[On the issue of treatment of exudative otitis media in children]. / K voprosu o lechenii ékssudativnogo srednego otita v detskom vozraste.

AIM: To increase the effectiveness of treatment of children with catarrhal and secretory stages of exudative otitis media (EOM) through the development of a therapeutic and diagnostic algorithm for the management of children with this condition. MATERIAL AND METHOD: From 2008 to 2017, 346 children (682 ears) aged from 3 to 13 years with exudative otitis media were examined and treated. Two groups of patients were formed: Group 1 (150 children, 298 ears) - with a catarrhal stage of EOM, group 2 (196 children, 384 ears) - with a secretory stage of EOM. Diagnosis and treatment algorithm was created for such patients based on the results of the examination. RESULTS: Depending on the treatment, 3 groups of patients were formed: Group I - 150 children with a catarrhal stage of EOM who received conservative and surgical treatment for upper respiratory tract conditions; Group II - 146 children with an a secretory stage of EOM, who underwent conservative and surgical treatment: myringotomy / installation of a shunt in the eardrum simultaneously with surgical removal of the block of the auditory tube ostium, a course of conservative treatment for children who did not require surgical treatment; Group III - 50 children with a secretory stage of EOM and grade III adenoids, whose parents, contrary to the doctor's advice, refused the proposed myringotomy / installation of a shunt in the eardrum simultaneously with surgical removal of the block of the auditory tube ostium. These children underwent only adenotomy. CONCLUSION: The developed treatment algorithm for children with EOM, depending on the stage of the disease, demonstrated high clinical efficacy and made it possible to achieve stable positive results in 94.7% of cases in patients with the catarrhal stage of ESO and in 84.8% of cases in patients with the secretory stage of ESO, which makes it possible for us to recommend it as an integrated method that improves the quality of treatment for children with EOM.

[Exudative otitis media in the childhood].

This review article was designed to systematize the literature data concerning etiology, pathogenesis, diagnostics and treatment of exudative otitis media (EOM) in the children. The review is focused on the prevailing current tendencies in the approaches to the problems of etiology, diagnostics, and treatment of EOM in the children as exemplified by the publications in the foreign and Russian-speaking literature. The special emphasis is laid on the description of the therapeutic and surgical methods for the management of EOM.

[The morphofunctional characteristics of the palatine and pharyngeal tonsils in children with chronic tonsillitis and adenoids]. / Morfofunktsional'naia kharakteristika nebnykh i glotochnoi mindalin u detei s khronicheskim tonzillitom i adenoidami.

22 palatine and 10 pharyngeal tonsils of 20 children, 4 to 15 years of age, with chronic tonsillitis and adenoids were studied histologically and immunohistochemically. The material was obtained at tonsillectomy, adenotomy and adenotonsillectomy. The expression of LCA, CD20, CD45 RO, CD45 RA, CD68 and HLA DR-antigen was determined immunohistochemically. Functional heterogeneity of the whole lymphoid population in the tonsil tissue is structured by dividing lymphoid tissue into T- and B-regions. However, this subdivision is relative. Interpenetration of T- and B-cells into structurally determined functional zones reflects cooperative cell relations in the immune response the obligatory participant of which are non-lymphoid cells of the microenvironment: antigen-representing macrophages of the follicle germinative centres and reticular epitheliocytes in the regions of lymphoepithelial symbiosis. HLA-DR-antigen expression of the reticulum epithelium cells and the presence of activated T-lymphocytes in the lymphoepithelial symbiosis zones allow one to consider these zones as an immunoregulatory compartment of the tonsils.

[Morphologic features of chronic otitis media in children]. / Morfologicheskie osobennosti khronicheskogo srednego otita v detskom vozraste.

Surgical material from the middle ear of 80 children at the age of 5 months to 15 years who suffered from chronic otitis media as well as 20 temporal bones of foetuses (24-36 weeks) and stillborns without ear diseases are studied. It is established that the character of topography and inflammation in the ear is associated with persistence of myxoid tissue and a low degree of differentiation in the retrotympanic regions of the middle ear this excluding the possibility of its functioning as a local immune barrier. Myxoid tissue is the main reactive substrate of purulent otoantritis and otomastoiditis in children of early age and, as mesenchymal tissue with angioplastic potencies, may be regarded as a conductor of a secondary cholesteatoma of the attico-antral region.