Vol 44, No 7 (2016)

Rationale: Temporomandibular joint (TMJ) dysfunction and occlusion abnormalities can cause cochlear and vestibular disorders. This issue is at the crossroads of several disciplines: otoneurology, physiotherapy, dentistry, medical rehabilitation and posturology, which often makes it difficult to timely diagnose them and delays the onset of treatment. Aim: To assess the role of abnormal dental occlusion and TMJ disorders in the pathophysiology and clinical manifestation of cochleovestibular syndrome. Materials and methods: We examined 300 subjects with clinical signs of cochleovestibular syndrome, asymmetry of occlusion and/or TMJ dysfunction (the main group), 55 patients with signs of TMJ structural and functional disorders and occlusal disorders without a cochleovestibular syndrome (the reference group), and 35 healthy volunteers (the control group). All patients were examined by a neurologist, an ENT specialist, a dentist and a physiotherapist. A series of additional investigations of the brachiocephalic vessels, cervical spine, TMJ, auditory and vestibular function, premature tooth contacts were performed. Results: The main group patients had high values of TMJ dysfunction in the Hamburg test (5.85 vs 2.2 in the reference group) and higher proportions of patients with moderate and severe TMJ dysfunction (n = 243, 81% and n = 13, 23.7%, respectively). The functional muscle test parameters and the results of manual muscle testing in the main group patients were significantly different from those in the control group (р < 0.05), whereas most values obtained in the reference group did not differ significantly (р > 0.05). Patients with cochleoves-tibular syndrome had 2 to 3-fold higher rates of vertebrogenic dysfunctions than those from the reference group. The video nystamography technique detected the positional cervical nystagmus in 100% (n = 300) of patients from the main group, whereas there were no nystagmus in those from the reference group. Voluntary dental occlusion in the main group patients was associated with a deterioration of postural tests in 61.8% (n = 185) of patients; in the reference group patients these parameters deteriorated in 38.2% (n = 21) of cases. According to T-SCAN assessment, 300 (100%) patients from the main group had in imbalance of total distribution of the occlusion force (р < 0.05 compared to the control group). The biggest number of patients from the main group (73.7%, n = 221) had an imbalance of occlusion force within 20 to 40%, and in most patients from the reference group this parameter was in the range of 10 to 30% (85.5%, n = 47), with 14.5% (n = 8) of this group having a normal balance of the occlusion force. Cerebrovascular reactivity parameters measured by ultrasound Doppler technique demonstrated a moderately significant (р < 0.05) strain of the cerebral hemodynamic reserve in the posterior arterial system in patients with cochleovestibular syndrome. Conclusion: Cochleovestibular disorders can be caused by a dysfunction of the dentoman-dibular system and/or cervical / masticatory myofascial syndrome. After exclusion of any otogenic pathology in patients with cochleovestibular syndrome, their neurological examination should include a visual assessment of the occlusion and mandibular movements, as well as testing of the cervical and masticatory muscles. If any abnormalities of occlusion and/or TMJ and local muscle dysfunction are revealed, then a dentist and a physiotherapist consultation should be performed.

Background: Reconstruction of the ossicular chain is performed in 70-90% of tympanoplastic interventions. A cholesteatoma in chronic suppurative otitis media is diagnosed in 24-63% cases, irrespective of localization of the eardrum perforation. Persistently good outcomes after radical mastoidectomy is obtained only in 65 to 66% of patients, and the proportion of unsatisfactory results remains to be rather high (10 to 15%). Aim: To analyze the effectiveness of surgical treatment of patients with chronic suppurative otitis media, operated in a single clinical center from 2014 to 2016. Materials and methods: A total of 212 patients (233 ears) with chronic suppurative otitis media patients, who underwent surgery, were included in this study. The effectiveness of surgical interventions were assessed as short-term (up to 3 months post-operatively) and long-term (6 to 12 months) anatomical and functional outcomes. The anatomical results were considered satisfactory if there was a well-formed mobile neotympanic membrane, air tympanic cavity and dry postoperative cavity. Pure tone audiograms were analyzed to evaluate the functional results. Results: Satisfactory anatomical results were obtained in 93.5% of patients with the safe type suppurative otitis, 88.9% of patients with the unsafe type and 91.2% of patients after a revision surgery. Displacement of total ossicular prosthe-ses was the main cause of poor functional results. The most common causes of unsatisfactory anatomical results were perforation (14 cases), cholesteatoma recurrence (2 cases) and lateralization of the neotympanic membrane (2 cases). Discussion and conclusion: Formation of a reliable sound conducting system with ossicular prostheses allows for persistent improvement of hearing. Various surgical techniques, such as extended posterior tympanotomy, endoscopic assistance, provide a good effect with the removal of non-aggressive cholesteatoma while preserving the bone structures, which are not involved in the disease. A complete removal of an advanced aggressive cholesteatoma with the opening of the temporal bone cell system ensures good functional and anatomical outcomes, makes it possible to prevent the spread of the pathological process and development of intracranial complications.

Background: Individuals with obstructive  sleep apnea syndrome (OSAS) have an increased risk of disabling disorders of the cardiovascular system, including  stroke.  The  mechanisms   of OSAS effects on cerebral blood flow and cerebral vascular autoregulation have not been clear enough. Aim: To study characteristics of cerebral blood flow in patients  with OSAS and the effect of CPAP therapy on cerebral hemodynamic reserve. Materials and  methods: One  hundred and  two  patients with various OSAS severity (61 male  and  41 female) and  20 healthy  volunteers  participated in the study. We performed  ultrasound assessment of cerebral  blood  flow with functional  tests  and calculated  reactivity indices. Results: With more severe OSAS, no significant differences in cerebral vascular reactivity compared to the control group were  registered. However, there  was a trend  to some  decrease  in the  index of constriction  and dilation  in the  vertebral  arteries  and  the  basilar artery, as well as to its increase in the middle cerebral artery in severe and moderate OSAS. The index of vasomotor  reactivity of cerebral  arteries was significantly (р < 0.05) lower in patients with  severe  OSAS:  for vertebral  arteries,  up  to 38.9 ± 8.5 and for basilar artery, up to 36.8 ± 15.7, compared to  the  control  group  (52.1 ± 9.8 and 50.1 ± 11.2, respectively). In patients who initiated CPAP therapy, there were no changes  in velosity, resistance  and  reactivity parameters of cerebral vessels after 2 months. Conclusion: We were able to  confirm a significant  impairment  of cerebral vascular autoregulation  in patients  with severe OSAS, predominantly in the posterior circulatory region. CPAP-therapy of 2 months'  duration  did not lead to restoration  of cerebral hemodynamic reserve.

We present  the  results of our studies  in various pathological   conditions   in  otorhinolaryngology performed  with  a diagnostic  technology  of functional morphology  of non-cellular tissue structures  (mouth  fluid, surgical wound  exudation, blood  serum, and  others). With the  use of methods of cuniform and  marginal dehydration of biological fluids, the possibility of developing essentially novel criteria was shown, such as:

• prediction  of complicated  course of post-operative wound  healing in subjects with a lamellar morphotype in the  wound  exudation  resulting from cholesterol residues due to massive cell death;

• prediction  of a polypous  rhinosinusitis  relapse in subjects with an increase in the proliferation marker, anisotropic  parallels lines in the  dehydrated  serum  obtained from the  blood  taken from the inferior nasal turbinate;

• diagnostics   of  the  middle  ear  cholesteatoma in children by combination of cuniform and marginal  dehydration of the  mouth  fluid. The singularity of the  technique  is based  on triple sampling  of the  fluid:  first sample  was  taken immediately  after awakening, the  second  one, after a few minutes  of active swallowing movements  and  the  third one,  after trans-tympanicair pumping.  Detection  of the  structural  signs of congestive effusion and the lamellar morphotype as a destruction marker in the third sample suggested the presence  of cholesteatoma;

• assessment  of  treatment  efficacy  in  patients with chronic tonsillitis and of the indications to tonsillectomy in patients  with persisting pathological  characteristics   of  the  exudation   from the palatal tonsil lacunes throughout the whole course of conservative treatment;

• determination of the grade of activity / absence of activity of laryngeal cancer by identification of a basic spherolith with various degrees  of anisotropy, abnormally  aggregated with a granular microspherolith;

• detection of the  signs of progression  in laryngeal  cancer  by  the  presence   of wave-shaped structures  in the  microspherolith during  radiation therapy.

The authors  discuss specifics of the  wound  process in modern  combat  injury of the  ear, significance  and  specifics of diagnosis  of gunshot ear injury related to individual characteristics of gunshot  wounds  with consideration of the  accepted anatomical classification of the injured zones. Typical complications of ear injuries are described that  can result in death. The authors  analyze an approach  to  surgical treatment of traumatic  ear injuries based on their own experience, including non-conventional choice  of the  type  of surgery. They proposed an algorithm to assess the auditory and  vestibular  analyzers in the  injured based  on their analysis of date obtained from 772 patients, determine types of pure-tone audiograms  typical for acoustic  and  barotrauma,  and  underline  the informative  value  of optokinetic  nystagmus   assessment. Various types of conservative  management of the sequelae of the mine-blast ear trauma are discussed  aimed at potential  minimization of the  post-traumatic reactions  of the  auditory  and vestibular  analyzers.  The  authors  draw attention to the importance of early treatment, the highest effectiveness of combination therapy and plasmapheresis. They propose  their  experience  of care for the above mentioned traumatic injuries to improve treatment efficacy.