[Long-term stenting as an option to ensure the stability of the respiratory tract in a patient with rhonchopathy and overlap syndrome]. / Dlitel'noe stentirovanie kak variant obespecheniya stabil'nosti dykhatel'nykh putei u patsienta s ronkhopatiei i sindromom perekresta.

Rhonchopathy is a major problem of both a medical and social nature, it is detected in about 33% of the adult population. It should be noted that snoring is often accompanied by a more formidable disease - obstructive sleep apnea (OSA) syndrome, which, in turn, is considered a life-threatening condition. It is known that in severe forms of OSA syndrome, up to 400-500 respiratory stops per night with a total duration of up to 3-4 hours can occur, which leads to acute and chronic lack of oxygen during sleep. In turn, chronic obstructive pulmonary disease (COPD) is one of the most common diseases and one of the leading causes of death worldwide. The association of OSA syndrome and COPD, which is designated by the term overlap syndrome, is characterized by the summation of the negative effect of these pathological conditions on the parameters of blood oxygen saturation during night sleep. Diagnosis, treatment and prognosis in patients with overlap syndrome should be based on an interdisciplinary approach, including the use of modern and highly informative methods of functional diagnosis. To date, many methods of treatment (conservative, surgical, combined) of rhonchopathy and OSA syndrome are known. In most cases, preference is given to minimally invasive methods, creating constant positive pressure in the respiratory tract. Tracheostomy is an absolutely effective method of treating OSA syndrome, however, it is very traumatic, but in exceptional cases it is necessary. This paper describes a clinical case of installing a T-shaped stent not only for the treatment of chronic cicatricial stenosis, but also to compensate for OSA syndrome and restore vocal function.

[Vocal fold polyps: modern possibilities of laser surgery in comparison with the use of cold microinstruments]. / Polipy golosovykh skladok: sovremennye vozmozhnosti lazernoi khirurgii v sravnenii s ispol'zovaniem kholodnykh mikroinstrumentov.

OBJECTIVE: To perform a comparative analysis of phonosurgical interventions, which were made using a 445 nm semiconductor laser or cold microinstrumentation in patients with «vocal fold polyp¼ diagnosis. MATERIAL AND METHODS: The number of surgical interventions equal 30 regarding vocal fold polyp was done in otorhinolaryngology clinic of Pavlov First State Medical University of St. Petersburg in the period from September 2021 yr. to September 2022 yr. The phonosurgical intervention was performed under the conditions of direct suspension microlaryngoscopy by Kleinsasser under general anesthesia using high frequency ventilation through an endotracheal catheter. Surgical interventions were carried out using a 445-nm semiconductor laser in pulsed mode for patients of the 1st group (n=15) and using microsurgical instruments for patients of the 2nd group (n=15). The comparative analysis was conducted based on the results of an objective vocal function assessment by acoustic analysis, as well as on the data of a subjective assessment of the voice using the questionnaire VHI-10rus. The severity of reactive inflammatory phenomena in the postoperative period has been compared and the oscillating movements of vocal folds have been evaluated according to the videolaryngoscopy data. The severity of pain syndrome in the postoperative period was assessed by visual analogue scale. RESULTS: There were no statistically significant differences in the results between two groups. Similarly, there were no statistically significant differences in parameter recovery degree, evaluated by videolaryngoscopy data. Moreover, a full recovery of mucosal wave was found in 93% of patients operated with laser on 7th day, while 47% of patients had the same result after use of cold microinstrumentation. CONCLUSION: The use of 445-nm semiconductor laser for phonosurgical interventions in vocal folds' polyps can be recommended for predicted successful recovery of vocal function, minimization of reactive inflammatory phenomena in postoperative period and early patients' rehabilitation.

[Comparison of pain after laser and traditional extracapsular tonsillectomy]. / Sravnenie vyrazhennosti bolevykh oshchushchenii posle lazernoi i traditsionnoi ekstrakapsulyarnoi tonzillektomii.

OBJECTIVE: To compare the pain during the postoperative period after the extracapsular tonsillectomy, performed with the 1.94 µm laser and cold steel tonsillectomy. MATERIAL AND METHODS: Sixty patients with chronic decompensated tonsillitis were enrolled in the study. Patients were randomized into two groups: the first one was subjected to cold steel tonsillectomy; in the second group tonsillectomy was done using a laser with 1.94 µm wavelength at pulsed mode. Patients' anamnesis was evaluated (the presence of signs of a toxic-allergic form of the disease, peritonsillar abscesses, the duration of the disease and the frequency of exacerbations of tonsillitis per year). In the postoperative period patients filled out questionnaires: the severity of pain was assessed for 10 days in points from 0 to 10, and painkiller use frequency per day. RESULTS: Statistical analysis revealed that the pain after tonsillectomy depends on the presence of peritonsillar abscesses in the anamnesis. In patients with abscesses, the pain and the need for anesthesia are significantly lower with the laser technique compared with cold steel. The tonsillectomy technique does not affect the risk of postoperative bleeding (in both groups - 1/30). CONCLUSION: The postoperative period after extracapsular laser tonsillectomy is characterized by significantly less pain than traditional tonsillectomy with cold instruments in patients with a history of peritonsillar abscess. Laser tonsillectomy does not have an increased risk of bleeding compared to traditional tonsillectomy.

[The role of secretory immunoglobulin E in the differential diagnosis of rhinitis during pregnancy]. / Rol' sekretornogo immunoglobulina E v differentsial'noi diagnostike rinita pri beremennosti.

OBJECTIVE: To evaluate the role of secretory immunoglobulin E in the differential diagnosis of rhinitis in pregnant women. MATERIAL AND METHODS: The study involved 97 pregnant women with rhinitis symptoms and 23 healthy pregnant women without rhinitis symptoms. The first group of the study included 37 pregnant women with previously confirmed (anamnestically and immunologically) allergic rhinitis (AR), the 2nd group of the study included 30 pregnant women with suspected beginning of the AR, the 3rd group of the study was 30 women with pregnant women's rhinitis, diagnosed on the base of follow-up study. The study included: anamnesis taking, routine examination of ENT organs, general clinical examination, study of the level of total IgE in blood, nasal secretion cytology study, secretory IgE level in nasal secretion analysis, follow-up telephone gathered catamnestic data analysis. RESULTS AND DISCUSSION: When analyzing laboratory data, an increase in the average number of eosinophils in the blood was not detected in any group. When examining secretory immunoglobulin E of the nasal secretion in the group of patients with previously confirmed AR, this indicator averaged 2.9±0.7 kE/L, in the group with AR beginning - 5.5±2.6 kE/L, which exceeded the value in the control group (1.2±0.6 kE/l, p<0.05). In the group of patients with pregnant women's rhinitis, the indices of nasal IgE did not differ significantly from the control group (1.9±0.3 and 1.2±0.6 kE/L, respectively, p<0.05). CONCLUSION: The level of secretory nasal immunoglobulin E can be used in the differential diagnosis of rhinitis in pregnancy.

[Features of the sinusitis course in pregnant women]. / Osobennosti techeniia sinusita u beremennykh.

The purpose of the work was to study the sinusitis diagnostic and clinical features in pregnant women. The pregnant women group (27 human) with sinusitis from 816 pregnant women with nasal congestion and/or nasal discharge was analyzed. The examination included: taking anamnesis, ENT examining, clinical blood test. The frequency of sinusitis in pregnant women with complaints of nasal congestion and/or nasal discharge is 4.7%. The development of sinusitis was associated with inadequate treatment of chronic rhinitis during pregnancy in a third of cases. The course of sinusitis was characterized by the absence of intoxication and fever, in 78% of cases - by the absence of facial pain. In 74% of cases, the onset of the disease was erased. In pregnant women with sinusitis, in comparison with pregnant women with manifestations of chronic rhinitis, had a significant increase in ESR and a tendency to an increase of neutrophils. CONCLUSION: The development of sinusitis in pregnant women in a third of cases is due to the ineffective treatment of chronic rhinitis, and the erased clinical picture of the disease suggests the need for a thorough assessment of the anamnestic and clinical symptoms of the disease.

[Allergic rhinitis in the pregnant women]. / Allergicheskii rinit u beremennykh.

The objective of the present work was to elucidate the specific features of the clinical picture of allergic rhinitis in the pregnant women. The study included 156 pregnant women presenting with the persisting form of the disease and 63 patients having its intermitting form. The character of the endoscopic manifestations of rhinitis, chronic tonsillitis, and gastroesophageal reflux was evaluated with the use of a scoring system. The progressive development of the clinical symptoms of allergic rhinitis during pregnancy related neither to the contacts with allergens nor to the discontinuation of pharmacotherapy was documented in 33 and 23% of the patients presenting with the persistent and intermitting forms of the disease, respectively. The symptoms of rhinitis in the pregnant women may be influenced by the presence of gastroesophageal reflux (the endoscopic evidence of this condition was documented in 84.6% of the examined patients with persisting form of the disease and in 40.3% of those having intermitting form) and chronic tonsillitis (purulent contents in the palatine tonsil lacunes were found in 46.8 and 40.3% of the women presenting with the persisting and intermitting forms of allergic rhinitis respectively). In 42% of the cases, the cause behind the negative dynamics or the absence of any dynamics during the treatment of allergic rhinitis was the withdrawal of the prescribed pharmacotherapy by the patients themselves. This observation gives evidence of the importance of explaining to the pregnant women suffering from allergic rhinitis the necessity of compliance with the prescribed treatment modalities in order to reduce the probability of development of complications of this condition.

[The use of fenspiride for the combined treatment of exacerbation of chronic laryngitis]. / Fenspirid v kompleksnom lechenii obostreniia khronicheskogo laringita.

The present study was carried out based at the Department of Otorhinolaryngology of I.P. Pavlov First State Medical University of Saint-Petersburg. The objective of this work was to elucidate the efficacy and safety of fenspiride therapy for the treatment of exacerbation of chronic laryngitis associated with an acute respiratory infection. The patients comprising the main group received fenspiride (Eurespal, 'Servier', France) at the standard dose in addition to the conventional therapy with the use of antibiotics, inhalation, and voice rest. The patients in the group of comparison were treated following the conventional protocol without fenspiride. The clinical symptoms evaluated based on the scoring system, the results of videolaryngoscopy, and computer-assisted analysis of the voice were compared before and after treatment in the patients of both groups. The results of the study have confirmed the high effectiveness and safety of fenspiride therapy of exacerbation of chronic laryngitis.

[The choice of parameters for the laser application in ENT surgery]. / Vybor parametrov lazernogo vozdeistviya v khirurgii LOR-organov.

The authors present the results and describe the methods of the experimental studies aimed at the evaluation of the biological effects of laser-assisted treatment of ENT pathologies at the wavelengths of 810 nm, 980 nm, and 1470 nm in comparison with the results obtained with the use of a radiofrequency scalpel in biological tissues having different optical and mechanical properties.Special emphasis is placed on the peculiarities of the action of laser irradiation and healing of radiation-induced wounds depending on the treatment regimens, viz. contact, remote, pulsed and continuous ones. The results of the analysis of the experience gained during the study and of the experimental findings provided a basis on which the main principles of the choice of the optimal parameters of the laser radiation action on the biological tissues have been formulated.

[Differential diagnostics of the causes responsible for a cough in the pregnant women]. / Differentsial'naya diagnostika prichin kashlya u beremennykh.

The objective of the present study was to elucidate the causes responsible for a cough in the pregnant women. It involved 92 patients including 23 ones presenting with bronchial asthma and 69 having no manifestations of asthma in their medical histories but suffering from dry cough that started after the beginning of pregnancy. All the patients were given counseling by the otorhinolaryngology and pulmonology specialists. The degree of endoscopic manifestations of gastroesophageal reflux was estimated based on a scoring scale. The study revealed the correlation between cough duration and gestational age. The signs of reflux-induced changes in the larynx were documented in 91% cases among the patients with bronchial asthma and in 97% cases in the pregnant women having no bronchial pathology in their medical histories. The main cause behind the cough during pregnancy in women without bronchial pathology was sluggish bronchitis (7%), arising asthma (12%), gastroesophageal reflux (77%), and allergic rhinitis (4%). This conclusion was confirmed by the results of therapy.