| Abstract: | As restoration of hearing in patients after radical surgery on the middle ear for otitis media purulenta chronica remains topical, we tried to increase the efficacy of ossiculoplasty in such patients by staged reconstruction of the middle ear. A total of 102 patients were examined and operated on. A modified classification of osseous chain defects was used to evaluate the degree of damage to the osseous system. The following policy was employed for reconstruction of the middle ear: in patients with large trepanation cavities (more than 5 ml) mastoidoplasty was carried out as the first stage using a musculo-periosteal flap with an anterior or inferior pedicle; at the second stage, myringoplasty was performed using a two-layer graft followed by ossiculoplasty with autotransplants (fingernail plate, auricular or tragal cartilage, cortical layer bone). Long-term follow-up of the patients showed that good and satisfactory hearing levels were obtained in 79.4% of the patients. The air-bone gap was closed by 10 dB or more in the speech frequency range in 80.4% of the patients. Staged reconstruction of the middle ear using autotransplant materials significantly decreased the number of postoperative complications (perforation of the plastic flap, cicatrical displacement of the prosthesis and graft rejection). |
