[Clinical protocol: audiological assessment of infants in Russian Federation. Part II]. / Protokol audiologicheskogo obsledovaniya detei pervogo goda zhizni v Rossiiskoi Federatsii. Chast' II.

This is the second part of the previously published clinical protocol of audiological assessment in infants. The goal of the protocol is unification approaches to audiological diagnosis of the infants. The following sections were included in the second part of the protocol: behavioral testing in infants, testing sequence, duration of the examination and necessity in follow-up, hearing assessment in special cases (premature children, children with congenital infections, after meningitis, with external ear abnormalities, single-sided deafness, with hydrocephalus and shunts, with auditory neuropathy spectrum disorder, with mild hearing loss and otitis media with effusion), medical report.

[Clinical protocol: audiological assessment of infants in Russian Federation. Part I]. / Protokol audiologicheskogo obsledovaniya detei pervogo goda zhizni v Rossiiskoi Federatsii. Chast' I.

The clinical protocol of audiological assessment in infants was prepared by the workgroup of Russian pediatric audiologists from different regions. The goal of the protocol is unification approaches to audiological diagnosis of the infants. The protocol has been developed according the evidence based medicine principles, by reviewing current scientific publications on the topic and taking into account the order of providing medical services and other clinical practice guidelines. When direct evidence was not available, both indirect evidence and consensus practice were considered in making recommendations. This guideline is not intended to serve as a standard to dictate precisely how the child should be diagnosed. This guideline is meant to provide the evidence base from which the clinician can make individualized decisions for each patient. The first part of the protocol covers following sections: equipment, staff requirements, timing of the diagnostics, case history and risk factors, preparing the child for the appointment, sedation and general anesthesia, otoscopy, tympanometry and acoustic reflex, otoacoustic emissions, skin preparing, electrode montage, choosing the stimulators, auditory brainstem responses on broadband and narrow-band stimuli, on bone conducted stimuli, auditory steady-state responses, masking, combined correction factors.

[Results of the audit of the first stage newborn hearing screening in St. Petersburg]. / Rezul'taty audita pervogo etapa audiologicheskogo skrininga novorozhdennykh v Sankt-Peterburge.

OBJECTIVE: Analysis of the first stage of universal newborn hearing screening in St. Petersburg and increasing its effectiveness. RESULTS: In result of the audit, it was found that screening performs in all maternity wards, children's hospitals and at the majority of pediatric clinics. Meanwhile only 14% of institutions meet criteria of good practice in providing screening. In other clinics improving the procedure of screening is needed: equipment update and calibration, correction of the method and conditions of examination, results documenting, etc. The set of activities for increasing the effectiveness of newborn hearing screening is proposed. The work which carried out with institutions during and after audit allowed to reach 100% involving clinics in screening system in 6 months. Due to information support of institutions coverage of newborns by the first stage of screening increased on 8.5% (matched to target) and the number of referred children who come to the second stage of screening increased on 18%. Results suggest that the audit of the first stage of newborn hearing screening by the district pediatric audiological centers is an effective tool for finding problems in the screening system and its solving.

[Hearing function in children after new coronavirus infection (COVID-19)]. / Sostoyanie slukha u detei, perenesshikh novuyu koronavirusnuyu infektsiyu (COVID-19).

The information about hearing status of patients who have had a COVID-19 is scattered. There are no studies among children population. OBJECTIVE: To evaluate hearing function in children after coronavirus infection. MATERIAL AND METHODS: 87 children aged from 5 months to 17 years who have had a new coronavirus infection were examined in three cities of Russia (St. Petersburg, Novosibirsk and Surgut). Audiologic examination depended on the age and included: otoscopy, TEOAE and DPOAE, ABR, impedansometry, pure tone audiometry, speech audiometry in quiet and noise. Fisher, LittlEARS and PEACH questionnaires were used as well. An evaluation of central auditory processing was performed in case of indications. RESULTS: In 80 children (92%) otoscopy didn't revealed any problems. All children had type A tympanogram. Acoustic reflex was registered in 49 children (56%), wasn't registered on 1-2 frequencies in 27 (31%) children, was registered on only 1 frequency or wasn't registered at all in 11 (13%) children. OAE was present in 83 (95%) children. Audiometric thresholds in all children were within a normal range. Speech intelligibility in quiet and noise in most cases was normal. 7 children with poor speech intelligibility or low Fisher questionnaire results got an extended examination. Binaural fusion speech test, dichotic test, RuMatrix test, gap detection test data showed no signs of central auditory processing disorders. CONCLUSION: There are no cases of hearing loss or central auditory processing disorders were found in children after new coronavirus infection. Due to variety of symptoms and long-term consequences of COVID-19 further hearing examination is required in this group of patients.

The benefits of underwater vibrostimulation in the rehabilitation of children with impaired hearing.

INTRODUCTION: Early intervention is crucial for the optimal speech and language development of children with impaired hearing. Underwater vibrostimulation could help develop behavioural reactions to low-frequency stimuli immediately after diagnosis and facilitate aural rehabilitation after hearing aid (HA) or cochlear implant (CI) activation. GOALS: To determine the limits of underwater vibrotactile stimuli perception and to measure the effect of vibrostimulation training on the aural rehabilitation of young children. METHODS: Two adults and three children with congenital hearing loss participated in the first part of the study. Pure tones between 100 and 4000 Hz and natural broadband sounds were delivered under water while the participants were sitting in a pool. The lower thresholds of perception and the maximum comfortable levels were measured and the subjective sensations were recorded. In the second part of the study, 15 children <3 years old were presented with the same stimuli until they developed stable conditioned reactions to the stimuli. The time until the development of "hearing behaviour" and the number of fitting sessions after HA or CI activation were compared between the vibrostimulation group and a control group who did not receive such training. RESULTS: In the first part of the study, participants were most sensitive to 100-400 Hz stimuli, while the stimuli >1000 Hz did not evoke any sensations. The vibrations were felt across all body parts and produced hearing-like sensations in the ear. In the second part of the study, children in the vibrostimulation group required fewer fitting sessions and developed "hearing behaviour" sooner than the control group. CONCLUSIONS: Underwater vibrostimulation is a promising new method of early aural rehabilitation that could be recommended for implementation in paediatric audiology centres.

[Complex disorders in children with sensorineural hearing loss - influence on the diagnosis of hearing pathology and hearing aid]. / Kompleksnye narusheniya u detei s sensonevral'noi tugoukhost'yu ­ vliyanie na diagnostiku patologii slukha i slukhoprotezirovanie.

The presence of additional disabilities (AD) in children with sensorineural hearing loss (SNHL) and influence of AD on age of hearing loss diagnosis and amplification were investigated. It was shown that 41% children with SNHL have different AD - pathology of the central neural system (including mental retardation, autism spectrum disorders, attention deficits), vision, motor and articulation impairments, cardiovascular, respiratory, urinary, digestive, endocrine diseases etc. 59% children among them have 2-3 AD. The most often combination of AD was pathology of central neural and motor systems. The genetic factor was revealed rarely in the group of children with AD than in children with SNHL only. The diagnosis of hearing loss before age 4 months was rarely in the group of children with AD. Possibly it is because of the most of such children got treatment in neonatal intensive care unit and didn't have access to universal newborn hearing screening. Moreover, SNHL might develop later as the outcome of their AD or their treatment. Suggestion about more late amplification in children with SNHL was confirmed. The cause might be wary relation of audiologists to amplification of children with AD and difficulties of this process.

[Asymmetric sensorineural hearing impairment in the adult population]. / Asimmetrichnaia sensonevral'naia tugoukhost' vo vzrosloi populiatsii.

The relevance of the problem of a sensorineural hearing loss (ASNL) arises from the necessity of the special approaches to the diagnostics of this condition, the complications accompanying this pathology, and the difficulties encountered in the implementation of the methods designed for hearing rehabilitation of such patients. The objective of the present study was to estimate the prevalence of ASHL among the adult population. The sensorineural impairment of hearing was diagnosed in a total of 2456 (72%) examined patients presenting with hearing loss. To determine the presence of asymmetry of sensorineural hearing loss, we employed three counting techniques allowing (1) to calculate the difference between the average hearing thresholds at four frequencies within the range from 0.5 to 4 kHz (the difference was found to be 15 dB or more in 17% of the patients), (2) to calculate the difference between the degrees of hearing loss in the right and left ears (the difference was documented in 47% of the patients), (3) to calculate the difference between the hearing thresholds at least at a single frequency within the range from 0.125 to 8 kHz (he difference was found to be 15 dB or more in 71% of the patients). When using the third method to characterize asymmetry of hearing impairment, it was identified in most patients (53%) at one or two frequencies. Moreover, there was a large number of the patients (13%) with asymmetry apparent over the entire frequency range. A high degree of threshold asymmetry (in excess of 40 dB) was more often noted in the mid-frequency range. In the majority of the patients, the asymmetry manifested itself as the different degree of bilateral sensorineural hearing impairment (51%) or unilateral sensorineural hearing loss with the normal hearing ability preserved in the contralateral ear (35%). The results of the present study give evidence of the necessity of developing a reliable method for the identification of clinically significant ACNL.

[Allergic rhinitis: the modern aspects of therapy]. / Allergicheskii rinit: sovremennye aspekty terapii.

The main objectives of the present article were to systematize the modern views of the causes and risk factors of allergic rhinitis, to clarify the manner of its development, to define the leading etiological mechanism underling the pathogenesis of this condition, to consider the methods used for the diagnostics and the treatment of this disease, and to sum up the clinical experience with the use of Levocetirizine (Allerwey) for the management of allergic rhinitis. Special attention is given to the achievement and the maintenance of control of the persistent or intermittent forms of allergic rhinitis and to approaches to its treatment based on the medications registered in the Russian Federation.

[Age related aspects of cochlear implantation.]

The objective of this study was to assess the long-term results of cochlear implantation in terms of age-related changes. 67 patients of different age with chronic bilateral severe sensorineural hearing loss and deafness with experience of use of cochlear implants (CI) for at least 5 years were tested. The 1st group included young patients (25,5±7,9 years), the 2nd group - middle-aged (51,4±5,4 years), the 3rd group - elderly patients (67±5,6 years). The examination, which conducted before and after the planned replacement of the speech processor, included: pure tone and speech audiometry in the free field, subjective assessment of satisfaction with CI, assessment of the state of speech function and psychological testing using the Montreal Cognitive Assessment and Mini-Mental State Examination. The increase in speech intelligibility in silence and in a background noise after the replacement of speech processors was revealed. The expediency of cochlear implantation in geriatric practice to maintain the mental and social status of elderly people, prevention of dementia, improving the quality of their lives in the conditions of increasing the age-related risks of sensory and cognitive dysfunction was shown.

[Validation of the Russian language version of the SSQ questionnaire].

The Speech, Spatial and Qualities of Hearing Scale (SSQ) is applied worldwide as a highly reliable tool for the characteristic of the quality of life and subjective sensations of the patients presenting with hearing impairment as well as for the estimation of the efficiency of hearing aids. The objective of the present study was to validate and adapt the Russian language version of the SSQ questionnaire (SSQrus) for its application in the audiological practice under conditions of this country. After the cultural and language adaptation of SSQrus, it was validated by means of repeat interviewing of three groups of the respondents (a total of 93 subjects with normal, moderately and severely impaired hearing). The results of the validation give evidence of the high reliability of the modified questionnaire. Specifically, high reproducibility of the data estimated from the results of the second interview has been demonstrated (r=0.85--0.99). High sensitivity of SSQruswas confirmed by the agreement between the results of the estimation (in scores) and the degree of the observed loss of hearing. The estimates obtained by the application of the SSQrus questionnaire are comparable with those reported by the foreign authors. It is concluded that the SSQrus questionnaire can be used in routine audiological practice as an additional diagnostic instrument for the estimation of hearing problems experienced by a patient, monitoring efficiency of therapy and surgical treatment of hearing impairment, improvement of hearing aids, and hearing dysfunction research.

[The state of the larynx in the patients presenting with chronic obstructive pulmonary disease].

The objective of the present study was to evaluate the clinical state of the larynx and its microbial population in 49 patients examined at the stage of stable condition of chronic obstructive pulmonary disease. Examination of the larynx was carried out with the use of a rigid laryngoscope having a visual angle of 70 degrees, videofibrolaryngoscopy, and stroboscopy using a «TelePac¼ videocomplex (Karl Storz, Germany). It was supplemented by the study of the bacteriological and mycological paysage. The acoustic analysis of the voice was performed with the help of the Specta PLUS computer program. It was shown that more than 70% of the examined patients presented with various forms of chronic laryngitis. Potentially pathogenic St. pyogenes and yeast-like fungi C. albicans were isolated from 59% and 29% of the patients respectively.

EPIDEMIOLOGIC AND DEMOGRAPHIC FEATURES OF INTRACRANIAL OTO- AND RHINOSINUSOGENIC PYOINFLAMMATORY COMPLICATIONS IN RUSSIAN FEDERATION.

An analysis of demographic and epidemiologic situation was made in cases of otogenic and rhinosinusogenic intracranial complications on the area of 32 regions of Russian Federation at the period from 2009 to 2014. The state of ENT-service of examined subject is characterized by reduction of provision of during ENT-beds and lower level of hospitalization of population over indicated period. There was revealed a reliable correlated dependence of the main medical statistical indices from the intracranial complications with climatic and demographic factors, the rate of morbidity and activities of ENT-service in the area of this region.

[The specific clinical features of otogenic intracranial complications: the current views].

The objective of the present study was to elucidate the specific clinical features of otogenic intracranial complications (ICC) encountered in the current otorhinolaryngological practice. The work is based on the results of the retrospective analysis of 106 adult patients presenting with otogenic intracranial complications admitted for the treatment to multidisciplinary clinics of Sankt-Peterburg and Krasnoyarsk. Forty six (42.5%) patients presented with acute otitis media. 90% of them had suppurative destructive mastoiditis. In sixty (56.6%) patients, chronic suppurative otitis media (epitympanophonia) was associated with the extensive destructive process spreading toward dura mater of the medial and posterior cranial fossae and onto the sigmoid sinus. The prevalence of intracranial complications among the adult patients suffering from suppurative otitis media and treated in the otorhinolaryngological clinics amounted to 3.17%. The overall structure of otogenic intracranial complications was as follows: meningitis 42.5%, brain and cerebellum abscess 24.5%, suppurative meningoencephalitis 19.8%, sinus thrombosis 5.7%, epidural and subdural empyemas 4.7%, the combined suppurative brain lesions 2.8%. Systemic inflammatory response syndrome (sepsis) was diagnosed in 33 (31%) patients with otogenic ICC. The high intrahospital mortality rate among the patients with this condition (20.8%) is emphasized. The main causes of the fatal outcome in the patients with otogenic intracranial complications are supposed to be brain oedema with the concomitant development of dyslocation syndrome and sepsis.

[The place of mucoactuve therapy of rhinosinisitis in the international and Russian guidelines]. / Mesto mukoaktivnoĭ terapii rinosinusita v mezhdunarodnykh i rossiĭskikh rekomendatsiiakh.

The results of clinical studies giving evidence of the therapeutic effectiveness of the mucoactive preparations for the treatment of rhinosinusitis made it possible to introduce the herbal medicinal product Myrtol into the European position paper on rhinosinusitis and nasal polyps (EPOS 2012). It was shown that the intake of Myrtol standardized preparation accelerates the regress of clinical symptoms of the disease, decreases the requirement for antibiotic therapy, and reduces the period of disability as compared with the similar effects of placebo.

[FEATURES OF OTOGENIC INTRACRANIAL COMPLICATIONS AT THE PRESENT STAGE].

A retrospective analysis of treatment was made in 127 adult patients with acute and chronic otitis media complicated by suppurative-inflammatory pathology of the brain. Purulent meningitis was revealed in 52 (40.9%) of hospitalized patients. Meningoencephalitis was often diagnosed in the cases of acute otitis media (15.4%) and in cases of chronic otitis (22.7%). The otogenic brain abscess was detected in 13.5% of otitis media cases and it was noted to be twice frequent (33.3%) in cases of purulent otitis media. The patients 124 (97.6%) have been operated. An extended mastoidotomy and antromastoidotomy were performed in the acute purulent otitis media. An extended radical operation on the ear was applied in case of chronic otitis media. Performance of craniotomy and complete removal of the abscess using modern systems of neuronavigation showed a higher clinical efficacy as compared with transtemporal approach during sanitizing intervention on the ear including the opening and abscess drainage in surgery of otogenic abscesses of the brain.

[The modern epidemiological characteristics of oto- and rhinosinusogenic intracranial complications].

The objective of the present study was to survey epidemiology of oto- and rhinosinusogenic intracranial complications that are currently diagnosed at the territory of the Russian Federation. The work was based on the analysis of the official statistical reports together with the data obtained from the chief specialists responsible for the otorhinolaryngological services in 32 subjects of the Russian Federation during the period from 2009 to 2014. It was shown that the state of the otorhinolaryngological service in the period covered by the study was characterized by the reduction in the number of beds available for the patients presenting with ENT pathology by 14.0% and the lowering of the hospitalization rate for the general population by 6.3%. The frequency of oto- and rhinosinusogenic intracranial complications among the patients hospitalized to occupy the beds intended for the care of the patients suffering from ENT diseases was estimated at 0.03% and intrahospital lethality at 21.2%. The prevalence of pyogenic intracranial complications associated with the inflammatyory pathology affecting ENT was 0.61 per 100.000 population per year, with the mortality rate amounting to 0.17 fatal outcomes per 100.000 population per year. The study revealed significant correlation of the principal medico-statistical characteristics of high-frequency oscillatory ventilation (HFOV)---?? between themselves and with the parameters of ENT morbidity and activities of the otorhinolaryngological services at the territory of a given administrative territory. It is concluded that the improvement of the quality of healthcare for the population presenting with intracranial complications and inflammatory ENT diseases is possible only on the baseis of the combined and interdisciplinary approach to the solution of the problem.