[Efficacy and safety of topical combination therapy in patients with acute otitis externa].

AIM: To study the structure of the microbial landscape in patients with acute otitis externa, as well as to evaluate the efficacy and safety of the combined drug chloramphenicol/clotrimazole/beclomethasone/lidocaine (Candibiotic) as an empirical therapy of this disease. MATERIALS AND METHODS: In this retrospective study of real clinical practice, outpatient records of 963 patients who applied to the KDO of the Sverzhevsky Research Clinical Institute of Otorhinolaryngology with symptoms of otitis externa in the period from 2017 to 2022 were selected. Additional analysis was carried out on the clinical records of patients who received the combined drug Candibiotic. The endpoints of this analysis included data on the clinical and microbiological efficacy of therapy, as well as safety information. RESULTS: According to microbiological testing, 60.6% of microorganisms belonged to bacterial flora, 26% were bacterial-fungal associations, 11.6% were monofungal flora, in 1.8% of cases there was no growth of microorganisms. The most frequently isolated microorganisms were: Pseudomonas spp (n=291; 29.16%), Staphylococcus spp. (n=214; 21.4%), Candida spp. (n=194; 19.4%), Aspergillus spp. (n=133; 13.3%). Most of the patients (71.0%) received Candibiotic. In 69.7% of patients, the resolution of the clinical symptoms of otitis externa occurred within 7 days of therapy with Candibiotic. Complete eradication of microorganisms occurred in 87% of cases. Adverse events were recorded only in 3 (0.04%) cases. CONCLUSION: The study demonstrated an extremely high level of clinical efficacy and safety of therapy in patients with acute external infectious otitis who received the Candibiotic, which can be used as an initial empirical therapy in patients with otitis externa.

[Fungal adenoiditis and tonsillomycosis in children: features of diagnosis and therapy]. / Gribkovyi adenoidit i tonzillomikoz u detei: osobennosti diagnostiki i terapii.

The purpose of the work is to study the current state of the problem of diagnosing and treating fungal adenoiditis and tonsillomycosis in children. This article summarizes the literature data on the predisposing factors and characteristics of the occurrence of fungal infections of adenoid vegetations and tonsils in children. The works present modern approaches to the diagnosis and treatment of children with fungal adenoiditis and tonsillomycosis, depending on the selected genus and the type of fungus. Based on the conducted research, performed on the basis of "The Sverzhevskiy Otorhinolaryngology Healthcare Research Institute", we found that the incidence of fungal adenoiditis in children is 16.4%, and the incidence of tonsillomicosis in children with chronic tonsillitis is 21.5%. The most frequently detected strain in this pathology is C. albicans. In the presented study, a justification of the chosen treatment regimen was made on the basis of the data obtained during microbiological (bacteriological and mycological) studies.

[The clinical and functional evaluation of the combined treatment of vasomotor rhinitis in the children].

The objective of the present work was the comparative analysis of the results of the application of different methods for the treatment of the children presenting with vasomotor rhinitis. It was shown that the proposed combined approach including remedial therapy for the normalization of the function of the vegetative nervous system and the local application of fluctuating current to the nasal cavity mucosa has an advantage over the traditional modalities. Specifically, this newly developed simple and efficacious method for the combined conservative treatment of vasomotor rhinitis in the children has practically no contraindications for use, yields the most stable positive functional outcomes, and can by recommended for the application in both inpatient and outpatient settings to manage the patients with vasomotor rhinitis.

[The experimentally-based rationale for the application of the new methods designed to treat fungal adenoiditis in the children].

The objective of the present was to evaluate the influence of local anesthetics protargol, miramistin, chlorohexidine, and photodynamic therapy (PDT) on the polyresistant strain of Candida tropicalis isolated from a sick child presenting with fungal adenoiditis. In vitro experiments were designed to estimate the inactivation potential of the Candida tropicalis blastospore suspension (5.107 CFU/ml) following the preliminary incubation with a 5 mcmol/l methylene blue solution. A Kreolka FDT apparatus operated at the 680 nm wavelength was employed as the source of radiation in a broad power and time ranges. Simultaneously, experiments were carried out to determine the minimum concentration of the protargol, miramistin, and chlorohexidine solutions inhibiting the growth of the same fungal strain. The minimum growth inhibitory concentrations of these solutions were found to be 0.1%, 0.005%, and 0.005% respectively. The photodynamic therapy using the minimal inhibitory dose of 150 J with a 5 min exposition and an output power of 0.5 W completely suppressed the growth of the Candida tropicalis colonies in the presence of methylene blue as the photosensitizer.

[The concept of the development of the otorhinolaryngological service in Moscow under conditions of modernization of the healthcare system and single-channel funding].

This paper highlights the complex of organizational and socio-economic measures designed to modify the healthcare system in the city of Moscow, improve the quality of medical aid, and ensure its availability for the urban population. The proposed methods were developed based on the results of analysis of the data obtained in the course of checking the work of the otorhinolaryngological services of the city, analysis of effectiveness of using the hospital stock in the therapeutic and prophylactic facilities of Moscow.

[Morphological peculiarities and possibilities of the conservative treatment of perforations in the nasal septum].

The objective of the present work was to enhance the effectiveness of the conservative treatment of perforations in the nasal septum (PNS) with the use of the newly developed method that includes septal splinting with the possibility of the long-term targeted medicamental treatment of the affected nasal septum tissue taking into consideration its morphological characteristics. The study included a total of 67 patients presenting with perforations in the nasal septum. The authors distinguished the following four types of septal perforations: non-inflamed (n=4; 6%), subatrophic (n=9; 13.4%), erosive-ulcerative (n=12; 17.9%), and mixed (n=42; 62.7%) ones. Twenty six patients were given conservative treatment by means of the original method including preventive splintage of the nasal septum with the use of silicone splints one of which had a slot-type conduit designed for manipulations. The inclusion of physiotherapeutic procedures in the protocol of the treatment of the perforated nasal septum was substantiated. It is concluded that the proposed original method for the conservative treatment of perforations in the nasal septum has advantages over the traditional approaches for the same purpose; it ensures complete (100%) regeneration of the affected mucous membrane of the nasal septum and a four-fold increase in the duration of remission of the disease.

[Peculiarities of the application of a multi-angle endoscopy during surgical interventions on the ethmoidal and sphenoidal sinuses: the anatomical study].

This work was designed to carry out the postmortem evaluation of the potential of using a multi-angle endoscope for endonasal surgical interventions on the ethmoidal and sphenoidal sinuses. The study was performed on 5 fresh cadavers (10 sides). It was shown that the range of the angles and directions of view during dissection of ethmoidal sinuses is 10-50 degrees and 360 degrees respectively. The use of an Acclarent Cyclops endoscope made it possible to visualize all walls of the sphenoidal sinus through the enlarged aperture which confirms the higher effectiveness of this instrument compared with the traditional endoscopes having the fixed angle of view of 0, 30, 45, and 70 degrees. The disadvantages of the Acclarent Cyclops endoscope are its heavier weight and a somewhat poorer quality of the screen image of the operative field.

[Paresthesias of the upper respiratory tract].

This review concerns the modern views of etiology, diagnostics, and treatment of the patients presenting with paresthesias of the upper respiratory tract. Various concepts of etiology of this pathology are described along with the relevant diagnostic and therapeutic approaches. Special attention is given to the debatable aspects of diagnostics and treatment of the patients complaining of the feeling of a lump in the throat ("globus sensation"). The opinions of the domestic and foreign authors concerning this problem are considered. The necessity of the search for the new additional therapeutic procedures for the treatment of paresthesias of the upper respiratory tract, including the non-medicamental modalities, is substantiated. It is concluded that the development of the new adequate diagnostic and therapeutic algorithm is indispensable for the enhancement of the effectiveness of the management of the patients with paresthesias of the upper respiratory tract and complaints of "globus sensation".

[Clinical and roentgenological diagnostics of the severity of mucositis in the patients presenting with chronic suppurative otitis media].

The objective of the present study was to determine the prevalence of mucositis and its roentgenological manifestations in the patients presenting with chronic suppurative otitis media (CSOM). A total of 390 patients with CSOM (mesotympanitis) and 85 ones suffering CSOM with concomitant mucositis were available for the observation. The signs of mucositis were evaluated based on the patients' complaints, results of otomicroscopy, and computed tomography (CT) of the temporal bones. This randomized clinical study involving 390 patients presenting with CSOM revealed the signs of mucositis in 44.6% of the cases. Analysis of the results of temporal bone CT performed in 85 patients with CSOM and mucositis in the absence exacerbation has demonstrated the possibility of detecting mucositis and evaluating its severity from the changes in the airness of the tympanic cavity, attics, and antrum due to the presence of the pathological substrate in these regions.

[The phenomenon of vascular microthrombosis in mucoperichondrium associated with plastic closure of nasal septum perforations].

The objective of the present study was to identify specific hematological features characterizing the pathophysological processes of clinical significance associated with plastic closure of nasal septum perforations. Changes of clinical, biochemical, and coagulation-related blood characteristics developing as a result of the surgical treatment of the patients with ENT pathology were analysed. It was shown that D-dimer is a specific hematological characteristic that reflects the phenomenon of postoperative vascular microthrombosis in mucoperichondrial-periosteal flaps associated with plastic closure of nasal septum perforations. Based on the results of this study, the authors recommend to prescribe low-molecular weight heparins for prophylactic purposes to the patients undergoing plastic closure of nasal septum perforations.

[Conservative therapy and surgical treatment of chronic tonsillitis in the children].

The objective of the present study was to undertake the statistical analysis of the methods employed to treat tonsillitis in the children with a view to optimizing adequate dispensary observation, planned conservative therapy and surgical treatment of the patients presenting with chronic tonsillitis. The analysis of the excerpts from the annual reports presented by the head of the otorhinolaryngological department of the Children's City Clinical Hospital No 9 involved the patients admitted for the pre-planned and urgent treatment of paratonsillar abscess between 1990 and 2010. It was shown that the number of children with paratonsillar abscess increased during this period from 5.8 to 12.0%. At the same time, the number of such patients undergoing surgery for the treatment of toxico-allergic forms (TAF-I and TAF-II) decreased from 26.7 to 8.7-11.6% of their total number admitted to the department for the treatment of pharyngeal pathology. These diseases developed in the children frequently ill with chronic tonsillitis after its recurrent exacerbations. Importantly, all these children were registered in the dispensaries of district out-patient clinics at the places of residence and repeatedly underwent courses of conservative therapy of chronic tonsillitis that either resulted in the temporary improvement of their health conditions or produced no effect whatever. Nevertheless, no district otorhinolaryngologist recommended tonsillectomy to a child with chronic tonsillitis. It is concluded that adequate regular medical check-ups in combination with the planned courses of conservative treatment and hospitalization of the patients in due time for the surgical treatment (tonsillectomy) permit to reduce the frequency of complications of such an insidious disease as chronic tonsillitis.

[About certain medical errors in the practical work of the otorhinolaryngologist].

The results of analysis of the most widespread medical errors made when providing emergency and routine medical aid to the subjects suffering respiratory distress are presented. The authors propose their own approaches to the prevention of such errors in the hope that this experience will be helpful for practicing otorhinolaryngologists in the choice of adequate treatment strategies and will promote professional advancement of young specialists.

[Diagnostics of sepsis in the patients presenting with pyo-inflammatory ENT pathology].

The objective of the present study was to develop the algorithm for early clinical, laboratory, and instrumental diagnostics of sepsis in the patients presenting with pyo-inflammatory ENT diseases. The study included 50 patients with pyo-inflammatory ENT diseases complicated by generalization of infection. The scheme (algorithm) developed for their examination allowed to diagnose sepsis at the early stages of hospitalization in the patients presenting with pyo-inflammatory ENT pathology. The diagnostic algorithm included the criteria for syndrome of systemic inflammatory reaction (SSIR), the Kalf-Kalif leukocytic intoxication index (LII), the procalcitonin test (PKT), the integral severity of illness scale (APACHE-II) and the organ failure assessment score (SOFA). Timely preoperative diagnostics of septic complications and sanation of the primary infection site in the combination with early intensive therapy under conditions of a resuscitation department made it possible to avoid further progress of generalization of the infection and thereby to reduce the number of secondary interventions, to improve prognosis of the disease, and lower the mortality rate down to 12% in the study group (compared with 44% in the control one).

[Peculiarities of clinical and laboratory characteristics of the activity of streptococcal infection in the patients presenting with tonsillar pathology].

The objective of the present study was to characterize peculiar clinical and laboratory features of trivial tonsillitis for the substantiation of the necessity of prescription of antibacterial therapy. A total of 386 patients presenting with various forms of trivial tonsillitis were available for the determination of anti-streptococcal antibody (ASLO, anti-DN-ase B, ASPH) levels. The results of the measurement were compared based on the Centor scale generally used to estimate the necessity of prescribing antibacterial therapy for the treatment of sore throat. It is concluded that laboratory studies of characteristics of S. Рyogenes activity are needed in all the patients presenting with tonsillitis in order to elucidate the etiological factors responsible for pharyngalgia and the necessity of prescription of antibacterial therapy for the prevention of pyogenic systemic complications of streptococcal infection.

[Diagnostics of endolymphatic hydrops].

The objective of the present work was to analyse the methods for diagnostics of endolymphatic hydrops associated with Miniere's disease most frequently employed in clinical practice using both the data from the world scientific literature and our own 25-30 year experience based on the observation of more than 500 patients. Camertonal studies of hearing acuity estimated from the results of air conduction measurements and relevant acoumetric curves were considered. The main methods of research are discussed including such as tonal threshold audiometry, ultrasound testing, loud sound lateralization, dehydration test, extratympanic electrocochleography, otoacoustic emission, and functional computed stabilometry. It is concluded that none of the above methods is as reliable as to yield the comprehensive information being sought. All the data obtained by the application of these techniques need to be supplemented by the medical history data, the patients' complaints, clinical signs and symptoms of the disease if the definitive diagnosis of endolymphatic hydrops is to be made.

[The results of laser-assisted piston stapedoplasty in the patients with otosclerosis].

The objective of the present study was to compare the immediate result of laser-assisted piston stapedoplasty with the use of prosthetic stapes of different diameter in the patients with otosclerosis. The patients of both (study and control) groups underwent the measurement of the bone conduction (BC) auditory threshold before, 10-12 days, and 1 month after surgery. The bone-air interval (BAI) was measured in the same time periods. A CO2 laser was used to form a hole 0.5 mm in diameter at the base of the stirrup bone in the patients of group 1; titanium prostheses (Heinz Kurz GmbH) were 0.4 mm in diameter and 4.25 mm in length. The patients of group 2 were treated similarly, but the hole at the base of the stirrup bone had a greater diameter of 0.7 mm while the prostheses were 0.6 mm in diameter and 4.25 mm in length. The BC auditory thresholds were not significantly different after surgery in the patients of A and B subgroups (mixed forms I and II of otosclerosis, respectively). The postoperative BAI values in the patients with a larger hole at the base of the stirrup bone and prostheses of greater diameter were significantly lower than in the patients of the other group (p≤0,05). These data suggest that the use of prostheses of greater diameter has certain advantages for stapedoplasty by the methos employed in the present study.

[Optimization of the plastic closure of perforations in the nasal septum with the use of vector analysis of CT-anatomy of the nasal cavity].

The objective of the present study was to develop a planar template reflecting the spatial location of mucoperichondrium/mucoperiosteum in the nasal cavity that can be used to shape pedicled flaps for the plastic closure of perforations in the nasal septum. The vector analysis of computed tomograms of the nasal cavity obtained from 73 patients was employed to determine the size of the mucoperichondrium/mucoperiosteum of the septum, floor, and lateral wall of the nasal cavity. The resulting picture (template) has the form of an irregular polygon. Extrapolation of real perforation to such template makes it possible to more rationally plan surgery for the plastic closure of perforations in the nasal septum.

[Cycloferon as an agent for the anti-relapse therapy in patients with chronic hyperplastic sinusitis].

The data on the efficacy of cycloferon as an agents of antirelapsing therapy in management of 123 patients with chronic hyperplastic sinusitis are presented. The drug induction of endogenous interferons was validated by the properties of the local mucosal immunity, virus invasion and virus persistence in the nasal an d accessory nasal sinuses mucosa, as well as by different levels ofthe interferon production deficiency. The clinical efficacy was stated in 53% of the cases. The relapses were recorded in 13.1% of the patients treated with cycloferon vs. 33.3% of the patients under the local corticosteroid therapy.

[The surgical strategy for the treatment of intraoperative ruptures of nasal septal mucosa (part II)].

The objective of the present study was to develop the surgical strategy for the treatment of intraoperative mucosal ruptures on the nasal septum. This paper highlights the problems of etiology and pathogenesis of postoperative perforations in the nasal septum. The intraoperative mucoperichondrial ruptures are considered to be the principal risk factors of septal perforations. A total of 188 patients suffering unilateral linear mucosal ruptures in the nasal septum following septoplasty were available for observation during the period spanning from 2009 to 2011. It was shown that postoperative defects in septal mucosa eventually lead to the long-term persistent collapse of mucociliary activity. A surgical strategy for the management of interoperative mucosal ruptures of the nasal cavity has been developed taking into account the character and the length of the ruptures. An original method is proposed for the fixation of mucoperichondrial flaps used for the plastic closure of intraoperative defects in septal mucosa. The data obtained provided a basis for the development of recommendations to be used by otorhinolaryngologists for the purpose of both septoplasty and plastic closure of perforations in the nasal septum.