CHRONIC SUPPURATIVE OTITIS MEDIA WITH MUCOSITIS

Background. Chronic suppurative otitis media with mucositisis manifested by chronic catarrhal inflammation, combining hyperplastic processes in the intrinsic lamina of the mucous membrane (MM) with hypersecretion of the cover epithelium. Main Contents. Mucositis of three degrees is distinguished: At the first degree in the tympanic cavity (TC), pink swelling is determined with a small amount of mucus, the functions of the Eustachian tube (ET) are impaired slightly; during the pathomorphological examination the replacement of ciliated cells with hypertrophied abundantly secretly gorgeous cells, insignificant lymphoid-plasmocytic infiltration are noted; computer tomogram (CT) shows impaired pneumatization of the middle ear cavities, which almost completely disappears during the period of remission, there are no destructive changes in the auditory bones and the walls of the TC. WAt the second degree with hyperplated MM separated more dense, the functions of the Eustachian tube are moderately impaired; in pathomorphological examination, infiltration with leukocytes is more pronounced, with the formation of focal lymphoid clusters, the presence of proliferating vessels, the accumulation of mononuclear cells with a gradual increase in sclerosis; CT notes a violation of the pneumatization of the middle ear cavities, and destructive changes in the auditory bones may join, often in combination with their dislocation. At the thirddegree, a pale “pillow-like” MM is noted, its partial fusion with the edges of the perforation or the inner surface of the tympanum membrane can be observed, in the tympanic cavity there is viscous, thick mucous discharge; in pathomorphological examination, infiltration with leukocytes is expressed to the maximum extent with the increase in histiocytic infiltration and the development of fibrosing; in CT, impaired pneumatisation of middle ear cavities not only during exacerbation, but also during remission, often accompanied by polyposis formation, destructive changes of the elements of the auditory ossicle chain and the walls of the tympanic cavity. Surgical tactics: at the first degree of chronic suppurative otitis media, thympanoplasty of type I is performed, which from a technical point of view does not differ from sedimentation with a “dry” ear using autotransplants; with CSOM of II and III degree, thympanoplasty is combined with the method of drainage of the middle ear, which is stopped only after improving the function of ET and the restoration of TC aeration; with CSOM of II degree, it is recommended to additionally make notches in the area of the altered MM; at the degree III separate attico- anthromastoidotomy with tympanoplasty and drainage through antrum is indicated. in addition, excision of the altered areas of the MM of the TC is performed due to proven irreversible morphological changes. Conclusion. Treatment of patients with chronic suppurative otitis media with mucositis is an extremely difficult task for an otorhinolaryngologist. Currently, most surgeons are of opinion on the effectiveness and need for prolonged ventilation of the tympanic cavity in the postoperative period, while the development of new methods and operations techniques has not lost its relevance.