Проблеми екології та медицини (Jul 2018)
ETIOPATHOGENETIC APPROACH TO MANAGING PATIENTS WITH ACUTE INFLAMMATION OF THE MIDDLE EAR STRUCTURES
Abstract
At present, the signs of transition from the stage of inflammation – antrocellulitis (inflammation of the lining cells of the mastoid process), to mastoiditis (purulent fusion of bone cells of the mastoid process system) are not studied, and clear evidence of the timing and extent of surgery is not identified. The aim of the research is improving the treatment of patients with acute mastoiditis by new scheme of using conservative therapy and modified antromastoidotomy with drainage. Material and methods: the study was conducted in clinical settings: Otolaryngology Department of Poltava Regional Hospital and Otolaryngology Department of the City Hospital No.2 of Poltava. Results in the period from 2009 to 2016 were examined, and 83 patients with acute and middle otitis, complicated with mastoiditis, were treated. All patients were divided into 2 groups: study group – Group 1 (n = 48) and control group – Group 2 (n = 35). Results: in patients of studied groups 1-b and 1-c, we used new developed technique of surgical sanitation of the mastoid process with draining the atticoantral passage with rubber drainage, and postoperative cavity – with teflon tubes with momentary wound suturing. Patients of group 1-b underwent tunnel antrotomy, the aim was to determine the condition of the cells of the mastoid process. In cases when the phenomena of destruction and necrosis were observed, antromastoidotomy was conducted by our own methodology. In conducting surgery, endoscopic techniques was used, air permeability test for atticoantral part was performed. Conclusions. When prescribing the treatment of patients with acute mastoiditis, it is necessary to take into account, in addition to clinical signs of disease, the data of cone-beam CT, the presence of atticoantral connection, which probably depends on the anatomical features of the structure of the middle ear and the severity and prevalence of inflammatory process. Morphological data necessitate the inclusion of antiviral drugs in the scheme of treatment, which significantly increases the effectiveness of treatment of patients with acute mastoiditis.
