[CHARGE syndrome in children with congenital choanal atresia]. / Sindrom CHARGE u detei s vrozhdennoi atreziei khoan.

One of the most commonly associated genetic syndromes with congenital choanal atresia is CHARGE syndrome, which includes multiple congenital anomalies with variable phenotypic manifestations. The article presents data on the history of the study, prevalence, etiology and clinical criteria of this pathology. OBJECTIVE: To determine the frequency of detection and features of clinical manifestations of CHARGE syndrome in children with congenital choanal atresia. MATERIAL AND METHODS: Based on the literature data and our own research, the features of the clinical manifestations of CHARGE syndrome in children with congenital choanal atresia are presented. RESULTS: The association of malformations, which in most cases had bilateral localization, was detected in 27 (18.8%) patients with congenital choanal atresia. In 20 children, the analysis for the presence of the CHD7 mutation was carried out by sequencing, while CHD7 mutations were detected in 18 (90%) patients meeting the clinical criteria of CHARGE syndrome. The absence of mutations of the CHD7 gene in the remaining patients indicates the genetic heterogeneity of this syndrome. CONCLUSION: The detection of CHARGE syndrome in children with congenital choanal atresia is of great clinical importance, since timely diagnosis and correction of other pathology minimizes the chance of complications during surgical treatment and allows for the formation of individual routing of patients for treatment and rehabilitation. Therefore, the examination and management of children with congenital choanal atresia associated with other malformations should be carried out on the basis of an interdisciplinary approach.

[Objective parameters of auditory function in premature infants in the first year of life after taking ototoxic antibiotics]. / Ob"ektivnye pokazateli slukhovoi funktsii u nedonoshennykh detei pervogo goda zhizni posle priema ototoksicheskikh antibiotikov.

OBJECTIVE: To compare the condition of auditory function during the first year of life according to the registration of distortion product otoacoustic emission (DPOAE) and short-latency evoked potentials (SLEP) in premature infants who received ototoxic antibiotics to those ones, who did not. MATERIAL AND METHODS: Auditory function was examined in 145 premature infants. Auditory assessment was carried out by registration of DPOAEs, SLEPs and tympanometry. Statistical processing was performed using the program Statgraphics Centurion XV. RESULTS: In this study, according to DPOAE, the average response values of the cochlea in premature infants who had a history of ototoxic therapy, undergo final changes after children reach the age of 6 months. The study of latent periods and threshold values of the V peak of SLEP showed a delay in the maturation process of the perceiving and conducting auditory structures during the first year of life in children who received ototoxic antibiotics in the first month of life. CONCLUSION: We evaluated the timing of the completion of response changes in children of the control group using the DPOAE and SLEP registration data. In children of the study group, we evaluated the effect of the administered ototoxic antibiotics. Timing of audiological control of the hearing organ condition are demonstrated for premature children after ototoxicosis, required methods of its examination are established.

[Age features of the lower nasal passage according to endoscopy in children]. / Vozrastnye osobennosti nizhnego nosovogo khoda po dannym endoskopii u detei.

OBJECTIVE: To study the anatomical features of the lower nasal passage in children in the age aspect by analyzing the results of endoscopic examination of the nasal cavity. MATERIAL AND METHODS: The study included 377 children who did not have otorhinolaryngological and ophthalmological pathologies, as well as congenital anomalies in the architectonics of the nose. The distribution into 4 groups, depending on age, was carried out according to the main provisions of the classification of childhood periods by N.P. Gundobin: the first group - children under 1 year old - 80 (21.2%), the second group - from 1 year to 3 years inclusive - 97 (25.7%), the third group - from 4 to 6 years inclusive - 96 (25.5%), the fourth group (control) - from 7 years and older - 104 (27.6%). All patients underwent endoscopic examination of the nasal cavity using rigid endoscopes with a viewing angle of 0 and 30 degrees, 2.7 mm in diameter, and a fibroscope with an inspection angle of 0 degrees, 2.5 mm in diameter. RESULTS: The data on the features of the development of the lower nasal passage in children were obtained. Changes in such anatomical parameters as the diameter of the lower nasal passage, the location of the distal opening of the nasolacrimal canal and the lower turbinate itself in the nasal cavity are presented. Highlighted the peak age periods of the development of the lower nasal passage in children: the first 6 months, 3-4 years and 7-8 years of a child's life. It was revealed that in children under 6 months of age, the middle turbinates are closely adjacent to the lower ones, which, as a rule, are large, tightly pressed to the bottom of the nasal cavity, and therefore the lower nasal passages are extremely weakly expressed. With growing up, their diameter grows from less than 2.0 mm to an average value of 2.90±0.03 mm, while after 7 years, fully formed volumetric lower nasal passages are already noted. In newborns and children of the first year of life, the mouth of the nasolacrimal duct is as close as possible to the bottom of the nasal cavity, and during growing up it gradually shifts upward (finally settling in the area of the fornix of the lower nasal passage or in the area of transition of the fornix to the lateral wall of the lower nasal passage) and posterior to the anterior the end of the inferior turbinate (up to 4 years old is at a distance of less than 1.0 cm, from 4 to 6 years old - 1.0 cm, from 7 years old - 1.14±0.01 cm). CONCLUSIONS: The data obtained as a result of the study are necessary for an otorhinolaryngologist and an ophthalmologist for a full understanding of the processes of development and course, as well as methods of treating various combined rhinological and dacryological pathologies in children.

[Features of bacterial microbiota in acute purulent otitis media in children]. / Osobennosti bakterial'noi mikrobioty pri ostrom gnoinom srednem otite u detei.

PURPOSE OF THE STUDY: The purpose is to study the spectrum of bacterial pathogens that cause acute purulent otitis media (APOM) in children of the Moscow region in modern conditions and assess their sensitivity to the main groups of antibiotics. MATERIAL AND METHODS: The study included 1.864 children who underwent examination and received treatment in the otorhinolaryngological department of Morozovskaya Pediatric Municipal Clinical Hospital in the period from 01 July 2018 to 31 June 2020 with a diagnosis of APOM. RESULTS: The study showed that the leading bacterial pathogens of APOM are Streptococcus pneumoniae (28.0%), Staphylococcus aureus (27.2%), Streptococcus pyogenes (22.2%), Haemophilus influenzae (7.8%), and Pseudomonas aeruginosa (6.5%). Attention is drawn to the increase in the level of resistance of S. pneumoniae to oxacillin (11.64%). CONCLUSIONS: The data obtained indicate the feasibility and prospects of vaccination against pneumococcal infection as one of the ways to curb the spread of resistance of S. pneumoniae to antibacterial drugs.

[Transcanal endoscopic middle ear surgery in children with chronic suppurative otitis media]. / Transkanal'nye endoskopicheskie operatsii na srednem ukhe u detei s khronicheskim gnoinym srednim otitom.

Otomicroscopic surgery remains the gold standard in the surgical treatment of patients with CHS. Endoscopic ear surgery is gaining more and more importance as an adjunct to microsurgery. Recently, thanks to the resolution of the endoscopic technique, endoscopic surgery can be used as an independent method. This article presents the results of endoscopic tympanoplasty, endoscopic removal of the tympanic cholesteatoma, performed on the basis of the otorhinolaryngology department of the Morozov Children's City Clinical Hospital. Research has shown that transcanal endoscopic surgery is an effective alternative to traditional otomicroscopic surgery. Advantage in minimal impact and improved visualization of all quadrants of the tympanic membrane, the anterior tympanomeatal angle of the NSP, and structures of the middle ear.

[Features of the architectonics of the structures of the nasal cavity and choanal zone in children with congenital malformations of the eyes]. / Osobennosti arkhitektoniki struktur polosti nosa i khoanal'noi zony u detei s vrozhdennymi porokami razvitiya glaz.

The article provides data on the embryogenesis of the eyeball, nasolacrimal canal and nasal cavity. A frequent combination of congenital choanal atresia and anomalies in the development of the eyes was noted, most likely associated with the temporal and topographic parallelism of the intrauterine development of these anatomical areas. In order to assess the condition of the nasal cavity and choanal region in congenital eye pathology, 43 children with ophthalmological malformations were examined. In 32 (74.4%) children, according to endoscopic examination, changes in the anatomy of the choanal region with a change in its size in the form of incomplete atresia were revealed. The results obtained allow the authors to recommend that all children with congenital ophthalmological malformations be examined and monitored by an otolaryngologist with an endoscopic examination of the nasal cavity and nasopharynx.

[Clinical case of a hairy polyp in a 6 month old baby]. / Volosatyi polip u rebenka 6 mesyatsev (klinicheskoe nablyudenie).

Hairy polyp is a rare congenital anomaly, pharynx mass, that causes respiratory and swallowing disorders, and sometimes threatens child's life. A 6 mounths old girl with this pathology was examined and surgically treated at the Department of Otorhinolaryngology, Pediatric Faculty, N.I. Pirogov Russian National Research Medical University. Epipharingoscopy and computed tomography (CT scan) were used during diagnosis. The surgery was performed under endotracheal anesthesia using ERBE VIO electrosurgical complex.

[Integration of diagnostic and treatment methods of pediatric ENT diseases into the practice of a pediatrician]. / Voprosy integratsii metodov diagnostiki i lecheniia lor-patologii detskogo vozrasta v praktiku vracha-pediatra.

In his or her daily practice, a pediatrician often has to encounter various ENT diseases, since more than half of visits to children's clinics are associated with various conditions of ENT organs. This article highlights the issues of introducing diagnostic and treatment methods for acute and chronic diseases of ENT organs into the daily practice of pediatricians.

[Screening audiological control in children of different ages after taking ototoxic medications]. / Skriningovyi audiologicheskii kontrol' detei raznogo vozrasta posle priema ototoksicheskikh preparatov.

AIM: To compare auditory function during screening of children of different age groups who received ototoxic therapy. PATIENTS AND METHODS: Auditory function was studied in various categories of children receiving ototoxic drugs. Hearing was assessed by the registration of distortion product otoacoustic emission (DPOAE), short-latency evoked potentials (SLEP), tympanometry. Statistical processing was performed using the C program Statgraphics Centurion XV. RESULTS: In this study, screening of auditory function in children suffering from cystic fibrosis and receiving ototoxic treatment revealed pathologic conditions of the middle ear according to tympanometry in 15.4% of cases, impaired auditory function in 28.2% of cases according to DPOAE. Early ototoxicosis presented as a decrease in the amplitude of the response at a frequency of 4 kHz, and a change in the structure of the DP-gram in the form of a shift to the low-frequency area. Examination of the auditory function of premature infants receiving potentially ototoxic drugs in the early neonatal period demonstrated that the administration of ototoxic drugs does not affect the maturation of outer hair cells. CONCLUSION: Audiological control, such as tympanometry and registration of evoked otoacoustic remission should be included in the outpatient observation of children with a history of ototoxic drugs.

[New ways of solving the problem of restenosis in the surgical treatment of congenital choanal atresia in children]. / Novye puti resheniia problemy restenozirovaniia pri khirurgicheskom lechenii vrozhdennoi atrezii khoan u detei.

This article presents the literature data and our own findings on the surgical treatment and options for solving the problem of restenosis in congenital atresia of the choanae (CAC) in children. PURPOSE: In order to solve the issues of prevention of the fibrosis in the postoperative period in patients with CAC, the prospects of using the carboxymethyl cellulose gel-sodium salt (CGSS) were assessed. PATIENTS AND METHODS: This medicine was used in patients, who were: primarily operated, after a period of wearing a protector (n=17); primarily operated without using a protector, at the final stage of the operation and in the early postoperative period (n=15); reoperated because of the restenosis, also at the final stage of the operation and in the early postoperative period (n=12). RESULTS: We present our results of application of the carboxymethyl cellulose gel-sodium salt for the prevention of scar adhesions in this condition: endoscopy of the nasal cavity and choanal region in all 44 patients with follow-up observation (from 1 year to 5 years) showed no signs of restenosis. CONCLUSION: The use of sodium carboxymethyl cellulose sodium salt in the intra- and postoperative period may be one of the ways of solving the problem of restenosis after surgery in children with CAC along with the use of endoscopic techniques for performing choanotomy.

[Paracentez]. / Paratsentez.

In this article, we present the analysis of the data of the specialized literature and the results of our own observations on the use of paracentesis in the treatment of acute suppurative otitis media. We highlight a method for diagnosing acute otitis media, which makes it possible to determine the rational algorithm of treating this disease - digital videootoscopy. Common methods of procedures aimed at draining the tympanum in acute purulent otitis media, such as tympanic membrane puncture, myringotomy, tympanostomy, tympanocentesis, and the differential approach to these methods of surgical treatment of the disease are discussed. The very concept of paracentesis is specified, the history of this surgical intervention is presented. Authors described the technique and features of paracentesis, a number of indications for its implementation, possible complications of surgical intervention and their causes. The risk of developing a chronic pathological process after the use of paracentesis or, conversely, due to the rejection of this manipulation during acute inflammation in the middle ear is assessed.

[Causes of restenosis in the surgical treatment of congenital choanal atresia in children]. / Prichiny restenozirovaniya pri khirurgicheskom lechenii vrozhdennoi atrezii khoan u detei.

This article presents the literature data and our own findings on the surgical treatment congenital atresia of the choanae (CAC) in children. AIM: To find the causes of restenosis after a choanotomy in children with CAC. PATIENTS AND METHODS: We analyzed the results of surgical treatment of 144 children with the use of an endoscopic transnasal technique (n=94) and without using endoscopy (n=67). In patients with signs of restenosis, endoscopic revision of the choanal opening, computed tomography results clarifying the anatomy of the abnormal zone, anamnestic data, and the presence of concomitant pathology were assessed. RESULTS: The primary causes of the recurrence of the CAC are the concomitant anatomical features of the structure of the choanal zone, insufficient period of protector insertion in the postoperative period, and surgical intervention without visual control. CONCLUSION: Endoscopic transnasal choanotomy with intraoperative rhino- and epipharingoscopic imaging, which is performed taking the individual characteristics of the anatomy of the anomalous zone into account, is the most optimal surgical procedure in pediatric patients. In combination with the use of a protector with a distal extended zone, high efficiency and rarity of restenosis are achieved.

[Two cases of bilateral lymphangiomatous palatine tonsil polyps in children]. / Nabliudenie dvukh sluchaev dvustoronnikh limfangiomatoznykh polipov nebnykh mindalin u detei.

Lymphangiomatous polyps of palatine tonsils are a rare condition, which is diagnosed with patomorphological study. About cases in total are reported in the literature, mostly with one-sided lesions. We managed to find only two reports of lymphangiomatous polyps of palatine tonsils in the available literature. The patients were children in both cases. We report our two cases of children with lymphangiomatous polyps of palatine tonsils.

[Glomus tumors of the middle ear in children].

Glomus tumor (GT) is a rare tumor of the middle ear in children. In spite of cytologically benign nature of this tumor, its course can be characterized as malignant because of GT infiltrative growth, destruction of the adjacent bone tissue, possible intracranial involvement. Because of scare symptoms, early GT diagnosis is problematic. At admission to hospital principal complaints of the children are poor hearing, discharge from the ear. These often underlie misdiagnosis -- acute otitis media. GT of the middle ear are detected with application of computed tomography which is able to show changes in the soft tissue and bone destruction, and angiography. Combination of the above two methods allows assessment of location and advance of the pathological process. GT treatment planning depends on the examination data and can include radiotherapy, endovascular occlusion of the vessels carrying blood to the tumor, surgical treatment and combination of the methods. Modern approaches to GT diagnosis and treatment are described. A case of GT of the temporal bone with involvement of the middle cranial fossa in a 4-year-old child is reported.

[Potentialities of conservative therapy of vocal disorders in children].

The article concerns problems of classification and treatment of various vocal problems in children, presents treatment outcomes in patients with functional and organic dysphonia using complex homeopathic drugs.