 months in combination with irrigation with isotonic salt solutions was prescribed. At the same time, 30 patients 1.5 months after polysinusotomy were additionally given a short course of systemic corticosteroid therapy with Methylprednisolone, starting at 20 mg/day in combination with Omeprazole at 20 mg /day for 14 days. Subjective assessment of the patients ‘condition was carried out by questionnaire, for objective diagnosis acoustic rhinometry and CT of the paranasal sinuses were used.Results. Simultaneous administration of a short course of corticosteroid therapy in combination with prolonged intranasal use of Nasonex spray in patients with nasal polyps in the postoperative period contributed to the most rapid subjective improvement of nasal breathing. The combined scheme in 27 (90%) subjects showed a statistically significant improvement in intra-nasal aerodynamics (p<0.05) 2 months after polysinusotomy according to the results of acoustic rhinometry, the average MPPS1 was 0.67 ± 0,04 cm2 before and after the decongestant test. In 13 patients (44,3%) who received only intranasal corticosteroids reactive edema from the nasal mucosa were more pronounced, which contributed to the formation of zones of pathological narrowing of the nasal flow and a decrease in МППС1 to 0.43 ± 0,04см2 to test with decongestant. 2 years after surgical treatment in patients undergoing a combined course of corticosteroid therapy in relation to patients receiving only monotherapy with intranasal corticosteroids, there was no recurrence of polyposis in 86.7% of cases (26 patients), against 66.7% (20 patients), receiving only intranasal corticosteroids.

The present article reports the clinical cases of the surgical intervention on 20 patients presenting with petrous bone cholesteatoma. We have identified several clinical variants of petrous bone cholesteatoma based on the results of multispiral computed tomography (MSCT) of the temporal bones and categorized them into the following types in accordance with the classification proposed by Moffat-Smith an M. Sanna for this pathological condition: supralabyrinthine (n=8), supralabyrinthine-apical (n=2), infralabyrinthine (n=3), infralabyrinthine-apical (n=5), massive (n=1), and massive - apical (n=1). The surgical sanation of petrous bone cholesteatoma was performed in all the 20 patients in the absence of the pronounced bone destruction in the walls of the temporal bone pyramid and of the subdural expansion of cholesteatoma. In all the cases, the trepanation cavity remained open till its complete epidermization. The follow up period was around 3 years in duration on the average. The post-surgical analysis of the clinical conditions of each of the 20 patients was performed with special reference to the surgical technique applied for the removal of petrous bone cholesteatoma and the final outcome of the radical treatment.