OBJECTIVE To describe the technique and determine the indications for sleep endoscopy in children. MATERIAL AND METHODS This study included 35 children, the average age of 5 years 1 month ± 3 years 4 months (from 1 year 6 months to 14 years 5 months). All children underwent standard polysomnography and sleep endoscopy. RESULTS According to polysomnography, severe obstructive sleep apnea (OSA) was diagnosed in 21 children, moderate - in 8 children and mild - in 6 children. Sleep endoscopy revealed that in most cases in unoperated children (about 70%), adenoids and palatine tonsils were the cause of obstruction. In the group of children, who previously underwent surgery for OSA, the causes of residual apnea more often were soft palate and palatine tonsils. In 5 of 8 children, tonsils pharyngoscopy size did not exceed the 1st degree. In 1 child after adenotonsillectomy, the hypertrophic tori tubarii were the cause of obstruction. Another rare cause of upper airway obstruction, lingual tonsil hypertrophy, was found in 2 primary patients. CONCLUSION Sleep endoscopy is a safe and useful method that makes it possible to determine the level of obstruction in children and to plan the optimal amount of surgical treatment.

In this article, we consider the influence of combined general anesthesia on the results of electrically-involved stapedial reflex threshold (esrt) registration. We pay a special attention to the anesthesia to exclude its influence on the esrt. This study included 52 patients with bilateral chronic neurosensory hearing impairment. We conducted a retrospective (from 2014 to 2016) and prospective (from 2017 to 2018) analysis of anesthesia protocols. Even though the inhaled anesthesia (sevoflurane in this case) has a depressive effect on esrt registration (the higher the minimal alveolar concentration of anesthetic agent, the higher the reflex threshold), our study shows a possibility of using it in an extended anesthesia monitoring. Inclusion of myorelaxants in cochlear implantation anesthesia protocol not only provides a safe anesthesia, but also does not prevent a timely intraoperative cochlear implant testing.

Introduction. Cochlear implantation is a recognized treatment method for patients with severe and deep neurosensory hearing loss. To adjust the parameters of the speech processor of a cochlear implant (CI), the implementation of subjective techniques is not always possible, especially for younger patients. A good starting point for determining patient comfort levels during the initial connection of a speech processor is the intraoperatively obtained data of objective methods, one of which is the registration of an electrically induced stapedial reflex (EISR). Due to the marked effect of general anesthesia on the results of testing of CI and the lack of a universal anesthesiological protocol for this surgical intervention, the purpose of the study is to study the effectiveness of using extended intraoperative monitoring during testing of CI. Material and methods. The study included two groups, each consisting of 26 patients aged from 1 year to 15 years with a diagnosis of chronic sensorineural hearing loss. All children were installed CI delivered by company Med El (Austria). In the 1st group, data from medical records were analyzed retrospectively (anesthetic patient card and ESRT threshold values registration card during anesthesia and standard anesthesia monitoring volume). In the 2nd group of patients, intraoperative monitoring of anesthesia was extended by continuous evaluation of EEG (BIS-index) and indices of the degree of myoplegia. CI testing in this group was carried out in the recovery phase of neuro-muscular conductivity (4 TOF responses) and with BIS-index values from 60 to 80, which corresponded to sedation during drug sleep. Results. In the course of the work done in two groups of patients, the average values of intermediate points of the ESRT were analyzed, a comparative assessment of hemodynamic parameters at the main stages of the operation was carried out, and the optimal values of the minimum alveolar concentration of sevoflurane anesthetic and BIS index were determined for timely registration of the movement of stapedial muscle by the surgeon.

Active progress in otosurgery opens up new opportunities for minimally invasive surgeries and significantly improves the results of treatment, but a number of problems remain unsolved, including in children. Despite the general positive trend of using the endoscope in otosurgery, in pediatric practice the data are insufficient and extremely contradictory. Literary sources show that, with certain advantages, the existing techniques of endoscopic tympanoplasty are far from perfect and inferior in effectiveness to classical microscopic techniques, which also necessitates further research in this field.

Relevance. The hypoplastic left-heart syndrome at congenital heart disease has frequency of 261 cases out of 10,000 newborns. Children with hypoplastic left-heart syndrome can have comorbid congenital anomalies and acquired diseases that require treatment and are associated with high mortality risk. Description of a clinical case . Female patient, 6 years 4 months, with the hypoplastic left-heart syndrome was admitted to our hospital with the diagnosis «Sensorineural hearing loss, speech delay» for performing of cochlear implantation. The council of physicians was convoked before the surgery to coordinate patient management. Members of surgical, anesthesiology, laboratory and instrumental examination departments were involved into preoperative assessment and planning due to the high level of surgical and anesthetic risk. The patient was dismissed from hospital on the 10th day after cochlear implantation. The patient has undergone the course of auditory-verbal therapy a month after. The child was dismissed wit state improvement. Conclusion. The example of successfully performed surgery in the patient with hypoplastic left-heart syndrome and such severe comorbid pathology as sensorineural hearing loss is presented. Complete physical examination of the child in preoperative period and adequate preparation for the surgery were the key factors for patient successful management and further rehabilitation.

For the time present, the cochlear implantation is a widely used method of the treatment of deafness and severe hearing impairment. The operation is time-consuming and requires a long stay of the child in the hospital. The placement of the cochlear implant (CI) is executed under general anesthesia through transosseous access. The executive work of the surgical and anesthetic teams is an integral part of the successful implementation of intraoperative CI testing, on the base of results of which, in the postoperative period, there will be carried out the initial adjustment of the speech processor. An anesthesiologist should create conditions that facilitate the use of nerve stimulators in the intraoperative period and in a timely manner prevent such common postoperative complications as nausea, vomiting, and dizziness. This article provides a review of the literature of domestic and foreign authors on the issues arising in anesthesiologists during the implementation of cochlear implantations and the ways of their solutions. It is considered what difficulties can arise during the installation and initial adjustment of CI, as well as what anesthesia complications are most frequent in operations of this type. After studying the results of the work of different authors, the initial adjustment of the CI in the anesthetic management under the control of BIS and TOF monitoring was concluded to be performed at a higher level, and the timely and targeted administration of various drugs, at certain stages of anesthesia, contributed to the decline of the complications rate in the postoperative period.