Microbial biocenoss in chronic purulent otitis media

The objective of the present work was to study microflora in the middle ear of 100 patients aged from 30 to 70 years presenting with chronic purulent otitis media (CPOM) by microbiological and genetic (PCR) methods. An important role of persistence factors, pathogenicity, and microbial antibiotic resistance in the development of CPOM was demonstrated. The frequency of occurrence of herpes and papilloma viruses was estimated. The most common form of the mixed infection was two-component virobacterial associations (46.2%). Three-component associations of viruses with bacteria (Chlamydiae or Mycoplasmas) formed less frequently (34.6%). In 19.2% of the cases, yeast-like fungi of the genus Candida were identified in these associations.     

On certain aspects of chronic purulent otitis media

The author reviews some etiological, pathogenetic aspects of OMPC, methods of diagnosis. Most effective surgical methods in epitympanitis are outlined, causes of relapsing purulent process in the middle ear following surgical interventions are analysed.     

Rehabilitation of patients with chronic purulent otitis media

Among 4200 patients of ENT clinic with otitis, 868 had chronic otitis media purulenta (COMP). Epi- and mesoepitympanitis developed in 272 of them. Exacerbation of COMP was treated locally with drugs immobilized on sorbents and new-generation medicines--ofloxacin and roxitromycin. Complicated epi- and mesoepitympanitis need surgical treatment. Special attention should be given to complete removal of all the affected tissues and postoperative control over wound healing. The course of healing can be evaluated by changes in cytological picture of the wound surface. 255 radical operations were performed. A complete postoperative epidermisation failed only in 16 (7.3%) patients.     

Surgical policy in chronic purulent otitis media in children

Surgical outcomes in 603 children with otitis media purulenta chronica (OMPC) have shown that early microsurgery (endaural tympano-, attico-, aditotomy) improved or reestablished normal anatomy and physiology of the middle ear in 85% of the patients. One-stage cleansing or plastic surgery is preferable. In operations on mastoid process in the absence of complications, prevention of reoperation seems most effective by autotissue plastic reconstruction of the mastoid bone wound in the end of the operation.     

Chronic purulent otitis media

This lecture reviews up-to-date information on the classification, etiology, pathogenesis, clinical features, diagnostics, surgical and conservative treatment of chronic purulent otitis media. It is maintained that surgical intervention including sanative and reconstructive procedures as well as hearing improvement measures is currently the preferred approach to the treatment of the disease in question. Special attention is given to different variants of sanative surgery in combination with tympanoplasty. The author emphasizes that the conservative therapy of chronic otitis media has the objective to eliminate exacerbation of the chronic process and does not substitute the surgical treatment.     

Sparing conservative surgery in children with chronic purulent otitis media

A novel method of treatment of otitis media purulenta chronica in children implies administration of donor (from the parents or donor with the same blood group) plasm possessing a complete set of humoral and cellular immunity components. As a monotherapy, plasm treatment proved highly effective both before surgery and after it.     

Treatment of chronic otitis media in continuous or recurrent purulent discharge

It is proposed to treat otitis media purulenta chronica with combination of antibacterial and, on demand, antifungal drugs. Pumping the drugs into the airways of the middle ear produces better results than routine drops. If local or general treatment is uneffective, it is recommended to conduct mastoidotomy followed by mastoidoplasty. This allows to arrest persistent purulent discharge and conversion of the purulent process into a dry one.     

Cochlear-vestibular disorders in the patients presenting with chronic purulent otitis media

The author presents statistical information concerning the prevalence of chronic purulent otitis media. Characteristics of typical complaints are described with special reference to cochlear-vestibular disorders in patients presenting with epitympanitis. The results of detailed analysis of the causes of cochlear-vestibular disorders in the patients with chronic purulent otitis media during the preoperative and postoperatve periods are reported.     

The vestibular function in patients with various forms of chronic purulent otitis media

A complex vestibulologic examination of 131 patients with otitis media purulenta chronica (OMPC) was made. The patients were divided into groups and subgroups basing on the course of OMPC and presence or absence of subjective vestibular disorders. Vestibular function was assessed in various OMPC forms. Vestibular abnormalities were found in all the examinees. Therefore, all OMPC patients should be examined vestibulologically for early detection of initial, subclinical changes of the inner ear vestibular apparatus and decision on treatment policy.