[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.

[Chronic fungal sinusitis caused by Schizophyllum commune]. / Khronicheskii sfenoidit, vyzvannyi gribom Schizophyllum commune.

Treatment of patients with fungal sinusitis, in some cases, does not lead to complete sinus sanitation, which may be due to insufficient surgical intervention and/or incorrectly selected antimycotic therapy. Treatment of such patients must necessarily include the complete removal of fungal masses from the affected sinus and the further use of antimycotics that ensure complete elimination of the pathogen. A clinical case of chronic fungal operated isolated sphenoiditis caused by the fungus Schizophyllum commune is presented. For extensive drainage of the sphenoid sinus, the patient underwent translamellar sphenoidotomy on the right with further antifungal therapy.

[Treatment of chronic eczematous otitis externa]. / Lechenie khronicheskogo ekzematoznogo naruzhnogo otita.

Otitis externa is a common disease. The article discusses the anatomical and physiological features of the structure of the outer ear, the epidemiology of otitis externa. Acute inflammation is characterized by the presence of significant microflora, and most often it is preceded by the impact of various physical factors. With chronic inflammation, more changes from the skin are recorded, while the microflora is not always isolated. The authors consider the problem of chronic inflammation of the outer ear. They provide their own data on the etiology of inflammation. Particular attention is paid to local treatment, including their own experience of using the combined drug Candiderm. As a result of the treatment, the skin changes of the external auditory canal were completely resolved in all patients by day 28, the itching in the ears completely stopped after 10-14 days of therapy. Stable remission was achieved in 89% of patients.

[Fungal otitis externa in children: principles of diagnosis and rational therapy]. / Gribkovyi naruzhnyi otit u detei: printsipy diagnostiki i ratsional'noi terapii.

AIM: To study the current diagnosis and treatment of fungal inflammation of the external auditory canal in children. This article summarizes the literature on predisposing factors for the occurrence of fungal infections of the external auditory canal in children. PATIENTS AND METHODS: In this study, we present modern approaches to the diagnosis and treatment of external fungal otitis media in children depending on the isolated genus and species of fungus. RESULTS: We established that, according to the study conducted from 2015 to 2017 in the L.I. Sverzhevskiy Clinical Research Institute of Otorhinolaryngology, the incidence of the external fungal otitis media in children is 13,0%. The primary causative agents of fungal inflammation are fungi of the genera Aspergillus, Candida and Geotrichum. CONCLUSION: In the presented study, the rationale for the selected treatment regimen was made based on data obtained during microbiological studies.

[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 role of microbiota in chronic pharyngitis]. / Rol' mikobioty pri khronicheskim faringite.

This article describes the modern approaches to the diagnostics and treatment of fungoid conditions of the pharynx with special reference to the main methods for the detection of pharyngomycosis and its clinical manifestations based on the results of analysis of the investigations carried out during the period from 2012 till 2016. Among the 3,465 patients presenting with chronic inflammatory pathology of the pharynx who sought medical advice and treatment at the clinical departments of the Institute, 861 ones (25%) were found to have mycotic lesions of the pharynx. Erythematous (atrophic) chronic pharyngitis was the predominant form of the disease documented in 2,059 patients whereas the remaining 1, 406 ones presented with the hypertrophic forms. The fungal infection was diagnosed in 403 (19,5%) patients with erythematous atrophic chronic pharyngitis in comparison with 458 (32,5%) patients suffering from the hypertrophic forms of this pathology including pseudomembranous, hyperplastic (granulomatous), and erosive-ulcerative ones. The principal pathogenic agents responsible for the development of fungal pharyngitis in our patients were fungi of the genus Candida that accounted for 97 - 99% of all the cases of this disease. The currently available modalities for the treatment of pharyngomycosis are described.

[The treatment of laryngomycosis]. / Lechenie laringomikoza.

The objective of the present study was to elaborate the therapeutic algorithm for the treatment of laryngomycosis. We have examined a total of 430 patients suffering from chronic laryngitis including 100 ones (23.2%) having the fungal flora. Mycosis was diagnosed by the microscopic study of the stained preparations with the application of various techniques; moreover, cultivation in elective nutrient media was used. The yeast-like fungi of the genus Candida were identified in 98 (98%) and mold fungi of the genus Aspergillus in the remaining 2 (2%) patients. All these 100 patients were given the antifungal treatment. 98 of them presenting with candidal laryngitis were allocated to three groups. Group A was comprised of 33 patients who received the local treatment alone, group B contained 31 patients given only systemic therapy, and group C included 34 patients undergoing the combined treatment with the use of the medications possessed of both the local and systemic actions. The best clinical results were obtained in the patients of the latter group in which the therapeutic efficiency proved to be as high as 79.4%. It is concluded that all the patients suffering from laryngomycosis are in need of the combined treatment designed to eradicate the causative agent, restore the vocal function, and achieve the stable remission of the chronic inflammatory process in the larynx. The combined treatment with the antimycotic medications exhibiting both the general systemic and local activities during 3 weeks appears to be the optimal therapeutic modality for the management of laryngomycosis. Of special importance is the dynamic follow-up of the treated patients including the control examinations in the course of the treatment (days 7, 14, and 21) to be followed by the mycological study after the termination of therapy and its repetition every 3 months during the subsequent period.

[Otomycosis: the modern view of etiology and management]. / Otomikoz: sovremennyi vzgliad na étiologiiu i lechenie.

This article deals with the modern approaches to the diagnostics and treatment of fungal ear infection depending on the localization of the inflammatory process and the species of the causative fungal agent with special reference to the factors underlying the development of otomycosis under the present-day conditions based on the results of the analysis of the studies carried out during the period from 2010 to 2014. The materials of the examination of 2152 patients who applied for the medical care to various clinical departments of the Institute and were found to present with chronic inflammatory ear pathology were available for the analysis. Fungal lesions were diagnosed in 495 (23%) patients with this condition. Fungal lesions of the external ear were the predominant form of pathology; they were documented in 331 (67%) patients. Fungal otitis media was diagnosed in 85 (17%) patients and fungal lesions of the postoperative cavity in 79 (16%) patients suffering from otomycosis. 65% of the patients presenting with external fungal otitis, 20% of those with fungal otitis media, and 95% of the patients with inflammation of the postoperative cavity were infected with mold fungi dominated by the genus Aspergillus spp. 79 (16%) patients suffering from otomycosis. In 35% of the patients presenting with fungal external otitis, 80% of those with fungal otitis media, and 5% of the patients with inflammation of the postoperative cavity of the middle ear, the causative agents of the disease were the fungi Candida spp. The authors describe the modern schemes for the treatment of otomycosis elaborated at the L.I. Sverzhevskiy Research Institute of Clinical Otorhinolaryngology.

[The prevalence of the fungal flora in association with chronic inflammatory pathology of the larynx]. / Rasprostranennost' gribkovoi flory pri khronicheskoi vospalitel'noi patologii gortani.

The present article was designed to analyze the prevalence and clinical features of laryngomycosis associated with chronic inflammatory diseases of the larynx. We examined 430 patients suffering from chronic pharyngitis and found the fungal flora in 100 (23.2%) of them. Diagnostics of the fungal infection was performed by the microscopic study of the stained preparations (including the Gram method, Romanovskiy-Giemsa and fluorescent microscopy). The sowing on elective nutrient media was used. The study revealed the presence of yeast fungi (Candida) in 98 patients (98%) and mold fungi (Aspergillus) in the remaining two (2%). The hyperplastic form of fungal pharyngitis was diagnosed in 55% of the patients. We have identified the following predisposing factors for fungal laryngitis: the gastroesophageal reflux disease in 56% of the patients, smoking in 50%, the long-term use of the removable dentures with the inadequate care for them in 30%, and the consistent use of inhaled corticosteroids in 27%. Hyperglycemia was documented in 6% and the history of long-term treatment with antibiotics in in 10% of the patients. The scheme for the combined antifungal therapy has been developed. Its practical application allowed to achieve the eradication of the fungal flora and to improve the clinical course of chronic laryngitis in 75% of the patients.

[The current views of the treatment of diffuse external otitis].

The objective of the present study was to evaluate the clinical effectiveness and safety of the local application of triderm for the treatment of diffuse external otitis. The study included 68 patients presenting with bacterial and fungal diffuse external otitis. The treatment in the form of local empiric therapy was continued till the results of microbiological treatment became apparent. The beneficial outcome achieved in 91.2% of the patients was clinically manifest as the regression of the inflammatory process in the external auditory meatus. No complications, such as ototoxic events, either local or systemic allergic reactions, were documented. The authors substantiate the possibility of the application of the medication under consideration for the treatment of diffuse external otitis based on the knowledge of the mechanism of the actin of its constituent components, viz. betamethasone, dipropionate, gentamicin sulfate, and clotrimazole, taking into account the occurrence of the most common causative agents of diffuse external otitis. It is concluded that triderm is a safe medication for the local application and, probably, for the initial empiric therapy of diffuse external otitis to be continued till the results of the microbiological treatment become apparent.

[The clinical manifestations and diagnostics of otitis media caused by tuberculosis].

The objective of the present study was to clarify the characteristic pathognomonic features of middle ear lesions associated with tuberculosis and the approaches to their diagnostics under the present-day conditions. The study included 11 cases (18 ears) of tuberculosis otitis media and the related lesions of the mastoid process diagnosed with the use of clinical, roentgenological, cytological, bacteriological, pathomorphological, and molecular-genetic methods (including PCR diagnostics). The primary localization of tuberculosis in the middle ear was documented in 6 patients; in 5 patients, it was associated with pulmonary involvement. Five patients presented with smoldering exudative otitis media and the remaining six ones with suppurative perforating otitis media. The tuberculous process was diagnosed with the use of various methods including clinical examination, bacteriological (9%), cytological (27.3%), pathomorphological (18%) studies, and PCR diagnostics (55%). Diagnosis was made within a period from 1 month to 1.5 years after the application of the patients for medical assistance which suggests the difficulty of verification of tuberculous etiology of the disease of the middle ear. It is concluded that the high index of suspicion in the case of smoldering middle ear pathology facilitates its early diagnostics and successful treatment.

[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 treatment of acute inflammation of the middle ear].

The authors propose the differential approach to the treatment of acute inflammation of otitis media and otitis externa taking into consideration etiology of the disease. Its clinical form and stage. Special attention is given to the method of local treatment including the use of various eardrops. The results of their comparative assessment are presented.

[The modern approach to diagnostics and treatment of mycotic lesions in ear, nose, and throat].

The analysis of the prevalence of mycoses based on the literature data and original observations gives evidence of the increase in the relative frequency of mycotic lesions in the overall ENT morbidity. The occurrence of otomycosis among otitides of different etiology is estimated at 25% and that of pharyngomycosis in the patients presenting with chronic pharygitis and tonsillitis up to 28%. The mycotic lesions in the larynx are diagnosed in almost 15% of the patients with chronic laryngitis. Chronic inflammation of intranasal cavity and paranasal sinuses is associated with mycosis in 7% of the patients. The factors that promote the development of mycotic lesions are considered and specific clinical manifestations described with special reference to their localization and taxonomical identification of the fungi. The optimal approaches to the diagnostics and treatment of ENT mycosis are discussed. The strategies of local and general antimycotic therapy are proposed with the use of modern antimycotic agents taking into account peculiarities of the clinical course of the disease, indications and contraindications for their application.

[Selected aspects of modern epidemiology of ENT-mycoses].

The prevalence of mycosis affecting ears, nose, and throat was analysed based on the literature data and the results of original observations of 3964 patients who applied for medical aid to the counseling department of our centre during the period from 2005 to 2007. The study revealed a relative increase in the occurrence of ear, nose, and throat mycosis in the structure of chronic inflammatory pathology. Specifically, the frequency of mycotic otitis rose to 25.2%, mycotic infestation of the pharynx in patients with pharyngitis and tonsillitis to 28.7%, mycotic infestation of the larynx associated with chronic laryngitis to 20%, and mycosis in patients presenting with chronic inflammation of the nasal cavity or paranasal sinuses to 7%. The spectrum of pathogenic fungi affecting ears, nose, and throat has been identified. The enhanced contribution of various non-albicans Candida strains to the development of chronic inflammation is documented. Aspergillus species are shown to play the increasingly more important role in the affection of palatal tonsils, laryngeal and pharyngeal mucosa.

[Middle ear mycosis]. / Mikoz srednego ukha.

Clinical, mycological and histological examinations of 608 patients who had chronic purulent otitis media (n=232) or persistent purulent discharge after surgery on the middle ear (n=376) detected mycosis in 22 (9%) patients with chronic purulent otitis media and in 77 (20%) patients after surgery on the ear. Aspergillus niger occurred in 52.5% patients. Specific general or local treatment was made basing on the species of the pathogen.