[Prevention of thromboembolic complications in otorhinolaryngological surgery]. / Profilaktika tromboembolicheskikh oslozhnenii pri otorinolaringologicheskikh khirurgicheskikh vmeshatel'stvakh.

The article reviews current clinical guidelines and recent publications on the perioperative prophylaxis of venous thromboembolism (VTE) in ENT-HNS patients. The literature review is descriptive and includes foreign sources and national guidelines on diagnosis, treatment, and prevention of VTE. The average risk of VTE in otorhinolaryngology - head and neck surgery is lower than in the other surgical specialties, not reaching 1% in total. Major oncologic head and neck surgery carries higher risk of VTE. When prescribing anticoagulants after ENT-HNS surgery, one should predict and compare the risk of postoperative bleeding with the risk of VTE.

Cyclamen europaeum improves the effect of oral antibiotics on exacerbations and recurrences of chronic rhinosinusitis: a real-life observational study (CHRONOS).

SUMMARY: Chronic rhinosinusitis (CRS) is an inflammatory disease of the nose and paranasal sinuses affecting 11% of the European population. Cyclamen europaeum plant extract (CE) has demonstrated efficacy in treating acute rhinosinusitis, but its role in CRS exacerbations remains unknown. In this real-life, prospective, epidemiological, observational study, a total of 317 patients with exacerbations of CRS without nasal polyps (CRSsNP) of moderate severity were treated using three different options: oral antibiotics, CE extract nasal spray, or the combination of oral antibiotic with CE extract. The main outcomes were the effect of treatment on sinonasal symptoms and endoscopic appearance after 6 weeks of therapy, and the number of recurrences of CRS exacerbations after 6 months of follow-up. On the top of oral antibiotics, CE extract significantly improved sinonasal symptoms and endoscopic findings and caused a 4-fold reduction of CRS recurrences. When administered in monotherapy, CE extract was at least as effective as antibiotic in monotherapy on relief of both symptoms and reduction of CRS recurrences. In patients with CRS exacerbation of moderate severity, CE extract nasal spray in monotherapy or added to standard antibiotic treatment significantly reduces sinonasal symptoms and CRS recurrences compared to antibiotics in monotherapy.

[The results of the surgical treatment of otosclerosis in the elderly subjects].

The objective of the present study was to evaluate the effectiveness of the surgical treatment of otosclerosis in the subjects of advanced age. The medical histories of 19 patients aged above 65 years (20 ears) presenting with otosclerosis were available for the retrospective analysis. All of them had undergone surgical interventions (a total of 22 ones or 4.49% of the 489 operations performed between 2001 and 2012). The audiometric assessment was made at four wavelengths (0.5, 1, 2, and 4 kHz). Primary surgery (n=18) was preceded by the determination of the high air and bone conductivity thresholds (76.18 dB and 42.15 dB respectively), with the mean bone to air interval (BAI) being 33.99 dB. The surgical treatment resulted in the improvement of hearing; in 83.33% of the cases, BAI was reduced to 10 dB or below this value. It is concluded that the surgical intervention on the stirrup bone for the treatment of otosclerosis in the patients above 65 years of age is a safe and efficacious method despite marked hearing impairment in this group of patients.

[Secondary operations for the treatment of nasal septum deformities].

The objective of the present retrospective study was to improve the methods of secondary surgical intervention for the treatment of nasal septum (NS) deformations and evaluate their immediate outcomes. A series of 56 re-operations on NS is represented. Two main approaches to the treatment of secondary deformation were applied: repeated septoplasty with autocartilage and bone re-implantation and tissue-preserving endoscopic submucous resection of deviated septal portions. Endoscopic studies, CT of the nasal cavity and paranasal sinuses, anterior active rhinomanometry, and acoustic rhinometry were used to clarify the character of deformation and to objectively assess the resulting disorders of nasal breathing. The differential approach to the choice of the surgical correction strategy made it possible to restore nasal breathing in all 40 patients followed up during 3 months after re-operation. The results of anterior active rhinomanometry indicate that the mean total volumetric flow increased after the secondary treatment from the initial value of 467.7±89.1cm3/s to 901.1±115.4 cm3/s within the following three months. The cases of postoperative perforation or the development of other possible complications were not documented.

[The effectiveness of long-term treatment of polypous rhinosinusitis with low doses of macrolides].

The objective of the present study was to estimate the effectiveness of the long-term treatment with low doses of macrolides for the prevention of early relapses of polypous rhinosinusitis in the postoperative period. A total of 66 patients at the age from 18 to 77 years presenting with the clinical diagnosis of bilateral polypous rhinosinusitis were randomly allocated to 3 groups; fifty five patients completed the study. All the patients underwent endoscopic polysinusotomy. All of them were given basal therapy with mometasone furoate at a daily dose of 400 mcg throughout 6 month postoperative period. The patients of groups 1 (n=22) and 2 (n=14) additionally received daily doses of 25 mg clarithromycin during 6 and 3 months respectively. The patients of group 3 were given basal therapy alone. All the patients were followed up within 6, 12, and 24 weeks after surgery with the use of a visual-analog scale, SNOT-20 questionnaire, acoustic rhinometry and rhinomanometry, endoscopic study of the nasal cavity, computed tomography of paranasal sinuses, determination of saccharine transport time, evaluation of olfactorial sense, and measurement of the eosinophilic cationic protein level in the nasal secretion. It was demonstrated that the patients treated with clarithromycin show significantly better outcomes of therapy compared with controls (p<0.05), the effectiveness of the 6 month clarithromycin therapy being higher than that of the 3 month treatment. The exception was the results of estimation of clinical symptoms and signs based on the visual-analog scale and the acoustic rhinometric data that did not reveal significant differences between the groups. The patients of the control group given no clarithromycin significantly more frequently developed relapses of polypous rhinosinusitis (p=0.02).

[The evolution of adenoidectomy].

The critical analysis of publications concerning methods designed for the surgical treatment of adenoids is presented. Various surgical techniques are considered with special reference to their indications for use, invasiveness, effectiveness, and safety. Recent developments in this field give evidence that evolution of adenoidectomy brought about highly efficacious (up to 99%) mini-invasive and safe surgical procedures producing the minimal risk of relapses and postoperative complications. All these advancements became possible due to the introduction of endoscopic intraoperative control, general anesthesia, and the use of modern surgical instruments. Modern approaches make unnecessary radical removal of the lymphoid tissue.

[Hemorrhage following tonsillectomy: analysis of the prevalence and risk factors].

The objective of the present study was to analyse the modern literature concerning the prevalence of hemorrhage following tonsillectomy (TE) and the factors responsible for its development. Chronic tonsillitis affects from 4% to 15% of the general population and accounts for 23.7% of all pharyngeal disorders. Despite the significant decrease in the frequency of TE during the last years, it remains a most popular surgical procedure in otorhinolaryngological clinics all over the world. Hemorrhage is the most frequent complication of TE registered in 2.5% to 9.2% of the patients on the average, with early (primary) hemorrhages occurring more frequently than late ones as shown in the majority of the studies. The possible risk factors of postoperative hemorrhage are described. The significance of some of these factors (male sex, age, surgeon's experience, surgical technique,techniques of intraoperative hemostasis, elevated arterial pressure) is estimated based on the analysis of results of many relevant studies; their influence on the frequency of hemorrhage following tonsillectomy is fairly well confirmed. The effects of other factors, such as the season, whether conditions at the time of TE, duration of surgery, smoking, etc. are hypothetical.

[Peculiarities of the surgical treatment of nasal septum perforations].

The objective of the present study was the retrospective analysis of the results of nasal septum perforation (NSP) surgery. We report our experience with the operations on the perforated nasal septum based on the treatment of a total of 84 patients. Plastic repair of the perforated nasal septum was undertaken in 54 of them. The endonasal approach with the use of local tissue flaps was employed in 47 cases. Additional bucco-gingival flaps were used in another 4 patients and the open rhinoplastic approach in 3 cases. The complete closure of nasal septum perforations was achieved in 34 (63%) patients. The reduction of the size of perforations was documented in 17 (31%) patients whereas in the remaining three the perforation size slightly increased. The surgical technique and peculiarities of the postoperative management of the patients are described; the possible causes of NSP relapses following surgery are discussed.

[The state of the stirrup prosthesis estimated from the results of functional multispiral computed tomography].

The objective of the present study was to estimate the state of the stirrup prosthesis based on the results of functional multispiral computed tomography (fMSCT). A total of 30 patients suffering otosclerosis and treated by stapedoplasty were examined using the modified fMSCT technique developed by the authors. The data obtained were compared with the results of the audiologic study. It was shown that modified fMSCT makes it possible to objectively and visually estimate the state of the stirrup prosthesis, elucidate the causes of poor outcome of the surgical treatment and identify the indications for the second operation. The study has demonstrated that a more pronounced decrease of the air-bone gap (ABG) is associated with a rise in the amplitude of prosthesis movements whereas the degree of reduction of bone conduction does not significantly correlate with the depth to which the prosthesis reaches into the vestibulim.

[The potential of multislice computed tomography for the detection of specific anatomic and topographic features of the facial nerve canal prior to stapedoplasty].

The objective of the present study was to estimate the potential of multislice computed tomography (MSCT) for the detection of specific anatomic and topographic features in the structure of the middle ear and the oval window region prior to stapedoplasty. We analysed the results of MSCT of the temporal bones in 20 patients presenting with otosclerosis (40 observations). All these patients underwent stapedoplasty, and the intraoperative findings were compared with the MSCT data. Specificity and sensitivity of MSCT for the detection of structural abnormalities in the middle ear were estimated at 91.3% and 84.6% respectively. It is concluded that the preoperative MSCT examination of the temporal bones yields the data that allow for the more accurate planning of the succeeding surgical intervention as well as for choosing its optimal strategy and extent, proper instruments, the type and length of the implant (prosthesis), and thereby for avoiding the possible complications and improving the prognosis of the treatment.

[The influence of the surgical and medicamental treatment on the olfactory function in the patients presenting with polypous rhinosinusitis].

The objective of the present investigation was to study dynamics of the olfactory function in the patients presenting with polypous rhinosinusitis receiving medicamental therapy and in different periods after the surgical intervention. A total of 40 patients were available for the examination in the "Sniffin Sticks" test. The patients of group 1 (n=20) were treated with intramuscular injections of dexamethasone (8 mg twice daily) with gradual tapering the dose during 10 days. The patients comprising group 2 underwent bilateral endoscopic polysinusotomy. Both treatment modalities were followed by momethasone fuorate therapy 6 months in duration. Examination of the patients on the first control visit (i.e. within 1 month after the onset of the treatment) revealed the significant improvement of all measured olfactory parameters that were not significantly different between the two groups. On the second control visit (within 4 months after the onset of the treatment), the patients of group 1 showed a significantly impaired ability to identify smells although other olfactory parameters remained virtually unaltered as compared with those on the first visit. At the same time, no significant impairment of the olfactory function was apparent in the patients of group 2. It is concluded that the patients having non-obstructive polyps in the nasal cavity should be advised in the first place to undergo a course of glucocorticosteroid therapy rather than surgical treatment because the results of conservative therapy and endoscopic polysinusotomy do not differ significantly, at least within the first 4 months after the beginning of the treatment.

[The assessment of the state of the immune system in the patients presenting with bronchial asthma and concomitant diseases of the nasal cavity and paranasal sinuses].

The objective of the present investigation was to study the influence of diseases of the nasal cavity (NC) and paranasal sinuses (PNS) concomitant with bronchial asthma (BA) on the development of peculiar features of the patients' immune status. Phenotypic characteristics of the main lymphocyte subpopulations from peripheral blood of 101 patients were obtained by means of flow cytometry with the use of fluorescein isocyanate- or phycoerythrin-labeled monoclonal antibodies. Special emphasis was laid on the elucidation of characteristics of humoral and cell-mediated immunity in the patients presenting with BA and concomitant NC and PNS diseases and their comparison with the respective parameters in the patients with isolated lesions in the upper respiratory tract (allergic rhinitis and polypous rhinosinusitis) and lower respiratory tract (bronchial asthma). It was shown that the patients with concurrent lesions of the upper and lower respiratory tracts experience marked intensification of the immune reactions in the form of the elevated number of activated B-lymphocytes (CD23+), serum IgE level, and peripheral eosinophil count.

[Our experience with the application of collagen-based preparations in reconstructive surgery of the middle ear].

This paper summarizes our experience with the application of collagen-based preparations for reconstructive surgery of the middle ear. The best morphological results (88.46%) were obtained by the closure of extensive defects with the Oblecolum membrane as a temporary supporting structure and the outer atraumatic dressing for the tympanic transplant (in 30 patients) or by the use of the compact-porous explants from the "Sanguicol" preparation as an overlay on the transplant (in 22 patients). Twenty seven patients presenting with the so-called "operated ear disease" underwent mastoidoplasty with the use of the compact-porous preparation "Stimul-oss" as a supporting structure to induce the ingrowth of the bone tissue and the subsequent substitution of the defect. This treatment ensured the reduction of the volume of the bony trepanation cavity. In addition, we have obtained preliminary encouraging results of the application of collagene preparations for the surgical intervention on the stirrup in the patients suffering otosclerosis.

[The olfactory function in the patients with the curved nasal septum before and after surgical treatment].

The authors compared the frequency of subjective complains of hyposmia and results of objective study (olfactometry) in the patients with the curved nasal septum. In addition, the influence of septoplastic surgery on the olfactory function in such patients was estimated. The study included 40 patients aged from 18 to 59 years who examined by olfactometry with the use of the Sniffing sticks test. Subjective evaluation of the olfactory function was performed based on the 10-point visual analog scale. All the patients underwent septoplasty; olfactometry was repeated within 1 and 4 months after surgery. Sixty percent of the patients interviewed prior to the surgical treatment complained of compromised sense of smell. Olfactometry revealed this condition in 75% of the patients of whom 52.5% presented with hyposmia of the mixed type. Significant improvement of all parameters of the olfactory function was documented within 1 month after the surgical treatment. The results of estimation of certain parameters (differentiation, identification, overall olfactory index) suggest further recovery of the olfactory function during the next 4 months. It is concluded that normalization of the nasal breathing improves the function of the olfactory analyzer even though the complete recovery of the olfactory function is hardly possible in the patients presenting with the curved nasal septum prior to surgical treatment.

[Application of sinuforte in domestic and foreign practices].

A comprehensive report designed to evaluate clinical effectiveness of sinuforte (Cyclamen europaeum extract) for the treatment of acute rhinosinisitis is presented based on the results of the studies carried out in this country and abroad. The available data give convincing evidence of beneficial effects of sinuforte used either as the starting monotherapy for the management of mild and moderately severe disease or in combination with other agents for the treatment of all cases of acute or exacerbated chronic rhinosinusitis. It is concluded that the use of sinuforte provides an opportunity for the treatment of each patient on an individual basis, permits to prevent polypragmasia and avoid unneeded antibiotic therapy.

[Oropharyngeal candidiasis in the practical work of the otorhinolaryngologist].

Mycotic diseases are ubiquitous pathologies. Candidiasis frequently affects oral and pharyngeal mucosa (oropharyngeal candidiasis). The immunodeficiency conditions are the key factors responsible for the development of mycoses. Colonization of pharyngeal mucosa by yeast-like fungi is a frequent consequence of local and systemic antibacterial therapy. Clinical manifestations of ENT diseases caused by microscopic fungi depend on the localization of the pathological process. Mycotic lesions in the pharynx are especially often caused by fungi of the genus Candida. Mild cases are possible to manage by the local treatment. Severe infection refractory to local therapy and characterized by regular relapses require systemic antimycotic agents to be applied. The application of fluconazole is generally accepted to be the method of choice for the elimination of different strains of Candida.

[Endoscopic rhinosurgery: from simple intranasal surgery to interventions on orbital apex and base of the skull].

This paper is focused on the main methods and indications for endoscopic intranasal surgery, from conventional infundibulotomy for the management of chronic rhinosinusutis resistant to conservative therapy to up-to-date endoscopic techniques for the treatment of lacrimal duct obstruction, nasal liquorrhea, endocrine ophthalmopathy, benign and malignant tumours of paranasal sinuses, and skull base lesions. A review of the literature data is supplemented by original clinical observations.

[Endonasal endoscopic orbital decompression through the transethmoidal approach].

The paper is designed to discuss the possibilities for the extension of indications to endonasal endoscopic surgery. Original experience with the surgical treatment of endocrine ophthalmopathy in patients with pharmacologically compensated thyroid dysfunction and clinical manifestations of exophthalmus is presented. A total of 6 operations were made through the transethmoidal approach with the resection of medial and inferior orbital walls. Regression of exophthalmus from 3.5 to 6 mm was achieved in 5 patients. Postoperative diplopia was documented in two patients within 3 weeks after surgery. Five patients enjoyed improvement of vision and quality of life due to correction of the cosmetic eye defect. None of the patients developed purulent complications affecting orbital tissues and paranasal sinuses. Surgical techniques and peculiarities of postoperative patient care are discussed.

[Peculiarities of sanitizing middle ear reoperations].

This paper is devoted to the problem of surgical rehabilitation of patients with the so-called <>. Twenty such patients underwent second operation following sanitization ear surgery for the treatment of recurrent (more than once a year) otorrhoea in the previous period. The operation was performed in two (sanitizing and reconstructive) steps. All the patients were allocated to 3 groups based on the results of preoperative examination and the cause of purulent discharge. Group 1 comprised patients with the <> Eustachian tube, group 2 included patients with the carious-granulation process in the mastoidal part of the cavity, group 3 was composed of patients with the both conditions. Reconstructive surgery in patients of groups 1 and 2 included tympanoplasty (n=7). Four patients of group 2 underwent mastoidoplasty with the use of osteotropic material Stimul-oss, and 9 patients were treated by simultaneous tympano- and mastoidoplasty using Stimul-oss blocks. The outcome of surgical treatment in all reoperated patients was regarded as positive taking into account the absence of purulent discharge from the treated ear and the formation of a small self-purifying cavity. Improved hearing was documented in 15 cases. These results give reason to recommend two-step (sanitizing and reconstructive) reoperation to patients with <> using a surgical procedure chosen individually depending on the cause of purulent discharge.

[Endoscopic surgical treatment of vascular tumors of the paranasal sinuses and base of the skull].

Fourteen endonasal endoscopic operations for vascular tumors of the paranasal sinuses, mainly of stage II-III, were performed in 1997-2006. In one case intraoperative navigation was used. Preoperative angiography was made in 4 patients with a definite diagnosis of hemangioma. Out of them, in three cases preoperative embolisation of the afferent vessel was conducted; apparent vascular bed in tumor stroma was not found. Follow-up from 1 to 8 years registered no further growth of the tumor in patients operated endoscopically.