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Structural features of the extarnal ear form a number of factors that affect the course of inflammatory and scar processes. A strong difference in the structure of the external ear requires an individual approach, taking into account their structure. To maintain normal functioning, the external ear has specialized defense mechanisms, such as the presence of ceruminous glands, a weak acidic environment with bactericidal properties, a special epidermal migration mechanism aimed at self-cleaning the lumen of the auditory canal. But in addition to protective factors, the structure of the external ear has features that contribute to the development of a long-term inflammatory process. The data of studies describing the features of the narrowing of the of the cavity external auditory canal, both due to age-related changes in the auricle and due to the bending of the walls of its bone section. The shape of the external auditory canal affects not only the visualization of ear structures, but also the course of the inflammatory process. In the case of the development of scar and adhesive changes in the external auditory canal, this leads to a significant hearing loss. The main principles of the methods developed by the authors for the elimination of scar changes in the external auditory canal, depending on the localization in its departments, are described. In addition to the direct elimination of cicatricial changes, it is mandatory to eliminate the places of maximum narrowing of the external auditory canal with the expansion of its cavity, the formation of a skin lining, taking into account the complexity of epithelialization and the need to restore protective mechanisms. An important role in maintaining the effectiveness of treatment is played by the correct choice of tamponade and stenting for a long time. To correct the inflammatory process and prevent excessive formation of connective tissue, injections of ultra-long-acting glucocorticosteroids are used, carried out directly at the site of scar formation. Such an integrated approach to the correction of scars in the external auditory canal, taking into account the peculiarities of its structure, allows achieving high treatment results (up to 80 %), preventing the recurrence of the adhesive process and prolonged inflammation.
Structural features of the extarnal ear form a number of factors that affect the course of inflammatory and scar processes. A strong difference in the structure of the external ear requires an individual approach, taking into account their structure. To maintain normal functioning, the external ear has specialized defense mechanisms, such as the presence of ceruminous glands, a weak acidic environment with bactericidal properties, a special epidermal migration mechanism aimed at self-cleaning the lumen of the auditory canal. But in addition to protective factors, the structure of the external ear has features that contribute to the development of a long-term inflammatory process. The data of studies describing the features of the narrowing of the of the cavity external auditory canal, both due to age-related changes in the auricle and due to the bending of the walls of its bone section. The shape of the external auditory canal affects not only the visualization of ear structures, but also the course of the inflammatory process. In the case of the development of scar and adhesive changes in the external auditory canal, this leads to a significant hearing loss. The main principles of the methods developed by the authors for the elimination of scar changes in the external auditory canal, depending on the localization in its departments, are described. In addition to the direct elimination of cicatricial changes, it is mandatory to eliminate the places of maximum narrowing of the external auditory canal with the expansion of its cavity, the formation of a skin lining, taking into account the complexity of epithelialization and the need to restore protective mechanisms. An important role in maintaining the effectiveness of treatment is played by the correct choice of tamponade and stenting for a long time. To correct the inflammatory process and prevent excessive formation of connective tissue, injections of ultra-long-acting glucocorticosteroids are used, carried out directly at the site of scar formation. Such an integrated approach to the correction of scars in the external auditory canal, taking into account the peculiarities of its structure, allows achieving high treatment results (up to 80 %), preventing the recurrence of the adhesive process and prolonged inflammation.
For a long time for otolaryngologists, the issues of identifying and treating such a formidable disease as chronic suppurative otitis media (CSOM) have been topical. This disease still haunts many specialists, as it leads to acquired hearing loss in people of working age. Only in the last ten years, the number of children of younger age groups with already manifested acquired hearing loss has increased. Along with the correct and timely diagnosis, it is very important to cure this disease once and for all, since exacerbations often disrupt not only the performance, but also the quality of life of the patient. The gold standard for the treatment of patients with CHSO is surgical – tympanoplasty. In the process of studying the pathological process in chronic suppurative otitis media and methods of its more effective surgical treatment, the results of tympanoplasty were analyzed. An illustrative clinical example has been chosen, with the help of which it is possible to trace all the stages of surgical intervention in chronic suppurative otitis media. An otoscopic examination was carried out at several stages of observation of this patient, as well as the determination of auditory function. The presented clinical case shows step by step the effectiveness of the scheme of surgical treatment and postoperative management. Thus, these steps are applicable to any myringoplasty with tympanic membrane defects of any size. It is tympanoplasty and control in the postoperative period that makes it possible to completely close the defect of the tympanic membrane and prevent chronic otitis media from recurring.
In modern otomicrosurgery, there are significant successes of surgical treatment in the volume of tympanoplasty, but despite this, the problems of surgical treatment of chronic purulent otitis media are still relevant. One of the unsolved problems is the effective restoration of perforations of the tympanic membranemyringoplasty. The termination of infection of the tympanic cavity and the effect on the functional result of surgical treatment in chronic inflammatory diseases of the middle ear depends on the performance of this stage of tympanoplasty. The application of the layering method, the use of fascial-cartilage grafts, the formation of the neotimpanal membrane at the natural level is certainly the key to success in eliminating even total perforations of the tympanic membrane. However, it was noted that in the early postoperative period, the issue of effective flap vascularization and prevention of septic complications is of primary importance. Prolonged tamponade of the external auditory canal, the use of local and systemic antibacterial therapy reduces the risk of complications, but significantly increases the period of hospitalization, and hence the period of disability. It is observed that in large otorhinolaryngological surgical centers, mostly nonresident patients are in bed for several weeks. These patients are waiting for tamponade removal and evaluation of the effectiveness of surgical treatment, which, no doubt, is perceived positively from the point of view of the treatment process, but goes against the criteria for the effectiveness of specialized high-tech medical care. Therefore, many experimental and clinical studies have been conducted at present, which are aimed at finding an effective plastic material that contributes to the correct formation of the neotimpanal membrane, prevention of inflammation in the surgical wound area and shortening the period of engraftment of meattimpanal flaps. Considering the above, based on the latest data from domestic and foreign otorhinolaryngologists, in this article we offer our solution to the problem of effective performance of myringoplasty. It is noted that there is a need to study various materials for faster and more effective engraftment of the tissues of the tympanic membrane. The percentage of unsatisfactory morphological and functional outcomes, according to domestic and foreign authors, mainly in the plastic of suband total defects, remains high. The problem of surgical treatment of patients with chronic purulent otitis is of urgent importance for otosurgeons. The aim of the work was to study the use of biodegradable hydrogel in the healing of postoperative wounds in the surgery of chronic purulent otitis media. Description of a clinical case in a patient with chronic purulent otitis media using a biodegradable gel.
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