Опыт лечения мукозита при хроническом гнойном среднем отите у детей

Abstract

Background: the most common clinical subtype of chronic suppurative otitis media (CSOM) in childhood is low-grade catarrhal inflammation affecting the middle ear mucosa (mucositis). The etiology and pathogenesis of mucositis remain unclear. Virtually no data on the course and treatment of this disease in children are available. Aim: to share our experience with mucositis treatment in children with CSOM. Patients and Methods: we performed a retrospective analysis of treatment results in 118 children aged 5–14 years with subtotal and total tympanic membrane perforations and mucositis of the tympanic cavity of various severity without cholesteatoma. Results: no pathognomonic signs were identified in children with mucositis. All children had mild hearing loss. Temporal bone CT revealed signs of temporal bone and ossicular system destruction in 15 children (12.7%). Microbiological diagnostics demonstrated that the key bacterial pathogens were Pseudomonas aeruginosa (n=26, 22%) and Staphylococcus aureus (n=21, 17.8%). In children with mesotympanitis, the secretory stage of mucositis was diagnosed most often (n=79, 67%), as demonstrated by otomicroscopy. Hyperplastic and atrophic stages of mucositis were diagnosed in 31 (26%) and 8 patients, respectively. During CSOM remission, all patients underwent scheduled myringoplasty and tympanoplasty with revision of the tympanic cavity and mastoid. These procedures were performed under microscopic control via an endaural or transcanal approach. 12 weeks after surgery, 108 patients (92%) reported an improvement in hearing. Diastasis in the lower part of the created eardrum was detected in 11 patients (9.3%) only. Conclusion: given the understudied etiology and pathogenesis, conservative treatment is reasonable only during uncomplicated exacerbation of CSOM. The most effective treatment for mucositis of the tympanic mucosa is timely myringoplasty and tympanoplasty. KEYWORDS: chronic suppurative otitis media, mucositis, children, myringoplasty, tympanoplasty, hearing loss. FOR CITATION: Naumov O.G., Karpova E.P., Tulupov D.A. Treatment for mucositis in children with chronic suppurative otitis media. Russian Medical Inquiry. 2023;7(8):543–548 (in Russ.). DOI: 10.32364/2587-6821-2023-7-8-12.