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This article presents the results of a comparative evaluation of surgical treatment of patients suffering from conductive and mixed hearing loss in various clinical forms of otosclerosis using titanium and nitinol stapedial prostheses. Materials and methods. In the department of surgical treatment of diseases of the ear and the base of the skull of the NMICO from 2017 to 2020, the functional results of stapedoplasty using titanium and nitinol prostheses were compared in the near (up to 3 months) and long-term (more than 6 months) postoperative period. The comparison groups included 50 patients who were divided into two equal in all major indicators groups that differ only in the type of prosthesis used (SE NiTiNOL/PTFE and Ti/PTFE). In the postoperative period (the average follow-up period was 3 years), the values of the bone-air interval in operated patients were evaluated; clinical and experimental comparison of computed tomography data obtained during the installation of titanium and nitinol prostheses was also carried out. Results. Functional results were assessed in the immediate (13 months) and long-term (6 months3 years) periods after surgery. The average postoperative CVI was 12.29 dB (SD 5 dB) in patients in the group with nitinol prostheses and 11.93 dB (SD 5 dB) in titanium. 88% and 80% of patients in both groups had an "excellent" or "good" result in hearing improvement. The cadaveric material was used to compare the CT data obtained during the installation of stapedial prostheses: in 4 cases, when installing a nitinol prosthesis, there were no artifacts, which made it possible to visualize the prosthesis attachment ring; in the other 4 cases with a titanium prosthesis, this was not possible to detect. Conclusions. The installation of a nitinol prosthesis has a number of advantages: it does not require additional fixation of its head on the long stem of the anvil in the form of a compression, which minimizes the risks of traumatizing the structures of the inner ear and, accordingly, the development of sensorineural hearing loss in the postoperative period, as well as the use of SENiTiNOL prostheses reduces the likelihood of developing aseptic necrosis of the long leg of the anvil due to the properties of the metal and a decrease in its thickness. Analyzing the data of computed tomograms of patients after stapedoplasty, only in the group with installed nitinol prostheses, it was possible to visualize the position of the prosthesis on the long stem of the incus, in the area of the vestibule, its length, the integrity of the long stem of the incus.

The aim of present study was to investigate the hBD-3 gene expression in the surface epithelium of mucosa in ORL organs. We have studied a total of 210 mucosal samples, obtained at the most frequent surgical intervantions from 5 different anatomical functional areas: nose and paranasal sinuses, middle ear, nasopharynx, oropharynx, larynx. The inferior turbinate mucosa (1) and the normal middle nasal passage mucosa (2) served as controls. Estimation of hBD-3 and β-actin gene expression was performed by reverse transcription and realtime PCR. In the nasal and sino-nasal mucosa, only negligible expression levels were detected in 14.29-33.33% of samples, most often in the specimens from the middle nasal passage and ethmoid labyrinth polyps (53.84%), being absent in hypertrophic inferior turbinate. In the middle ear cavity, the frequency detection of the hBD-3 gene expression varied from 7.69% in the stapes superstructures mucosa to 53.85% of the mucosal samples in the presence of cholesteatoma. hBD-3 gene expression was detected in most tissue samples with high microbial contamination: palatine tonsils (100%); adenoid hypertrophy (84.62%); adenoids in hypertrophic states of adenoids and palatine tonsils (87.5%); laryngeal fibrous-vascular polyps (87.5%); other laryngeal pathology (77.78% of the samples). The highest levels of hBD-3 gene expression were found in laryngeal fibrous-vascular polyps. The findings presumed two functionally different types of immune response in mucosa of the ORL organs. In the anatomical-functional areas lined with ciliated epithelium (middle and inferior nasal passages, maxillary and ethmoid sinuses, middle ear), significantly lower frequencies (Fisher's exact test, p < 0.05 to p < 0.001) and levels (Mann-Whitney test, p < 0.05 to p < 0.001) of hBD-3 gene expression were detected, except of polyps of the middle nasal passage and ethmoid labyrinth, and mucosa of the tympanic cavity in cholesteatoma, which may be related to the nature of the pathological process. In the areas lined with squamous epithelium or a combination of squamous and ciliated epithelium, hBD-3 gene expression was detected almost everywhere and at significantly higher levels. In the context of chronic inflammation and infection-related diseases of the ORL organs, in addition to the direct microbicidal activity of hBD-3 as the first line of immune response, one may suggest peptide dysregulation and, even, pathogenetic effects of hBD-3, e.g., increased sensitivity to infections, pathological changes in the composition of the commensal bacteria, fibrous remodeling.

Introduction. One of the most relevant areas of modern medicine is research affecting the assessment of the quality of life of a person. Hearing loss can significantly limit various areas of life, thereby affecting the overall quality of life and certain particular characteristics. One of the methods of surgical treatment of otosclerosis is stapedoplasty with the installation of a titanium prosthesis.Aim of the study. To assess the quality of life index in patients with otosclerosis and its dynamics depending on the surgical treatment performed.Materials and methods. The study involved 39 patients who underwent piston stapedoplasty with the installation of a titanium prosthesis. Quality of life was assessed at the preoperative and postoperative stages. We used a Russified version of the SPOT-25 questionnaire (Stapesplasty Outcome Test 25) with a range of results, where 0 is the minimum impact, and 100 is the maximum.Results. All patients successfully underwent stapedoplasty. The average score in the preoperative period was 58.8 ± 14.9, in the postoperative period – 29.4 ± 20.4. Statistical comparison revealed a statistically significant improvement in all separately assessed indicators (p < 0.001) and overall quality of life (p < 0.001).Conclusion. The introduction into practice of a new tool for assessing the patient’s condition through such a parameter as quality of life can influence the rationale for the methods and tactics of patient treatment, which can positively affect the quality of medical care provided.

Otosclerosis is a chronic process that leads to hearing impairment and other onerous symptoms, such as tinnitus or dizziness. The following conclusions can be drawn from the analysis: they lead to problems in communication with the environment, as well as to different types of disorders of psychological nature, and this negatively affects the quality of life of patients. Despite the great progress in knowledge, the disease process cannot be completely stopped with otosclerosis. The most effective method of treatment is stapes surgery, which main goal is to improve speech hearing and understanding, as well as to reduce the accompanying symptoms. The greatest recognition among doctors collect stapedotomy surgery. The surgery may have unpleasant complications for some patients, but it is worth noting that in the majority of cases these problems disappear after a maximum of a few weeks. The aim of the study was to analyse previously published articles and other scientific literature on the impact of symptoms associated with otosclerosis on the quality of life of patients. Due to the small number of relevant publications, the search time frame has not been limited. The search for the literature needed to write the article was conducted using the Google Scholar and PubMed scientific articles databases. The topics of the described works included: generally quality of life, what is the sense of hearing for a person, the effects of hearing loss on the patient's functioning, the impact of tinnitus on the patient's life, possible methods of treatment for otosclerosis, improved hearing after surgery, as well as possible postoperative complications and their impact on well-being of the patient.

The article deals with optimization of the current technical methods in operations on the osteosclerotic stapes aimed at minimization of any trauma in the inner ear and at maximal possible safety for the sound-conducting structures - the factors that guarantee the functional results of the surgery.

The article presents various classifications of forms of otosclerosis (OS), which change with the development of diagnostic methods. At the same time, according to the literature, a unified OS classification has not yet been adopted. All existing classifications are imperfect to some extent. The classification of clinical forms of OS according to TPA data makes it possible to determine the indications for surgical treatment and to suggest its possible effect, but not the localization of OS foci. X-ray classifications of localization of OS foci indicate their diversity, distribution, and do not always correlate with the type of hearing loss. At the same time, modern diagnostics of OS should be based on audiological data, localization of foci and their density according to the results of X-ray methods of examination. Based on the examination and treatment of 1532 patients with various forms of OS, a modern clinical and radiological classification of the disease is proposed, based precisely on these provisions. This classification, in our opinion, will improve the quality of diagnosis of various forms of OS, will allow to differentiate the tactics of treating patients with this disease to stabilize hearing loss, indications for surgical treatment, suggest its effectiveness with a reduction in the risk of surgical failures and possible further rehabilitation of the patient.

The aim of this study - to investigate the practice of stapes surgery in Russia using a special questionnaire (Appendix 1). Thirty-three questionnaires were sent to specialists dealing with stapes surgery in various Russian medical institutions. Responses were received from all ENT specialists, of whom 75.7% use stapedotomy as a technique. In most cases, colleagues perform more than 30 operations per year, there were also reports of performing about 100 operations per year and in one case 370 operations annually. 45.5% of respondents preferred a combination of general and local anesthesia for stapes surgery. According to the results of the survey, the titanium K-piston prosthesis is most frequently used. Analysis of the survey results showed that to date there is no unanimous opinion concerning some aspects of stapes surgery; however, in many issues the approaches of Russian surgeons coincide with the general world trends.

The article presents a brief review of the literature on the anatomy and physiology of the round window (RW) niche, the causes of occlusion, the diagnosis of this pathology, the features of auditory disorders and tactics when it is detected in patients with otosclerosis (OS). A clinical case of diagnosis and effective surgical treatment for obliteration of RW in a patient with advanced OS, which occurred in 2019 in 0.7% of cases, is described. Removal of RW niche obliteration was carried out with a curette and microcresis by smoothing the canopy over RW until partial visualization of the secondary membrane. It was this stage of the operation that made it possible to restore the normal hydrodynamics of the inner ear fluids and contributed to a functional result. Thus, the diagnosis of RW obliteration in patients with OS is difficult, but possible when using computed tomography of the temporal bones and assessing the mobility of the RW membrane or analyzing changes in hearing at the end of the operation, if it is performed under local anesthesia. The simultaneous performance of stapedoplasty and the removal of bone obliteration of RW makes it possible to safely achieve functional rehabilitation in patients with OS.

The article briefly presents the physiology of the stapes muscle tendon (SMT), and features in its defeat. Its length was studied using high-resolution multispiral computed tomography of the temporal bones. We also studied the possibility of its restoration using the author's method of tendoplasty using metallized stapes prostheses. Tendoplasty with stapedoplasty was performed in 74 patients with otosclerosis (OS), and 48 patients had stapedoplasty without tendoplasty. As a result of research, the average length of the SMT was 2.38±0.02 mm, which explains the need to use a 3 mm long venous autograft for tendoplasty. The author's method of tendoplasty for stapedoplasty allows restoring the acoustic reflex in 54.1% of OS patients using artificial stapes prostheses. The preservation of the vascular bed in the thickness of the restored tendon can improve the trophy of the long incus process and reduce the risk of its dystrophic changes in the postoperative period. In addition, this fact confirms the importance of the stapes muscle in the acoustic reflex.

Rehabilitation of patients with sensorineural hearing loss is an urgent task of otorhinolaryngology. One of the diseases leading to a pronounced hearing loss is the cochlear form of otosclerosis. The article describes a clinical case of rehabilitation of a patient with this pathology by means of cochlear implantation. The classification of otosclerosis based on the interpretation of computer tomography of temporal bones is presented.

The objective of the present study was to characterize the effectiveness of the audiological and radiological diagnostic techniques as well as the results of the surgical treatment of the patients presenting with otosclerosis based at the hospital clinic of the Pacific State Medical University. The analysis included 49 surgical interventions for stapedoplasty carried out on 42 patients during the period from 2015 to 2017. The tympanic form of the disorder was diagnosed in 51.02% of the cases, the mixed form I in 16.28%, and the mixed form II in 32.7%. The excellent results within two months after surgery were obtained in 87.2% of the treated patients, the good and satisfactory results in 8.72% and 4.08% of them respectively.