[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.

[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.

[Tuberculous lesion of retropharyngeal lymph nodes responsible for labored nasal breathing]. / Tuberkuleznoe porazhenie zaglotochnykh limfaticheskikh uzlov, vyzvavshee zatrudnenie nosovogo dykhaniya.

A 62 year-old patient applied for the medical aid with complaints of labored nasal breathing. She was treated for tuberculosis in the childhood, underwent radical mastectomy in connection with left breast cancer in 2007 and adenotomy at the age of 60 years with the good functional outcome. One year after adenotomy, the enlargement of lymph nodes at the left-hand antero-lateral surface of the neck was detected. The histological changes in the lymph nodes corresponded to the picture of tuberculosis. Pharyngoscopy demonstrated an asymmetric protrusion at the posterior wall of the pharynx more prominent on the left side. Examination by spiral computed tomography revealed the presence of two enlarged lymph nodes with the signs of suppurative melting in the retropharyngeal space. These lymph nodes were opened through the posterior pharyngeal wall which resulted in the restoration of the normal pharynx configuration and the normalization of nasal breathing.