Оптимизация предоперационной верификации изолированных аномалий среднего уха при помощи виртуальной КТ-эндоскопии

Abstract

Isolated anomalies of the middle ear are one of the most difficult areas of practical otorhinolaryngology. Its relevance is due to the rare occurrence, high technical complexity of performing surgical treatment, and the high frequency of unsatisfactory results of surgical interventions. One of the most important factors determining the success of medical actions is high-quality X-ray imaging at the diagnostic stage. It allows you to correctly assess the anatomical features of the temporal bone and plan the tactics of the surgeon. Over the past few years, new technological possibilities have been introduced for the imaging of the ear. Over the past several decades, multispiral computed tomography has been the gold standard of radiation research used in otosurgery. This study has established itself as an informative method for diagnosing middle ear pathology and should be used before planning surgical interventions, as well as a monitoring tool in the postoperative period and for assessing the course of middle ear diseases. With the development of computer-mathematical technologies, over time, it became possible to model the result in three-dimensional space on the basis of axial projection, which led to the emergence of a branch of radiation diagnostics, called virtual CT endoscopy. The work evaluates the specificity of virtual CT endoscopy performed at the preoperative stage in patients with isolated anomalies of the ossicle chain with intact stapes, in terms of diagnosing the continuity of the ossicle chain, changes in their configuration and adhesions with the surrounding bone structures. A comparative analysis of the specificity of standard two-dimensional computed tomography and virtual CT endoscopy was performed, where explorative tympanotomy was used as test results in 43 patients. The advantages of virtual CT endoscopy in visualization of minor defects in the structures of the tympanic cavity were revealed. The importance of virtual CT endoscopy in measuring the tympanic cavity in arbitrary planes was determined. In addition to the above, virtual endoscopy opens up new possibilities for measuring the anatomical structures of the middle ear in arbitrary planes, which makes it possible, for example, to calculate the length of the prosthesis intended for use as plasty of the ossicular chain before surgery.