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ВВЕДЕНИЕОтогенные и риносинусогенные гнойно-воспалитель-ные внутричерепные осложнения (ВЧО) до настоящего времени являются актуальной проблемой оториноларин-гологии. По данным главных специалистов-оторинола-рингологов 34 субъектов Российской Федерации, сред-ний показатель летальности при отогенных внутричереп-ных осложнениях составил 19,7%, при риносинусогенных осложнениях -13,2%, при сочетании ото-и риносинусо-генной этиологии -34,6%. Высокий уровень летальности при данной патологии обусловлен общей тяжестью состо-яния больных при госпитализации: синдромом системно-го воспалительного ответа (ССВО), интоксикационным и очаговым поражением головного мозга [3][4]7]. Важнейшей проблемой, влияющей на результаты лече-ния больных с тяжелыми гнойно-септическими и внутри-черепными осложнениями, является сложность диагно-стики этой патологии, обусловленная полиморфизмом клинической картины заболевания [8][9][10][11]. ЦЕЛЬ ИССЛЕДОВАНИЯАнализ эффективности дифференцированного под-хода к диагностике и лечению больных с отогенными и риносинусогенными гнойно-воспалительными внутри-черепными осложнениями с использованием современ-ных критериев оценки тяжести общего состояния и стра-тификации риска. To evaluate the condition of patients and changes in course of the disease, the integral and quantifying scores to assess the severity of the systemic inflammatory response syndrome were used: SOFA, which allows to evaluate the level of organ dysfunction, the APACHE II severity of disease score and the Glasgow coma scale. The outcome is directly dependent on early comprehensive diagnosis of injury to the vital organs and systems of the body, timely initiation of specialized treatment. МАТЕРИАЛЫ И МЕТОДЫ

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The cochlear form of otosclerosis is characterized by irreversible metabolic changes that lead to complete hearing loss. Cochlear implantation, which is a high-tech method of rehabilitation for patients with profound hearing loss and complete deafness, becomes an opportunity for hearing restoration. However, CI in patients with cochlear otosclerosis may be accompanied by a number of difficulties due to the remodeling of the cochlea of varying severity. Thus, changes in the bony labyrinth play a crucial role in the management of patients with the cochlear form of otosclerosis and sensorineural hearing loss IV.

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.