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Background. Middle ear neoplasm is a rare pathology accounting for about 0.7% total head and neck tumours. The article describes the clinical presentation, diagnostic methods and surgical treatment for neoplasms of mastoid process, a quite rare tumour localisation.Clinical Case Description. Patient G., 66 yo, was admitted to a otorhinolaryngological unit with a preliminary diagnosis of left mastoid neoplasm and complaints of non-transient headache on the left and slight hearing loss in both ears. The symptoms have been persisting since childhood. Laboratory tests without abnormalities. Voluminous invasive neoplasm of left temporal bone mastoid in CT. Left mastoidectomy with mastoid neoplasm resection was performed routinely, with a histological examination of surgical material. Benign angiofibroma in morbid histology. Definitive diagnosis: neoplasm of left mastoid. Relief from headache and overall improvement were reported by the patient in two months after surgery.Conclusion. Benign mastoid angiofibroma is a rare tumour in terms of localisation and morphology reluctant to diagnosis in an asymptomatic form. We suggest computed tomography as the main diagnostic and surgery — as main treatment method in this pathology. The disease has a life-favourable prognosis.

Chronic tonsillitis (CT) is an urgent problem in modern otorhinolaryngology. According to various authors, the incidence of this pathology is 5–18%. Complications from other organs and systems that occur on the background of CT significantly worsen the quality of life and may cause disability of the patient and can cause the death of patients. A radical method of treating this pathology is surgery (tonsillectomy). The main complication during surgery is pharyngeal bleeding, which can develop both after the operation and in the postoperative period. The article presents data on the use of tranexamic acid (TC) to prevent pharyngeal bleeding and reduce pain in the throat in patients in the postoperative period after tonsillectomy. The study included 160 people, divided into 4 groups of 40 people each, depending on the method used to remove the palatine tonsils. The use of TC in the postoperative period helps to reduce bleeding after tonsillectomy, as well as reduce pain in the throat.

Aim. To describe a case of fat obliteration using platelet-rich plasma in a patient with recurrent chronic frontal sinusitis.Materials and methods. A clinical case of a 60-year-old patient who had repeatedly performed extranasal frontotomy for recurrent chronic frontal sinusitis with a short-term effect is described. Due to the ineffectiveness of conservative and traditional surgical treatment, taking into account the characteristics of the clinical picture and the presence of a cosmetic defect in the area of projection of the right frontal sinus, as well as CT results (postoperative bone defect of the right half of the frontal bone), a right-side extranasal frontotomy was performed. The operation involved sinus obliteration with adipose tissue obtained from areas of the thigh anterior surface by lipoaspiration under low pressures with the addition of platelet-rich plasma (PRP) prepared by a single centrifugation of whole venous blood. An assessment of the patient’s condition and fat transplant was carried out on the basis of objective examination after 4 and 6 months and 1.5 year after the surgery and the results of control computed tomography (CT).Results. No complaints regarding nasal breathing from the frontal sinus were registered during control examinations. A good cosmetic result and the absence of pain during palpation in the right frontal sinus were observed. According to CT results, the density of the contents of the frontal sinus corresponded to that of adipose tissue; the volume of material did not changed.Conclusion. Frontal sinus obliteration with adipose tissue and PRP addition is a promising method for treating patients with recurrent chronic frontal sinusitis and repeatedly performed extranasal frontotomy. This method has several advantages over other methods.

A comparative analysis of the results of a separate atticoantrotomy with tympanoplasty of type I in patients with serous mucositis (moderately thickened and edematous mucous membrane of the tympanic cavity with serous-mucous discharge, n = 59) and patients with intact mucous membrane (n = 48) was performed. The functional outcome of surgical treatment was evaluated using tonal threshold audiometry by calculating the average value of the air-bone gap (ABG) in the speech frequency range after 3 and 12 months. The condition of the graft (the presence or absence of perforation of the neo tympanic membrane) was determined by otomicroscopy 12 months after surgery. Hearing improvement was observed in patients in both groups: the air-bone gap after 12 months in the speech frequency zone was 13.5 ± 5.1 dB in the patients of the main group and 15 ± 5.0 dB in the control patients. The absence of perforation of the neo tympanic membrane 12 months after surgery was observed in all patients. The results obtained in this study suggest that the phenomena of serous mucositis in the form of edema of the mucous membrane of the tympanic cavity and serous-mucous discharge do not significantly affect the morphological and functional results of tympanoplasty in patients with a tubo-tympanic form of chronic otitis media.

One of the methods of surgical treatment of patients with chronic purulent otitis media is an "open" sanitizing surgery on the middle ear. One of its important features is the formation of a wound surface that communicates with the external environment, which subsequently leads to infection, lengthening the time for epithelization, and in 13-30% of cases, the latter is incomplete with the development of a "trepanation cavity disease".To establish the nature of the effect of retinoid-based drugs on the severity of the inflammatory process and the regeneration processes in the tissues of the trepanation cavity after sanitizing operations on the middle ear.The subjects of the study were 78 patients who underwent the first "open" sanitizing operation on the middle ear. At the final stage, turunda with a 1% dioxin solution in combination with a sterile ointment of 13-cis-retinoic acid, concentration 0.05% was injected into the postsurgery cavity. 30 patients additionally took 13-cis-retinoic acid in tablet form. In the control group, retinoids were not used.The obtained data allow us to recommend the use of retinoid-based drugs as a means of suppressing the inflammatory reaction and stimulating the regeneration process in the trepanation cavity after an "open" sanitizing surgery on the middle ear.Одним из методов хирургического лечения больных хроническим гнойным средним отитом является «открытая» санирующая операция на среднем ухе. Одной из ее важных особенностей является образование сообщающейся с внешней средой раневой поверхности, что впоследствии приводит к инфицированию, удлинению сроков эпителизации, а в 13—30% случаев отмечена незавершенность последней с развитием «болезни трепанационной полости».Установить характер влияния препаратов на основе ретиноидов на выраженность воспалительного процесса и процессы регенерации в тканях трепанационной полости после санирующих операций на среднем ухе.Объектами исследования стали 78 пациентов, которым впервые была проведена «открытая» санирующая операция на среднем ухе. На завершающем этапе в послеоперационную полость вводили турунду с 1% раствором диоксидина в сочетании со стерильной мазью 13-цис-ретиноевой кислоты концентрации 0,05%. 30 пациентов дополнительно принимали 13-цис-ретиноевую кислоту в таблетированной форме. В контрольной группе ретиноиды не применялись.Полученные данные позволяют рекомендовать применение препаратов на основе ретиноидов в качестве средства подавления воспалительной реакции и стимуляции процесса регенерации в трепанационной полости после «открытой» санирующей операции на среднем ухе.

A novel coronavirus infection SARS-CoV-2 (COVID19) is especially dangerous for elderly and senile patients. Preventive measures for elderly people should cover three areas: 1) direct prevention of the viral infection, 2) preservation of the functional status and prevention of geriatric syndromes, including the use of social support measures, 3) control of comorbidities. The clinical pattern of COVID-19 in older patients may be atypical, while the mildness of symptoms (no fever, cough, shortness of breath) may not correspond to the severity of the prognosis. Delirium may be the first manifestation of COVID-19, which requires special care in its screening. Management of elderly and senile patients with COVID19 should include measures for delirium prevention, the detection and improvement of nutrition. The risk of malnutrition with sarcopenia increases with hospitalization of a patient, especially when using artificial ventilation, is associated with an unfavorable prognosis during hospitalization, accelerates the progression of senile asthenia and reduces the quality of life. Geriatric assessment is the cornerstone of determining the management of an elderly patient.

The object of the clinical research was 367 patients after rhinoplasty. All patients before the operation fill in a special questionnaire, allowing to evaluate quantify the signs of dysmorphophobia. Patients with low index of dysmorphophobia (within 5-6 points) adequately estimated the result of the operation because their opinion coincided with the opinion of the doctor and in some cases they didn't notice even insignificant defects the doctor saw. The total number of these results satisfying the patient and the doctor composed 93% (341 patients). The patients who attaches great importance to insignificant defect of their appearance the index of desmorphophobia was high (16 patients - the average index of dysmorphophobia - 15). Questionnaires containing questions that allows to expose the signs of dysmorphophobia may be useful in the time of selection of patients for plastic surgery, in particular rhinoplasty. According to the questionnaire worked out by us, the index of dysmorphophobia of 5 points and below allows to count up on an adequate evaluation. The importance of index from 6 to 10 points may require psychological support of the patient who will much evaluate the result.Изучить взаимосвязь субъективной оценки результатов ринопластики с индексом дисморфофобии. Объектом клинического исследования послужили 367 пациентов, которым была выполнена ринопластика в 2016 г. Пациентам предлагалось заполнить накануне дня операции специальный опросный лист, позволяющий количественно оценить отношение анкетируемых к своей внешности и выявить пациентов с признаками дисморфофобии. Респонденты с низким индексом дисморфофобии (5—6 баллов) адекватно оценивали результат операции, их мнение совпадало с оценкой врача, а в ряде случаев они даже не замечали тех незначительных дефектов, которые видел врач. Общее количество результатов ринопластики, удовлетворяющих пациента и врача, составило 93% (341 человек). У пациентов, придающих большое значение мелким недостаткам внешности, индекс дисморфофобии был высоким (16 пациентов — средний индекс дисморфофобии 15). Анкеты, содержащие вопросы, позволяющие выявить признаки дисморфофобии, могут быть полезными при отборе пациентов для пластических операций, в частности ринопластики. По данным разработанного нами опросника, индекс дисморфофобии 5 баллов и ниже позволяет рассчитывать на адекватную оценку пациентом результатов ринопластики. Значение индекса от 6 до 10 баллов может потребовать психологической поддержки пациента, который будет слишком скрупулезно оценивать результат. Значение индекса дисморфофобии более 10 баллов должно насторожить хирурга в отношении неадекватной оценки пациентом результатов операции, особенно в случае малейших асимметрий в области хирургического вмешательства.

The objective of the present study was to evaluate the possibility of the application of the cyanoacrylate-based glue for the strengthening of the reconstructed elements of the middle ear and its influence on the regeneration of the cartilaginous tissue. We used the cartilaginous tissue from the auricles of the male California rabbits as a model. The cartilage was destroyed in a standard press. Half of the cartilage thus fragmented was implanted into the left auricle. The remaining part was mixed up with the cyanoacrylate glue and implanted into the right auricle of the same animal. The implanted material was used for the morphological study on day 10, within 1 and 2 months after the beginning of the experiment. The results of the study confirm the absence of the toxic action of the biologically compatible cyanoacrylate-based glue on the regeneration of the cartilaginous and connective tissues which suggests the possibility of its application for the surgical treatment of the diseases of the middle ear.Цель исследования - определить возможности использования биосовместимого клея на основе цианакрилата для укрепления реконструированных элементов среднего уха и влияние на регенерацию хрящевой ткани. В качестве объекта исследования была использована хрящевая ткань ушных раковин кроликов-самцов калифорнийской породы. Ушной хрящ подвергали деструкции в стандартном прессе, половину раздробленного хряща имплантировали в левую ушную раковину, а остаток с добавлением биоклея - в правую ушную раковину. На 10-е сутки, через 1 мес и через 2 мес животных выводили из эксперимента, а материал подвергался морфологическому исследованию. В результате проведенного эксперимента удалось подтвердить отсутствие токсического действия биоклея на основе цианакрилата на регенерацию хрящевой и соединительной ткани, что позволяет нам применять его в хирургии среднего уха.

The article presents a case of the middle ear obliteration in a 45 years old female patient that complained of a long-term continuous otorrhea and underwent 4 surgeries for congenital middle ear development abnormality (microtia, external auditory canal (EAC) atresia), paraauricular fistula and stage 3 chronic sensoneural hearing loss. The work provides detailed description of the course of interference that resulted in the fact, that no complaints of the operated ear have been observed for 12 months. Therefore, the fat tissue obliteration of tympanic cavity may be used as the method of choice in case of treatment of post-surgical cavity without result in patients with the chronic suppurative otitis media in the cases where reconstructive hearing improvement surgery is impossible or is not indicated. The latter is observed in the patients with the expressed sensoneural hearing loss.

The issues of surgical treatment and rehabilitation of the patients suffering from chronic suppurative otitis media (CSOM) belong to the most urgent problems in the present-day otiatrics. The latter is related to the significant number of unsatisfactory results in both sanitizing and reconstructive-functional interventions. Currently, most otosurgeons hold the opinion that alongside with sanation, it is necessary to restore the middle ear architectonics, thereby eliminating the conditions predisposing to inflammations. Reconstructive surgery of the middle ear retrotympanic regions is of high importance for solving this task.

The article presents information on the importance of this problem, as well as the experience of surgical treatment of nasal septal perforation using alloplant. The authors monitored the results of treatment of 31 patients aged 19 through 45 years, with the nasal septum perforation. Alloplant was used as the plastic material. Perforation edges suturing was performed both on two sides and on one side. The use of nasal splints in post-surgery period increases the efficacy of surgical treatment. Complete closure of the septum defect or the decrease of its size reduces the frequency and symptoms of the disease.

Congenital palatoschisis is one of the most common malformations of face and jaws. One of the important negative consequences of this pathology is the auditory analyzer dysfunction. Soft palate muscles are responsible for correct opening of the auditory tube. Coordinated work of the muscles creates a pump mechanism, providing evacuation of the pipe contents and air drawing in. This work is based on the study of the effect of surgical closure of cleft soft and hard palate on the auditory tube function. The study has proven that operative treatment of the cleft soft and hard palate has a positive effect on the function of auditory tube and in most cases provides its recovery.

Approaches have been developed to the application of the geomorphometric method for identification of neotectonic structures from maps of datum and summit planes by using the territory of Perm krai as an example. We carried out a comparative analysis of the resulting maps with existing neotectonic maps of local uplifts to reveal their good correlation. We substantiate the possibility of using the suggested approaches in forecasting deposits of sand-gravel raw materials.

The article presents data on the histological structure of the fascia of the temporal muscle, used for plastic eardrum. A electron microscopic examination of the fascia immediately taken after 10, 20 minutes and 1 hour after collection of the material. It has been found that the destructive changes in gross structure fascia not. Determined by minor changes in the form of mild disorganization of collagen complex, granular dystrophy with an increase in the cell.

Most of the standard methods of treatment of patients with inflammatory nose and paranasal sinuses diseases are not effective enough. Argogel is a topical nanotechnology-based preparation which could be a conservative therapeutic alternative for such patients. The objective of this study was to evaluate the efficacy of topical application of the preparation containing silver nanoparticles in the early post-surgery period of the nasal cavity and paranasal sinuses. The study covered 40 patients with chronic rhinosinusitis aged from 25 to 70 after the ambilateral endoscopic maxillary ethmoidotomy. In the course of treatment on most of the patients, Argogel preparation application was accompanied with rapid improvement of objective state, normalization of rhinoscopic pattern and rhinocytogram results in comparison with application of the ointment Levomekol. This tendency has been observed over the whole treatment period.

The objective of this work was to study the influence of platelet enriched plasma on regeneration of cartilage tissue after its mechanical destruction using morphological methods. In the process of study, withdrawal and fragmentation of cartilage tissue sections of both ear conches of rabbits was performed with subsequent reimplantation of the crushed cartilage tissue to the same place in the left ear and crushed cartilage tissue mixed with platelet­enriched plasma obtained from the blood of the same laboratory animal - to the right auricle. After that a cut was made and the peculiarities of regeneration of the cartilage on the 10th, 20th days and after 1, 2 and 3 months after surgery were studied. After that the platelet enriched plasma was injected in the defect site on the right ear conch once a week. The study revealed that in the experimental group in terms of platelet enriched plasma application, regeneration of cartilage tissue occurred more adequately in comparison with the control group, and was accompanied by the acceleration of healing processes, which was expressed in activation of fibroblastic and chondroblastic of programed differentiation.

The objective of the present study was to elucidate the influence of retinoid-based pharmaceutical products on the process of regeneration of the tissues surrounding an open osteal wound under the experimental conditions. The experiments were carried out using 20 'Sovetskaya shinshilla' rabbits (12 males and 8 females). The animals with the modelled open osteal wound underwent daily treatment by the placement of the dressings impregnated with a mixture of dioxo-methyltetrahydropyrimidine and chloramphenicol ointments supplemented by 0.05% retinoic acid (1:1:1). The rabbits of the control group were treated using the dressings impregnated only with a mixture of dioxo-methyltetrahydropyrimidine and chloramphenicol ointments containing no retinoic acid. The study has demonstrated that the application of the retinoid-based medications for the treatment of the open osteal wound resulted in the well apparent positive dynamics of the wound process in comparison with that in the control animals. It is concluded that the data obtained give evidence that retinoid-based preparations can be used as an adjuvant treatment for the acceleration and promotion of the wound healing process in the trepanation cavity following sanation surgery on the middle ear.Цель исследования - в эксперименте на животных установить характер влияния препаратов на основе ретиноидов на процессы регенерации в области открытой костной раны. В качестве объектов исследования использовались 20 кроликов породы советская шиншилла (12 самцов и 8 самок). После создания 'модели' открытой костной раны животным основной группы ежедневно накладывались повязки со смесью мазей диоксометилтетрагидропиримидина, хлорамфеникола и 13-цисретиноевой кислоты 0,05% в соотношении 1:1. В контрольной группе использовались только повязки с мазями диоксометилтетрагидропиримидина и хлорамфеникола. Применение препаратов на основе ретиноидов в области открытой костной раны сопровождалось положительной динамикой течения раневого процесса по сравнению с контрольной группой. Полученные результаты позволяют предположить возможность применения ретиноидов в качестве вспомогательного средства для решения проблемы затяжного и неблагоприятного течения заживления трепанационной полости после открытой санирующей операции на среднем ухе.

The objective of the study was to improve the functional outcomes of the treatment in the patients presenting with chronic otitis media by means of the combined application of platelet-enriched plasma and the biologically compatible cyanacrylate-based glue for the fixation of the reconstructed auditory ossicular chain. The functional results of the surgery were evaluated within 1, 3, and12 months after the intervention making use of tonal threshold audiometry. It was shown that the use of the platelet-enriched plasma with its subsequent fixation by the biologically compatible cyanacrylate-based glue enhances stability of the implanted prosthetic elements, reduces the risk of their displacement during the postoperative period due to the formation of the cicatrical tissue between the structural components of the middle ear. This approach improves the functional result of the described treatment and decreases the frequency of relapses associated with poor stability of the reconstructed sound-conducting system.Цель работы - улучшение функциональных результатов лечения больных хроническим гнойным средним отитом путем совместного применения обогащенной тромбоцитами плазмы и биосовместимого клея на основе цианакрилата для фиксации реконструированной цепи слуховых косточек. Оценку функциональных результатов операции проводили через 1, 3 и 12 мес с помощью тональной пороговой аудиометрии. Установлено, что использование обогащенной тромбоцитами плазмы с последующим укреплением ее биологическим клеем на основе цианакрилатов облегчает закрепление протезируемых элементов, снижает риск их смещения в послеоперационном периоде за счет формирования рубцовой ткани между элементами среднего уха, что позволяет улучшить функциональный результат проводимого лечения и уменьшить процент рецидивов, связанных с нестабильностью восстановленной звукопроводящей системы.Цель работы — улучшение функциональных результатов лечения больных хроническим гнойным средним отитом путем совместного применения обогащенной тромбоцитами плазмы и биосовместимого клея на основе цианакрилата для фиксации реконструированной цепи слуховых косточек. Оценку функциональных результатов операции проводили через 1, 3 и 12 мес с помощью тональной пороговой аудиометрии. Установлено, что использование обогащенной тромбоцитами плазмы с последующим укреплением ее биологическим клеем на основе цианакрилатов облегчает закрепление протезируемых элементов, снижает риск их смещения в послеоперационном периоде за счет формирования рубцовой ткани между элементами среднего уха, что позволяет улучшить функциональный результат проводимого лечения и уменьшить процент рецидивов, связанных с нестабильностью восстановленной звукопроводящей системы.

The objective of the present work was to estimate the possibilities of the application of platelet-enriched plasma as a filtering material for ossiculoplasty. The results of surgical interventions on 120 patients presenting with chronic suppurative otitis media are reported. All the patients underwent closed-type sanation surgery (differential atticoanthrotomy) including either complete or partial restoration of the sound conduction mechanism in the middle ear. Platelet-enriched plasma was applied into the tympanic cavity of 55 patients as a fixing material for the reconstruction of the chain of the auditory ossicles. Ossiculoplasty without additional fixation was performed in 65 patients comprising the control group. The results of the study indicate that a clot of platelet-enriched plasma may be a good fixing material for the reconstruction of the entire chain of auditory ossicles and can be used for all types of ossiculopasty.

The objective of the present investigation was to reveal clinical symptoms significantly associated with the cysts in the maxillary sinuses (MS). The study included 67 consecutive patients with the roentgenologically confirmed diagnosis of maxillary cysts in the absence of concomitant pathological changes in the nasal cavity and paranasal sinuses. Each patient was interviewed twice: first time before surgery when they were asked to fill a questionnaire and specify the disturbing symptoms, the second time postoperatively, i.e. during the follow-up examination within 4-6 months after the treatment. The statistical analysis demonstrated that MS cysts may be a cause of such symptoms as headache in the frontal region, feeling of pressure in the affected sinus, mucous rhinorrhoea, nasal obstruction, and probably coughing in the morning hours as a manifestation of postnasal drip syndrome.

This experimental study had the objective to estimate the functional state of the sound-conducting system of the middle ear and morphological changes in the tympanic cavity after its filling with platelet-enriched plasma (PEP) obtained by one-step centrifugation of the whole venous blood. The experiments were made on 6 pigs of the Large White breed. Tympanotomy performed under general anesthesia was followed by the introduction of a clot of platelet-enriched plasma into the tympanic cavity. The results of the study indicate that the ventilation function of the pharyngotympanic tube was fully preserved. The PEP clot was completely eliminated from the tympanic cavity within the first month after filling. Neither scars nor adhesions were recorded after the treatment with PEP. The study confirms the beneficial effect of using PEP for the support of the sound-conducting structures of the middle ear and stimulation of the regeneration processes after tympanoplasty.

The present study was designed to evaluate the influence of sealing the labyrinthine vestibule with platelet-enriched plasma (PEP) on the development of cochleovestibular complications following piston stapedoplasty. The platelet-rich plasma was prepared by single-step centrifugation of the whole venous blood. Analysis of the data obtained showed that the use of PEP for sealing the periprosthetic space after stapedoplasty reduces the risk of development of sensorineural hearing impairment compared with the application of fatty tissue for the same purpose or a freely positioned prosthesis. Moreover, the use of PEP decreases the probability of the development of tympanophonia and its intensity after piston stapedoplasty.

The objective of this work was to evaluate advantages and disadvantages of selected tympanoplastic stages under the endoscopic control during the surgical treatment of 93 patients presenting with chronic otitis media. The endoscopic techniques has indisputable advantages over traditional surgical microscopy when applied to elucidate the character and extent of the pathological process in the middle ear. This method allows to reveal granulation and cholesteatoma in difficult of access pockets and folds of the middle ear without enlargement of the extent of surgical intervention, to evaluate the "continuity" of the chain of auditory ossicles, etc. At the same time the use of an endoscope during performance of the majority of tympanoplastic procedures creates some difficulties related to the necessity of regular cleaning of the instrument and the impossibility of application of the bimanual technique.

Because numerous studies have demonstrated that the majority of acute inflammatory diseases of the upper respiratory tract are associated with viral infection, interferon-based medicines are being extensively developed for non-specific therapy and prevention of acute respiratory viral infections (ARVI). The objective of the present study was to evaluate the efficiency of local application of viferon gel for the treatment of acute rhinopharyngitis from the results of examination and treatment of a group of outpatients with this pathology (n = 90). Viferon gel was introduced into each half of the nose at a dose of 0.5 ml 4-5 times daily. It was shown that timely prescription of this preparation accelerates the achievement of positive results of AVRI therapy and thereby reduces duration of the disease and prevents the development of bacterial complications in the upper respiratory tract.

The rate of posttonsillectomy hemorrhage, pain severity were assessed in the study group (80 tonsillar niches) and in the control group (110 tonsillar niches). Treatment of postoperative tonsillar niches with platelet-enriched plasma (PEP) was performed in the study group and was not performed in the controls. No hemorrhage was registered in the study group and 9 cases of hemorrhage occurred in the control group. Swallowing test and analysis of the visual-analogue scales demonstrated that pain after tonsillectomy was less severe after local use of PEP. Thus, usage of PEP in the region of the postoperative wound is effective in prevention of hemorrhage and pharyngeal pain attenuation after tonsillectomy.

Different operations on the middle ear were performed in 86 patients with otitis media purulenta chronica (OMPC). Mean bone hearing thresholds in the high-pitched area (10,000-16,000 Hz) were determined and suprathreshold tests were made in 86 patients on day 10 and 6 months after surgery. Minimal changes seen only in early postoperative period occurred in canal wall up operations with tympanoplasty of type I-II. Canal wall down type of surgery had a negative effect on the function of the cochlear receptor system in the early postoperative period. All "open" types of ear surgery, even with tympanoplasty, provoked hearing deterioration with maximum elevation of the hearing thresholds in the high-pitched area (10,000-16,000 Hz). Middle ear surgery without forming a new tympanic cavity results in progressive deterioration of the peripheral part of the hearing receptor system.

The authors describe experience in application of bioglass preparations (biosit-elcor) for partial obliteration of mastoid cavities in open operations on the middle ear in 17 patients. Long-term results were studied with otomicroscopy and computed tomography of the temporal bones. A good morphological result of the operation (complete epithelization of the wound surface, no discharge from the ear) was achieved in all the patients. Computed tomography showed step-by-step osteointegration of the implant.

Nd-YAG laser radiation of 1.06 or 1.32 μ wavelength killed a proportion ofStaphylococcus aureus andEscherichia coli cells at power densities of 40 to 80 W/cm2 and effected a 100% kill of these cells at a power density of 1000 W/cm2. In blood agar, the radiation of 1.06 μ produced bactericidal effects to a depth twice that of the radiation of 1.32 μ. Laser radiation of these wavelengths did not cause elimination of R plasmids and had no effect on the antibiotic resistance of bacteria.

Curiosine solution was used in surgical treatment of 80 patients with chronic otitis media purulenta early after the intervention. Otoscopic, cytological and bacteriological examinations have demonstrated that the drug creates physiological conditions for activation, migration and division of cells participating in tissue regeneration, it promotes bacterial decontamination of the wound. Curiosine can be used after radical operations on the middle ear.

A novel method of surgical treatment of exudative otitis media with YAG-Nd laser for shunting of the tympanic cavity has been introduced in therapy of 75 patients. Long-term outcomes of the above treatment characterize it as effective and safe in exudative otitis media.

Effects of laser radiation on the function of the internal ear receptors were studied using short-latent acoustic evoked potentials (SLAEP) of rabbit truncus cerebri. Contact laser impact in the area of the medial wall of the tympanic cavity in one of the ear was made after registration of baseline SLAEP. The other ear served control. It was found that YAG-Nd laser radiation had the receptor damage threshold within 7-8 W. Assessment of laser energy reaching receptors of the animals' labyrinth was carried out by the thickness of the bone of tympanic medial wall in the rabbit middle ear. Differences in the above thickness in humans and rabbits and calculated transmission factors for laser radiation of the bone tissues indicate that radiation power 14-16 W may appear critical in manipulations on human middle ear.

The review concerns application of impulse Nd-YAG laser (wave length 1.32 micron) in stapedial operations. Laser beam provides more accurate and less traumatic conduction of complex stages of stapedoplasty: dissection of the limbs of the stapes with preservation of the stapedial muscle, arrest of bleeding from the vestibule mucosal vessels, thinning of the base of the stapes. However, perforation of the base of the stapes by impulse Nd-YAG laser is not safe because of the treat of radiation and mechanical damage to essential structures of the internal ear.

The article deals with the problems of medical boards work practice improvement in the process of choosing patients for sanatoria and resorts. It offers a set of improvement measures based on the authors' experience in this field.

Social and economic reforms in Russia have resulted in the appearance of the recreation services market. To coordinate its activities with orientation to consumers the Department of vouchers' distribution and realisation was set up in February 1998 in scientific methodology center in Marfino Central Military Clinical Sanatorium. The article deals with the Department's attempts to introduce principles of the market economy into the work practice of the military health resorts and sanatoria.