[Efficacy and safety of topical combination therapy in patients with acute otitis externa].

AIM: To study the structure of the microbial landscape in patients with acute otitis externa, as well as to evaluate the efficacy and safety of the combined drug chloramphenicol/clotrimazole/beclomethasone/lidocaine (Candibiotic) as an empirical therapy of this disease. MATERIALS AND METHODS: In this retrospective study of real clinical practice, outpatient records of 963 patients who applied to the KDO of the Sverzhevsky Research Clinical Institute of Otorhinolaryngology with symptoms of otitis externa in the period from 2017 to 2022 were selected. Additional analysis was carried out on the clinical records of patients who received the combined drug Candibiotic. The endpoints of this analysis included data on the clinical and microbiological efficacy of therapy, as well as safety information. RESULTS: According to microbiological testing, 60.6% of microorganisms belonged to bacterial flora, 26% were bacterial-fungal associations, 11.6% were monofungal flora, in 1.8% of cases there was no growth of microorganisms. The most frequently isolated microorganisms were: Pseudomonas spp (n=291; 29.16%), Staphylococcus spp. (n=214; 21.4%), Candida spp. (n=194; 19.4%), Aspergillus spp. (n=133; 13.3%). Most of the patients (71.0%) received Candibiotic. In 69.7% of patients, the resolution of the clinical symptoms of otitis externa occurred within 7 days of therapy with Candibiotic. Complete eradication of microorganisms occurred in 87% of cases. Adverse events were recorded only in 3 (0.04%) cases. CONCLUSION: The study demonstrated an extremely high level of clinical efficacy and safety of therapy in patients with acute external infectious otitis who received the Candibiotic, which can be used as an initial empirical therapy in patients with otitis externa.

[Pathogenetic approach in the treatment of inflammatory diseases of the nose and paranasal sinuses]. / Patogeneticheskii podkhod v terapii vospalitel'nykh zabolevanii nosa i okolonosovykh pazukh.

In recent years, inflammatory diseases of the nose and paranasal sinuses have been on the rise. In addition to infectious diseases, in the modern world a large percentage of the population suffers from allergic diseases. The approach to therapy and the choice of a drug should take into account the pathogenesis of the inflammatory reaction in the nasal cavity and paranasal sinuses. By exerting its effect, the drug should reduce hyperemia and swelling of the nasal mucosa, reduce the level of mucus secretion, improve the drainage of the paranasal sinuses, i.e. possess vasoconstrictive and anti-allergic properties. As such a drug, you can use the combined intranasal spray Frinozol, which basically contains cetirizine and phenylephrine. The use of Frinozol in the complex treatment of inflammation of the mucous membrane of the nasal cavity and paranasal sinuses contributes to the rapid and pronounced weakening of the symptoms of the disease, and is also the key to successful therapy.

[Actual issues of cerumenolysis]. / Aktual'nye voprosy tserumenolizisa.

The cerumen impaction is a pathological accumulation of earwax in the external auditory canal, which is accompanied by hearing loss, heaviness and discomfort in the ear, which leads to a significant decrease in the quality of life. The authors of the article consider the most common causes of excessive formation of cerumen, the mechanisms that prevent the normal separation of cerumen from the ear canal and the age-related features of the composition of earwax. The article discusses various ways to remove cerumen impaction, indications and contraindications to them. The authors conclude that the most effective and gentle way to evacuate sulfuric masses is the use of cerumenolytics, drugs that break down and thin the cerumen impaction, which facilitates its subsequent removal. Cerumenolytics based on plant components gently affect the skin of the outer ear, which allows them to be used for the purpose of hygiene of the ear canal and prevention of the formation of excess cerumen.

[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.

[Postviral rhinosinusitis, focus on pathogenetic therapy]. / Postvirusnyi rinosinusit, fokus na patogeneticheskuyu terapiyu.

Currently, the problem of acute rhinosinusitis continues to be relevant due to the frequent occurrence of this pathology. A certain difficulty is caused by the differential diagnosis of viral, post-viral and bacterial forms of rhinosinusitis, which carries the risks of irrational therapy. The authors of the article discuss the role of a viral infection in the etiology and pathogenesis of acute rhinosinusitis, the stages in the development of an inflammatory reaction on the mucous membrane of the nose and paranasal sinuses, and the disruption of mucociliary clearance. The authors consider options for the pathogenetic therapy of postviral sinusitis, concluding that the use of local combined preparations containing the mucolytic acetylcysteine and the vasoconstrictor component of tuaminoheptane sulfate is effective.

[Residency is a fundamental stage of professional training of an otorhinolaryngologist]. / Ordinatura ­ osnovopolagayushchii etap professional'noi podgotovki otorinolaringologa.

Systematic analysis of various indicators of the educational process becomes important to assess the effectiveness of the training of residents. One of the most common tools for monitoring the effectiveness of the educational process is a questionnaire of students. OBJECTIVE: To analyze the results of the assessment of the quality of training in the residency of the Sverzhevky Research Clinical Institute of Otorhinolaryngology according to the survey of residents. MATERIAL AND METHODS: The study includes the results of an anonymous questionnaire survey of a sample group of residents of the residency of the Sverzhevky Research Clinical Institute of Otorhinolaryngology of the second year of study. RESULTS: The data obtained allow us to judge the satisfaction with the quality of training of the absolute majority of the interviewed residents, their active use of specialized electronic search engines, a high assessment of the level of lectures, the desire to improve their surgical training. The importance for the professional development of residents of participation in weekly scientific and clinical conferences of the Sverzhevky Research Clinical Institute of Otorhinolaryngology, meetings of the Moscow Scientific Society of Otorhinolaryngologists, traditional annual scientific and practical conferences of otorhinolaryngologists of Moscow, as well as in the activities of the Youth Council of the Institute is noted. CONCLUSION: The results of the survey create prerequisites for improving the educational process, the formation of professional competencies and readiness for independent work among residents.

[The problem of chronic tonsillitis as a priority area of scientific research of the Department of Otorhinolaryngology named after acad. B.S. Preobrazhensky]. / Problema khronicheskogo tonzillita kak prioritetnoe napravlenie nauchnykh issledovanii kafedry otorinolaringologii imeni akad. B.S. Preobrazhenskogo.

The article summarizes data on many years of versatile research on the problem of chronic tonsillitis, which were conducted at the Department of Otorhinolaryngology named after acad. B.S. Preobrazhensky Medical Faculty of the Russian National Research Medical University N.I. Pirogov. The research results are presented in the context of the history of the department and the formation of the problem of chronic tonsillitis.

[Possibilities of modern forms of antimicrobial peptides in the treatment of inflammatory pathology of the pharynx]. / Vozmozhnosti sovremennykh form antimikrobnykh peptidov v terapii vospalitel'noi patologii glotki.

Inflammatory diseases of the pharynx occupy one of the leading places in the structure of otorhinolaryngological pathology. Acute and chronic inflammatory processes in the pharynx, as well as exacerbations of the latter, are faced by doctors of a wide range of specialties. Oropharyngeal swab laboratory testing is required to identify a specific pathogen, which takes time. In this regard, of particular interest are local drugs with the necessary spectrum of action, the use of which is possible, both as monotherapy and in combination with systemic therapy. The combination of tyrothricin (tyrothricin), benzalkonium chloride (benzalkonium chloride), and benzocaine (benzocaine) (dorithricin) is highly effective in the treatment of bacterial, viral and fungal infections of the pharynx, and microorganisms consistently demonstrate high sensitivity to the components of the drug.

[Phage therapy of purulent-inflammatory pathology of the outer and middle ear]. / Fagoterapiya gnoino-vospalitel'noi patologii naruzhnogo i srednego ukha.

The steady growth of antibiotic resistance of bacteria and, as a result, difficulties in selecting effective drugs determine the search for an alternative strategy for the use of antimicrobials, and therapy based on the use of bacteriophages is such. Phage therapy in otorhinolaryngology is actively used for the treatment of rhinosinusitis, diseases of the pharynx and larynx. However, it should be noted that the use of this group of drugs in the treatment of ear diseases is not sufficiently covered. Currently, institutes and clinics around the world are undergoing many large multicenter studies aimed not only at finding effective bacteriophages against antibiotic-resistant bacteria, but also at isolating their enzymes (lysines), expression of transport proteins, genetic modifications that lead to the restoration of the sensitivity of bacteria to antimicrobial drugs. In this review, we sought to highlight modern works concerning the treatment of inflammatory ear diseases with bacteriophage preparations, the results of microbiological studies conducted in vitro, the main purpose of which was to combat multi-resistant strains of microorganisms - pathogens of purulent-inflammatory diseases of the outer and middle ear.

[Features of topical therapy of inflammatory pathology of nasal cavity]. / Osobennosti topicheskoi terapii vospalitel'noi patologii polosti nosa.

Treatment of inflammatory pathology of the nasal cavity at the present stage requires a doctor to clearly understand the physiological mechanisms that implement the main functions of the mucous membrane of the nasal cavity and upper respiratory tract. One of the most important processes that ensure the normal functioning of the respiratory tract is mucociliary clearance. Violations of its work leads to stagnation of mucus and the development of inflammation not only in the nasal cavity, but also in the lower respiratory tract and middle ear cavities. The authors of the article consider the main etiological factors and mechanisms of the pathogenesis of inflammatory diseases of the nasal cavity, discuss approaches to the treatment of these conditions. The authors conclude that in conditions of acute and chronic inflammation of the nasal mucosa, accompanied by the secretion of thick viscous mucus, the most effective topical use of the combined preparation, which includes acetylcysteine, tuaminoheptane and sodium hyaluronate. This combination has both mucolytic, vasoconstrictive and protective effects, which increases the effectiveness of the drug and the adherence of patients to therapy.

[Modern approaches to the surgical treatment of chronic tonsillitis]. / Sοvremennye pοdkhοdy k khirurgicheskοmu lecheniyu khrοnicheskοgο tοnzillita.

At the moment, all over the world there are a large number of various methods of surgical treatment of chronic tonsillitis. In particular: classical tonsillectomy, cryosurgical method for removing the palatine tonsils, shaver tonsillectomy, monopolar and bipolar tonsillectomy, tonsillectomy with an ultrasonic scalpel, bipolar dissection using cutting instruments, laser tonsillectomy, coldablation. This article analyzes the existing methods, describes the fundamental technique for their implementation, as well as their advantages and disadvantages. Given the abundance of various surgical approaches to the treatment of chronic tonsillitis, there is a need for studies aimed at comparative study of their clinical and microbiological efficacy, including the postoperative period.

[Microbiocenosis-regulating therapy of inflammatory pathology of the oropharynx]. / Mikrobiotsenoz-reguliruyushchaya terapiya vospalitel'noi patologii rotoglotki.

Inflammatory pathology of the oropharynx, which does not lose its relevance, is a problem that is of interest to doctors of various specialties. As one of the main causes of inflammatory diseases of the pharynx, the influence of microorganisms, primarily viruses, on the mucous membrane of the upper respiratory tract is indicated. The authors of the article emphasize the importance of preserving the indigenous microbiota, which provides a barrier function and prevents the adhesion and colonization of pathogenic microorganisms. In this regard, the most effective and safe is local microbiocenosis-regulatory therapy using lysozyme, a natural peptide that has antiseptic, anti-inflammatory and immunoregulatory effects. As such a drug, the authors recommend the combined drug Lorolizin, which can be used in the treatment of acute pharyngitis, acute tonsillitis, and adenoiditis.

[Hearing dynamics in acute traumatic perforation of the tympanic membrane after application of blood plasma enriched with platelet growth factors]. / Regeneratsiya barabannoi pereponki i otsenka dinamiki slukha pri ostroi travmaticheskoi perforatsii barabannoi pereponki posle applikatsii plazmy krovi, obogashchennoi trombotsitarnymi faktorami rosta.

OBJECTIVE: The article considers the possibility of treating patients with acute traumatic perforation of the eardrum with a single application of blood plasma enriched with platelet-derived growth factors in the perforation area. As a result of the studies, it was found that the acceleration of its closure and the restoration of hearing. MATERIAL AND METHODS: The study included 43 patients with unilateral acute PBP of various etiologies (Table 1). Patients were divided into 2 groups - the main - 24 patients (10 men and 14 women), the average age - 30±9.7 years and the control - 19 patients (9 men and 10 women), the average age - 26.5±6.37 years. The compared groups did not reliably differ in age, gender, frequency and severity of hearing impairment. RESULTS: Analyzing the results, we can confidently talk about the beneficial effect of blood plasma enriched in platelet-derived growth factors on the speed, completeness of closure of traumatic perforation of the eardrum and the dynamics of restoration of auditory function. The use of blood plasma enriched with platelet growth factors led to a regular reduction in the time and increase in the frequency of cases of early closure of perforated eardrum, as well as improvement and restoration of auditory function according to the results of tonal threshold audiometry and otoacoustic emission in dynamics. CONCLUSION: Being generally available even in outpatient practice, the method of a single application of blood plasma enriched with platelet growth factors in the area of perforation of the tympanic membrane can significantly accelerate the healing process of the tympanic membrane, while improving the quality of life of the patient.

[Damage to the inner ear with syphilitic infection]. / Porazhenie vnutrennego ukha pri sifiliticheskoi infektsii.

The epidemiology of neurosyphilis is presented in article. The pathogenetic mechanisms of involvement in the syphilitic process are described already in the early stages of the disease of the central and peripheral nervous system and, in particular, of the auditory and vestibular analyzers. Described classical clinical forms of neurosyphilis. Statistical data on the incidence of syphilis in Russia from the 20-30s of the last century to the present are given. Presented analysis of the development of the incidence rate in Russia of syphilis and neurosyphilis, the main methods for the diagnosis of neurosyphilis. The changes in the structure of neurosyphilis disease that have occurred over the past 20 years, which are characterized by nonspecificity, course wear and inversion of typical clinical symptoms, as a result of pathomorphism, are described. The article describes the mechanism for the development of the pathological process in the inner ear with syphilitic infection. Described changes in the capillary wall of the vascular streak, leading to impaired hematolabyrinth barrier function and the development of the labyrinth hydrops. Literature data on the electron microscopic study of the vascular strip of the rabbit webbed snail infected with syphilis are presented. The article also collected literature data on indicators obtained by audiological and vestibulological studies of the inner ear in cases of early and late neurosyphilis. The article focuses on the possible only manifestation of neurosyphilis in the form of cochleovestibular symptoms.

[Results of the observational (non-interventional) research 'Analysis of therapeutic efficiency of the polyvalent Piobacteriophag (Secstaphag) in the treatment of acute sinusitis']. / Rezul'taty provedennogo nabliudatel'nogo (neinterventsionnogo) issledovaniia 'Analiz terapevticheskoi éffektivnosti preparata piobakteriofag polivalentnyi (Sekstafag) pri lechenii ostrogo gnoinogo sinusita'.

He article describes an observational (non-intervening) research 'Analysis of the therapeutic efficacy of the Polyvalent Piobacteriophage (secstafag) in the treatment of acute sinusitis'. The obtained results prove the effectiveness of the drug in the treatment of this ENT pathology.

[Peculiarities of clinical course of inflammatory diseases of the oropharynx of various etiologies and possibilities of local therapy]. / Osobennosti klinicheskogo techeniia vospalitel'nykh zabolevanii rotoglotki razlichnoi étiologii i vozmozhnosti mestnoi terapii.

The article covers the problems of diagnosis and treatment of inflammatory diseases of the oropharynx. The authors consider the main nosological forms of focal inflammation in the throat, discuss the role of ß-hemolytic streptococcus group A in the genesis of angina and chronic tonsillitis and their complications. The authors discuss the influence of irritants - smoking, alcohol, cold air, gastroesofareal reflux on the development of chronic inflammation of the oropharynx mucosa. Leading clinical symptoms in oropharyngeal diseases and the main methods of their treatment are presented. The authors conclude that the most effective treatment of focal inflammation in the throat is the use of combined topical drugs. As a choice for local therapy of pharyngeal diseases, the authors offer a combined drug Doritiricin, effectively and safely relieving pain syndrome and local inflammatory response.

[Symptomatic approach to diagnosis and treatment of inflammatory diseases of the outer ear]. / Simptomaticheskii podkhod k diagnostike i lecheniiu vospalitel'nykh zabolevanii naruzhnogo ukha.

The article presents a modern approach to the diagnosis and treatment of inflammatory diseases of the outer ear. The authors consider the main predisposing factors that determine the development of external otitis: traumatic injury, water ingress, use of in-the-ear headphones, occupational hazards and others. The role of various microorganisms, including Pseudomonas aeruginosa, Staphylococcus aureus, bacteria of Enterobacteriaceae family and fungi of genera Aspergillus, Candida, Penicillium, Mucor in the genesis of inflammatory pathology of the outer ear is discussed. For the purpose of effective treatment of external otitis the authors suggest to use a local combined preparation Candibiotic, which contains antibacterial, fungicidal, hormonal and analgesic components that affect the main factors of pathogenesis of the disease.

[Bacteriophages therapy in otorhinolaryngology. History and contemporaneity]. / Fagoterapiia v otorinolaringologii. Istoriia i sovremennost'.

Bacterial infections of the upper respiratory tract in the structure of the incidence of the population ranked second. Recently in practice there are more and more cases of a protracted course of the disease, chronic inflammation, as well as various kinds of complications. The abuse and misuse of antibiotics has contributed to the growth of antibiotic-resistant bacterial strains. This problem is named one of the most pressing for public health in the world. In this regard, the topical issue is the search for alternative drugs foe treating infectious diseases. Bacteriophage preparations that have a 100-year history and have gone a long way in development have shown their effectiveness as an alternative to antibiotics, and as an additional therapy in the treatment of certain bacterial infections. This review includes data from various studies available in English, as well as the results of domestic reports published in Russian scientific literature.

[Palatine tonsils: physiology and pathology]. / Nebnye mindaliny: fiziologiia i patologiia.

The article presents modern ideas about the etiology, pathogenesis, and features of the clinical picture of chronic tonsillar pathology. Specific attention is paid to the classification of chronic tonsillitis, in particular the classification of B.S. Preobrazhensky - V.T. Palchun. Data on modern methods for assessing the morphofunctional state of palatine tonsils, including immunohistochemical studies, are presented. Modern approaches to therapy are considered.

[The use of blood plasma enriched with platelet growth factors during experimental perforation of the tympanic membrane]. / Primenenie plazmy krovi, obogashchennoi trombotsitarnymi faktorami rosta, pri éksperimental'noi perforatsii barabannoi pereponki.

OBJECTIVE: To study morphofunctional tissue changes during perforation of the tympanic membrane using blood plasma enriched with platelet growth factors in the experiment. MATERIAL AND METHODS: Examined 36 rats (72 tympanic membranes), which were divided into 2 groups, experimental (1st) and control (2nd). Injected blood plasma enriched with platelet-derived growth factors into the external auditory canal once by application after perforation of the tympanic membrane in the rats of the experimental group. Sacrificed rats on the 5th, 10th, 15th day after surgery (6 animals in each group at each stage). Evaluated the condition of the tympanic membrane otoscopically during the experiment. Evaluated the signs of acute otitis media, the presence of 'dry' perforation of the tympanic membrane (without signs of inflammation), and the closure of perforation of the tympanic membrane. RESULTS: In the experimental group, on the 5th day after the surgery, there were no signs of acute otitis media, closure of perforation of the tympanic membrane was identified in 4 cases, 'dry' perforation of the tympanic membrane (without signs of inflammation) was preserved in 8 cases. In the control group, on the 5th day after the surgery, the signs of acute otitis media were identified in 9 cases, cases of closure of the perforation of the tympanic membrane were not noted, 'dry' perforation of the tympanic membrane was preserved in 3 cases. In the 1st group, on the 10th day after surgery, the signs of acute otitis media were identified in 1 case, 'dry' perforation of the tympanic membrane was preserved in 1 case, closure of perforation of the tympanic membrane was identified in 10 cases. At the same time in the 2nd group, the signs of acute otitis media were identified in 6 cases, the 'dry' perforation of the tympanic membrane was preserved in 6 cases, there were no cases of closure of the perforation of the tympanic membrane. In the 1st group, on the 15th day after the surgery, there were no signs of acute otitis media, 'dry' perforation of the tympanic membrane was preserved in 1 case, closure of perforation of the tympanic membrane was identified in 11 cases. In the 2nd group, on the 15th day after surgery the signs of acute otitis media was identified in 1 case, 'dry' perforation of the tympanic membrane was preserved in 10 cases, the closure of perforation of the tympanic membrane was noted in 1 case. CONCLUSION: Preliminary results show a favorable effect of blood plasma enriched with platelet growth factors on the regeneration of the tympanic membrane under conditions of its traumatic perforation in the rat experiment, which is manifested in a decrease in the incidence of acute otitis media on the 5th day after perforation and in an increase in the incidence of closure of tympanic membrane perforation both on the 10th and 15th day, and in general in the experimental group.