Удаление частичной атретической пластинки при изолированной аномалии развития среднего уха

Abstract

Congenital isolated anomalies of the development of the middle ear arising from a violation of embryogenesis occur in approximately 1 in 10,000–15,000 newborns and can cause significant hearing loss from the abnormal ear, leading to a delay in psycho-speech development. In particular, one of the rare isolated anomalies of the middle ear is a partial atretic plate, the probability of its occurrence has not been specified. Unlike the full atretic plate, the partial plate is thinner and partially blocks the entrance to the tympanic cavity from the side of the external auditory canal. In this article, based on the observations, we present the identified pattern of development of partial atretic plates relative to their location. The first option is tympanosquamous, in which the plate originates from sutura tympano-squamosa; the second is the tympanicmastoidea variant, in which it is determined in the area sutura tympano-mastoidea. A developed method for the surgical treatment of isolated anomalies with partial atretic plates, with the preservation of the fibrous layer, the creation of a neoannulus by forming a circular bone groove, which made it possible to solve the main problems in the treatment of this malformation, is presented. The aim of the study of this work was to increase the effectiveness of surgical treatment of patients with anomalies in the development of the ear accompanied by the presence of a partial atretic plate. From 2009 to 2018, 16 surgical interventions (16 patients, 16 ears) were performed at the Saint Petersburg Research Institute of Ear, Throat, Nose, and Speech for isolated anomalies in the development of the middle ear with the presence of a partial atretic plate. As a result of the study, it was determined that the method of preserving the ossicular chain, even considering its intraoperative mobilization, did not prove to be the best method of treatment due to a pronounced increase in the air-bone gap in the first months after surgery, which is due to refixation of the incus body and the malleus head in attica. The developed method for the removal of partial atretic plates in isolated congenital anomalies in the development of the middle ear has shown its high effectiveness in assessing long-term anatomical and functional results.