[Experience with dupilumab in the treatment of chronic rhinosinusitis with nasal polyps]. / Opyt primeneniya dupilumaba v lechenii khronicheskogo rinosinusita s polipami.

Chronic rhinosinusitis (CRS) with nasal polyps is the most severe form of inflammatory diseases of the paranasal sinuses, especially in combination with comorbid asthma. A new avenue for the personalized treatment of severe forms of eosinophilic inflammation are biologics based on humanized monoclonal antibodies. OBJECTIVE: To study the effectiveness of targeted therapy in patients with CRS with nasal polyps and comorbid asthma. MATERIAL AND METHODS: 19 patients selected for biological therapy according to international criteria were studied. The patients were randomly divided into 2 groups. The first group included 10 patients treated with dupilumab. Dupilumab was administered subcutaneously 300 mg every 2 weeks for 24 weeks. Group 2 included 9 patients treated with reslizumab for severe eosinophilic asthma with comorbid CRS with nasal polyps. Reslizumab was administered intravenously 3 mg/kg body weight once every 4 weeks for 24 weeks. These patients constituted the comparison group. Both drugs are used in treatment of eosinophilic inflammation but have different biological targets. RESULTS: Comparative analysis of the dynamics of the main indicators characterizing the clinical course of CRS with nasal polyps and asthma (SNOT-22, control of asthma symptoms - ACT, the results of SCT of the paranasal sinuses according to the Lund-Mackay score) revealed a positive trend in patients of both groups, more pronounced in patients receiving dupilumab. CONCLUSION: Changes in CT of the paranasal sinuses, characterized by the Lund-Mackay score, the results of SNOT-22 and ACT are the most demonstrative and can be used to assess the results of treatment with biologics in patients with chronic rhinosinusitis with nasal polyps.

[A case report of organ-preserving surgical treatment for large pleomorphic adenoma of the larynx]. / Klinicheskii sluchai organosokhranyayushchego khirurgicheskogo lecheniya pri pleomorfnoi adenome gortani bol'shikh razmerov.

Tumors of the salivary glands account for no more than 5% of all neoplasms of the head and neck. About 70% of all benign neoplasms of the salivary glands are pleomorphic. One of the rare localizations of pleomorphic adenoma is the larynx. Not more than 30 cases of laryngeal localization of pleomorphic adenoma are described in the literature currently. The article presents the result of organ-preserving surgical treatment of the patient with large pleomorphic adenoma of the larynx.

[Peculiarities of fungal and bacterial microorganisms persistence in the structure of fungal balls of paranasal sinuses]. / Osobennosti persistentsii gribkovykh i bakterial'nykh mikroorganizmov v strukture gribkovykh tel okolonosovykh pazukh.

OBJECTIVE: To compare the data of pathomorphological and microbiological examination of fungal balls removed at paranasal sinuses endoscopic surgery. MATERIAL AND METHODS: A total of 148 samples were obtained from patients histologically diagnosed with fungal balls. Microscopic evaluation of the specimens stained according to the Gram method, Gomori-Grocott method and PAS-reaction method, revealed phase changes in the fungal balls conditioned by their different life cycles: the areas of young, mature and degenerating mycelium were detected. Degeneration lead to detritus formation. Detritus areas contained accumulated bacterial colonies. The cultural study of the fungal balls removed from paranasal sinuses, showed fungi growth in 17.6% of cases, while the pathomorphological study confirmed presence of fungi in every investigated sample. Aerobic and anaerobic microbiota of the sinuses contents was represented by multi-agent bacterial and fungal-bacterial associations. Statistical analysis of contingency between culture-positive rate of fungi and different bacteria detected in clinical samples from fungal balls revealed inhibitory influence of Pseudomonas aeruginosa on fungi growth, which might be a reasons of their low isolation rate. Supposedly in some cases the fungal balls consisted of dead fungi, or the sampling was done in the area of the fungal balls degeneration, which might also account for the low sensibility of the cultural method.

[COVID-19 associated sino-orbital mucormycosis]. / COVID-19-assotsiirovannyi sinoorbital'nyi mukormikoz.

OBJECTIVE: To analyze the dynamics of symptoms in patients with COVID-19 associated sino-orbital mucormycosis. MATERIAL AND METHODS: We describe a series of 13 patients with COVID-19 associated sino-orbital mucormycosis aged 43 to 80 years diagnosed from August to October 2021. All of the patients had a severe disease and required noninvasive ventilation or intubation and administration of dexamethasone. 12 out of 13 patients (92.3%) suffered from diabetes mellitus. Symptoms of fungal infections of the nose and paranasal sinuses appeared in the interval from 7 to 25 days of hospital stay, most often in the second week (from 8 to 12 days). According to clinical and CT features the patients were divided into three groups, combining similar phenotypes of the disease. Group 1 - 1 patient with sinonasal mucormycosis, destruction of the alveolar ridge and the hard palate. Group 2 - 12 patients with sino-orbital mucormycosis. We noted, that in cases of bilateral sinus lesions orbital complications were unilateral in all patients, on the side of more severe lesion. Group 2 was divided into 2 subgroups: subgroup 2a included 2 patients with the superior orbital fissure syndrome: ptosis, proptosis, ophthalmoplegia, periorbital pain, pain or hypoesthesia of half face; subgroup 2b included 10 patients with the orbital apex syndrome, who, in addition to the above symptoms, had loss of vision and conjunctival chemosis. Group 3 - rhino-sino-cerebral mucormycosis. 2 patients from subgroup 2b were transferred to this group due to the intracranial spread of the process and focal neurological symptoms. CONCLUSION: Clinical forms of mucormycosis reflect successive stages of invasive spread of fungi.

[Children's rhinosinusitis orbital complications]. / Orbital'nye oslozhneniya rinosinusita u detei.

The number of cases of children's sinogenic orbital complications does not reduce in spite of the advanced methods of paranasal sinuses visualization, wide use of antibacterial therapy against sinusitis, and preventive vaccination against pneumococcal disease. Orbital complications are more common with children than with adults, the basic reason of their development being ethmoiditis. The prevailing classification of orbital complications proposed by J. Chandler et al. divides these into preceptal and postceptal forms and gives description to 5 development stages of orbital complications in the order of their increasing severity. At an early age preceptal and orbital cellulites prevail, and these commonly need conservative treatment only. In case of orbital cellulitis, the major treatment method is endovenous antibiotic therapy in which the chosen antibiotic is to cover the whole spectrum of aerobic and anaerobic microbes often extracted in such cases. At small subperiostal abscesses (<0.5-1 ml), conservative treatment during 24-48 hours is possible. If there is no positive dynamics, or abscess grows in size, or eye symptoms progress, abscess and affected sinuses drain is recommended. Orbital abscess is to be given surgical treatment; at the same time endoscopic management of paranasal sinuses might by complemented with external surgical approaches (lateral and medial orbitotomy).

[Anomalous bony portion of the Eustachian tube]. / Anomalii kostnogo otdela slukhovoi truby.

Reports of congenital anomalies of the Eustachian tube are scare. These anomalies are usually associated with chromosomal abnormalities, most often in oculoauriculovertebral spectrum. We present a case of completely bony widened Eustachian tube, entering the cells of sphenoid sinus lateral recess. No wall defect between the sphenoid sinus and the tube was found, nevertheless the tube and middle ear had normal pneumatisation. The anatomy of the outer ear, otoscopy and hearing thresholds were normal on the ipsilateral side. At the same time, there were microtia, atresia of the external auditory canal, underdeveloped tympanic cavity and cochlea hypoplasia and deafness on the contralateral side, although the majority of previous published cases described ipsilateral temporal bone anomalies. The patient had no facial asymmetry and was not given a syndrome diagnosis.

[Presbyvestibulopathy in clinical practice.]

With increasing life expectancy, there is an increase in the number of patients with symptoms caused by aging of the vestibular system - presbyvestibulopathy. Presbyvestibulopathy is based on degenerative processes in various parts of the vestibular analyzer - from the semicircular canals and otolithic receptors to the conduction tracts and vestibular nuclei. When examining such patients, it is necessary to take into account the multiplicity of damage to sensory systems in the elderly (impaired balance, vision, cognitive functions). Recognizing presbyvestibulopathy as part of the multifaceted aging process will help to develop comprehensive approaches to the treatment of patients who are always at risk for deterioration of the condition. In this review, we discuss the association of presbyvestibulopathy with neurodegenerative diseases, as well as the correlation between presbyvestibulopathy and balance, visual, cognitive, and psychological disorders.

[Postcovid sino-orbital mucormycosis: a case report]. / Sluchai postkovidnogo sinoorbital'nogo mukormikoza.

We describe a case of postcovid sino-orbital mucormycosis in a 74-year-old patient with diabetes mellitus. Orbital symptoms appeared after discharge from the covid hospital, in the third week of the disease and were represrnted by ptosis, proptosis, ophthalmoplegia, blindness and pain in the right eye, numbness of the right half of the face, edema of the periorbital region and cheek. The diagnosis of mucormycosis was confirmed by fluorescence microscopy of the discharge from the middle nasal meatus. SCT of the paranasal sinuses revealed pansinusitis with predominant destructive changes in the right maxillary, ethmoid and sphenoid sinuses. The patient underwent emergency endoscopic debridment, orbital decompression, orbitotomy; treatment with amphotericin B intravenously was started. 10 days after due to the deterioration of the patient's condition, more aggressive debridment of paranasal sinuses was performed: right maxillary sinus anterior, posterior and medial walls resection, medial orbital wall resection, necrectomy of the nasal cavity, paranasal sinuses, orbit, pterygopalatine fossa. Antifungal treatment was continued in the postoperative period. The patient was discharged on the 22nd day of stay in the ENT hospital.

[Impact of reslizumab on the course of chronic rhinosinusitis in patients with eosinophilic asthma]. / Vliyanie reslizumaba na techenie khronicheskogo rinosinusita u bol'nykh s eozinofil'noi astmoi.

Chronic rhinosinusitis (CRS) with polyps is associated with eosinophilic inflammation, in which the key mediator is interleukin - 5 (IL-5) and is often combined with asthma. RESEARCH OBJECTIVES: To evaluate the therapeutic potential of reslizumab-humanized anti-IL-5 monoclonal antibody for the treatment of CRS with polyps in patients with severe asthma. PATIENTS AND METHODS: We investigated the cases of 9 patients with severe asthma treated with intravenous reslizumab at a dose of 3 mg per 1 kg of weight with regularity once in 4 weeks. The presence of CRS with polyps was revealed in 7 of 9 patients, SCT scanning of the paranasal sinuses indicated changes in all the patients, 2 patients had symptoms of chronic non-allergic rhinitis (NARES).The treatment effectiveness control was carried out after 6 months from the beginning of the treatment by the dynamics of nasal symptoms (SNOT-22), endoscopic image of the nose, total polyp score (TPS), changes in the SCT of the paranasal sinuses on the Lund-Mackay scale, rhinocytogram, the content of eosinophilic cationic protein in the blood, the level of systemic eosinophilia. The effectiveness of asthma control was assessed by the reduction of the frequency of asthma exacerbations, the need for systemic corticosteroids, spirometry data and Asthma Control Test (ACT) results. Along with a marked improvement in asthma control, 8 out of 9 patients displayed clinical, endoscopic, radiological signs of weakening of nasal symptoms. More significant improvement in asthma control was achieved in patients having CRS with polyps. In the group of patients having CRS with polyps, it was possible to detect anamnestic presence of NARES symptoms in the early stages of the disease. This indicates that NARES can be a precursor to the development of eosinophilic, non-IgE-induced asthma and nasal polyps. CONCLUSION: Treatment with reslizumab in patients with eosinophilic asthma and concomitant CRS with polyps and chronic non-allergic rhinitis (NARES) leads not only to improved control of asthma symptoms, but also to a significant regression of nasal symptoms.

[Epistaxis and arterial hypertension: a pathogenic link]. / Nosovoe krovotechenie i arterial'naya gipertenziya: patogeneticheskaya svyaz'.

THE AIM OF THIS RESEARCH: Was to study changes in the nasal mucosa vessels in hypertensive patients suffering from recurrent epistaxis. PATIENTS AND METHODS: 78 hypertensive patients aged between 50 and 70, admitted due to epistaxis were studied. Diabetic, coagulopathic patients and those taking anticoagulants were excluded from the research. All the patients were divided into 2 groups: group 1 (46 people) with a single epistaxis, group 2 (32 people) with a recurrent epistaxis. At the admission time all the patients showed elevated arterial pressure, yet the differences between the patients of group 1 and group 2 were not significant. 14 patients of group 2 did not reveal any source of hemorrhage due to a severely deviated septum. These patients underwent septoplasty followed by mucoperichondrium biopsy. Histological study of samples showed multiple erosions within the epithelial layer, as well as necrotic patches spreading to the deeper mucous coat layers. The microvasculature showed dystrophic changes in the endothelium, its focal desquamation with basal membrane exposure and thrombocytes and erythrocytes adhesion at such places, erythrocyte aggregation, plasma separation, erythrocyte and fibrinous thrombi formation. Ultrastructural investigation revealed dystrophic changes in the capillary endothelium of the nasal mucosa combined with rheological disorders expressed as erythrocytes sludge. Thus, the cause of epistaxis is not high arterial pressure, but those changes in the nasal mucosa vessels promoted by long arterial hypertension.

[Subcutanious emphysema and pneunomediastinum - the rare complication of tonsillectomy]. / Podkozhnaia émfizema i pnevmomediastinum - redkoe oslozhnenie tonzilléktomii.

Tonsillectomy is one of the most common surgical interventions in the practice of ENT hospitals. As a rule, complications of tonsillectomy are early and late postoperative bleeding. However, in extremely rare cases tonsillectomy can be complicated by subcutaneous emphysema and pneumomediastinum. The mechanism by which these complications develop are poorly understood. The article describes the case of a rare complication of tonsillectomy - the intraoperative development of subcutaneous emphysema and pneumomediastinum. Such complications are most likely caused by deep trauma of the pharyngobasilar fascia of the tonsillar fossa, which causes the penetration of the air into the parapharyngeal space and its subsequent spread to the mediastinum.

[Proinflammatory cytokine content in the saliva of children suffering from chronic tonsillitis]. / Soderzhanie provospalitel'nykh tsitokinov v sliune detei s khronicheskim tonzillitom.

INTRODUCTION: We have examined 92 children aged between 6 and 15, suffering from chronic tonsillitis (CT). Tumor necrosis factor (TNF-α) and interleukin 1ß and 6 (IL-1ß and IL-6) contents have been defined in saliva. The control set comprised 17 healthy children. Cytokine content was defined with the enzyme multiplied immunoassay sets (Vektor Best Ltd., Russia) by enzyme-linked immunosorbent assay. The statistic analysis and data processing were carried out with statistic analysis programs (version 3.2, R Foundation for Statistical Computing, Vienna, Austria). RESULTS: The content of cytokines TNF-α, IL-1, IL-6 in CT children's saliva was high against the healthy children, yet the statistically significant differences were only noted for IL-6. In the CT group the median value of this factor (12.5) was significantly higher than in the control set (6.72) (p=0.01 in Mann-Whitney assessment). IL-6 was chosen as the basic factor for the mathematic model; its combinations in the form of a multi-factor logistic regression were given consideration. From out of the three possible models there was just one that had all the coefficients statistically significantly different from zero (TNF-α - IL-6). It was chosen as the basic diagnostic model for chronic tonsillitis. The created model's sensitivity is 80.4%, while its specificity is 82.4%. DISCUSSION: The revealed IL-6 dominance in saliva at CT can be is attributable to permanent antigenic challenge characteristic of the toxic allergic CT since, as previously shown, there are living proliferating microorganisms in the palatal tonsil tissues and their blood- and lymph vessels at CT. CONCLUSION: The conducted ROC-analysis has demonstrated high sensitivity and specificity of the mathematical model, which enabled us to recommend determination of IL-6 in the saliva of the children suffering from CT as an additional diagnostic criterion.

[Traumatic perilymphatic fistula with the luxation of the stapes into vestibule]. / Travmaticheskaia perilimfaticheskaia fistula s liuksatsiei stremeni v preddverie.

A case of perilymphatic fistula with the luxation of the stapes into vestibule was described, which was caused by a direct damage of the eardrum (the patient cleaned the right ear with a cotton swab and received a strong blow to the arm). The moment of injury was characterized by severe pain, a significant hearing loss, the appearance of tympanophonia and vertigo. Clinical examination revealed the eardrum rupture. After perforation healing the hearing did not improve, a high degree of mixed sensorineural hearing loss remained with a bone-air interval of up to 50 dB throughout the tone scale. CT of the temporal bones showed a pneumolabirinth and a change in the malleus position, which made it possible to suggest the presence of a perilymphatic fistula with the luxation of the stapes. The extent of damage was confirmed by surgery. The stapes was removed and the perilymphatic fistula was closed.

[The significance of antistreptolysin O characteristics for the determination of indications for tonsillectomy in the children]. / Znachenie pokazatelei antistreptolizina O pri opredelenii pokazanii k tonzilléktomii u detei.

The objective of the present work was to evaluate the diagnostic significance of the measurement of the antistreptolysin O (ASLO) titers in the children presenting with chronic tonsillitis for determining the indications for tonsillectomy. The study included 54 patients at the age varying from 4 to 17 years who had undergone bilateral tonsillectomy for the treatment of chronic tonsillitis. The diagnosis was confirmed by the results of the histological study of the removed amygdalae. Prior to surgery, all the patients had been subjected to the bacteriological investigation of the smears taken from the surface of the palatal tonsils. The titers of antistreptolysin O in the serum were determined with the use of the kinetic nephelometric technique before, 6 and 12 months after the surgical intervention. The results of the measurements were treated using the Statzilla software package (version 3.2, R Foundation for Statistical Computing, Vienna, Austria). Streptococcus pyogenes (group A) was identified only in 7 (13%) patients. The initially enhanced content of ASLO ranging from 273 to 1880 IU/ml was documented in 42 (77.7%) of the 54 patients. Twelve patients had the ASLO titers within the normal limits (from 13 to 124 IU/ml). The removal of palatal tonsils resulted in a significant decrease of the ASLO titers in the patients who had presented with the initially enhanced content of antistreptolysin O (p < 0.05); nevertheless, their ASLO titers remained higher than the normal values in 69% and 82% of the patients examined within 6 and 12 months after the surgical intervention, respectively. The patients who had exhibited the high levels of antistreptolysin O during the preoperative period did not experience normalization of this parameter after surgery. It is concluded, taking into account the absence of correlation between the enhancement of serum antistreptolysin O titers and the presence of group A beta-chemolytic Streptococci (BCSA), that the result of the measurement of ASLO titers can not be considered as a valid indication for tonsillectomy in the children.

[The diagnostics and treatment of tympanophonia]. / Diagnostika i lechenie shuma v ushakh.

Tympanophonia can be a consequence of a variety of diseases and pathological conditions diagnostics of which encounters difficulties. The comprehensive clinical examination of the patient is necessary to determine the cause of tympanophonia including elucidation of the following characteristics: initial (acute or gradual) sensation of sound in the ear(s), duration of persisting clinical manifestations, the presence of an acoustic or craniocerebral injury, characteristics of the noise, viz. continuous or intermittent, clicking sounds, paroxysmal or pulsed noise (synchronous with the heart beating), fluctuating, audible to the patient alone or to the surrounding people as well, unilateral and bilateral noises (either symmetric or asymmetric), perception of noise in the head rather than ears., high- and low-pitched noise together with the accompanying neurological symptoms. The analysis of these characteristics makes it possible to differentiate between objective and subjective sensation of noise in the ear(s), determine the amount of additional studies needed for the evaluatio of the conditions of a given patient, identify the possible cause of tympanophonia, establish the nosological diagnosis, and distinguish a group of the patients in need of emergency otological management.

[The influence of corticosteroids on the frequency of vestibular crises]. / Vliianie kortikosteroidov na chastotu vestibuliarnykh krizov.

The objective of the present study was to elucidate the dynamics of the hormonal status of the adrenal glands in the patients suffering from Menière's disease in its different clinical forms. We examined a total of 26 patients at the age from 29 to 47 years presenting with this condition. All the patients were divided into two groups depending on the character of the disease. Group 1 was comprised of 20 patients experiencing the crises from 2 to 6 times during a year. Group 2 was composed of six patients in whom the crises occurred with a frequency of 2-4 times per week within at least two weeks. The serum levels of cortisol and aldosterone were measured both during the crises and between them with the use of the proper immunoenzyme assays. The control group was formed of 20 practically healthy volunteers. It was shown that the blood cortisol level during a fit of dizziness in the patients of group 1 increased in comparison with that in the control subjects (798.7±71.2 nmol/l and 453.68±49.39 nmol/l respectively; p<0.05). The patients having recurrent crises (group 2) experienced a significant decrease in the blood cortisol levels down to 293.5±38.1 nmol/l during a crisis in comparison with the control subjects (453.68±49.39 nmol/l; p<0.05). During the inter-crisis periods , the blood cortisol level in the patients of the first group remained within normal bounds whereas in the patients of the second group its mean value was 18.7% lower (p>0.05). The serum aldosterone level in the patients of the first group was not significantly different from that in the second group both during crises and in the periods of remission. It is concluded that the results of the study provide the data for the pathogenetic substantiation of the possibility for the use of corticosteroids in the treatment of the patients suffering from frequent crisis of Menière's disease.

[Tinnitus: algorithm of diagnostics and clinical management]. / Shum v ushakh: algoritm diagnostiki i lecheniia.

Hearing of sound, or tinnitus, can be a symptom of different diseases. The differential diagnosis should be based on the identification of subgroups with confirmed causes of the disease. Subjective and objective tinnitus groups should be isolated. Objective tinnitus can be vascular or muscular. In making a diagnosis of tinnitus, it is important to know its characteristics, laterality, circumstances of onset, duration, comorbidity with other symptoms: headache, hearing decline, dizziness, depression, etc. Urgent diagnostic and treatment measures are needed after the identification of 'red flags': acute pulsatile tinnitus, in particular after the brain injury, combination of tinnitus with acute hearing loss and depression.

[Objective tympanophonia caused by myoclonus of the auricular muscles]. / Ob''ektivnyi ushnoi shum, obuslovlennyi mioklonusom myshts ushnoi rakoviny.

The objective of the present literature review was to systematize the available data on the etiology, pathogenesis, clinical features, diagnostics, and treatment of muscular tympanophonia. The commonest source of muscular tympanophonia is the tremor (myoclonus) of the soft palate or the middle ear; sometimes this condition can be a consequence of myoclonus of the external ear muscles or head muscles. Pharmacotherapy of muscular tympanophonia does not invariably result in the favourable outcome. The author describes a rare observation of objective tympanophonia attributable to myoclonus of the auricular muscle. The patient complained of sensation of clicking sounds in the affected right ear in synchrony with involuntary contractions of the muscles above the auricle and in the postaural region. The contractions of these muscular groups were palpable at the moments when the patient felt snaps in the ear. The presence of myoclonus of the auricular muscles was confirmed in the electromyographic studies. Multispiral computed tomography did not reveal pathological changes in the brain stem structures. The patient took the prescribed doses of clonazepam and baclofen during 5 weeks; however, this treatment failed to substantially improve his condition. Tympanophonia was eliminated by means of administration of botulinum toxin into the m. auricularis posterior and m. temporalis region.

[The detection of the human papilloma virus during hyperplastic processes in the nose, ears and throat]. / Obnaruzhenie virusa papillomy cheloveka pri giperplasticheskikh protsessakh v LOR-organakh.

The objective of the present work was to carry out the virological and histological studies of various neoplastic and hyperplastic processes in the nose, ears, and throat with a view to identifying the presence of human papilloma virus and Epstein-Barr virus. The brush biopsies and remote neoplasms obtained from 18 patients (including 2 children and 16 adults) presenting with various ENT diseases and tumours were available for the virological investigation with the use of the polymerase chain reaction (PCR) and a system MY09-MY11 degenerate primers . The histological study of biopsies and remote neoplasms was carried out by means of conventional light microscopy. The virological and histological studies conducted in parallel confirmed the diagnostic significance of morphological changes at the tissue and cellular levels caused by the human papilloma virus.