[The main provisions of programs of medical and social rehabilitation of patients with occupational diseases of ent organs]. / Poryadok razrabotki i osnovnye razdely programmy reabilitatsii postradavshego na proizvodstve s professional'nymi otorinolaringologicheskimi zabolevaniyami.

The article discusses the main, modern provisions of the programs of medical and social rehabilitation of patients with occupational diseases of the ENT organs. The criteria of the degree of loss of professional ability to work in hearing loss and malignant neoplasms of the upper respiratory tract are presented. Rehabilitation programs and forms are developed taking into account the needs of the victim in medical, social and vocational rehabilitation, taking into account the potential capabilities and abilities of the victim to carry out professional, domestic and social activities.

[New criteria for professional selection and professional suitability by hearing to work in conditions of exposure to industrial hazards]. / Novye kriterii profotbora i profprigodnosti po slukhu dlya raboty v usloviyakh vozdeistviya proizvodstvennykh vrednostei.

New regulations of professional selection and professional suitability for the state of auditory function for persons entering for the first time and already working under the influence of harmful and (or) hazardous production factors are discussed.

[Coverage of issues of professional malignant neoplasms of the respiratory tract in modern clinical guidelines of the Ministry of Health of Russia]. / Osveshchenie voprosov professional'nykh zlokachestvennykh novoobrazovanii respiratornogo trakta v sovremennykh klinicheskikh rekomendatsiyakh Minzdrava Rossii.

OBJECTIVE: Analysis and comparison of clinical guidelines (CG) on malignant neoplasms of the respiratory system, placed in the CG rubricator of the Ministry of Health of Russia, for the information they contain on the role of factors and working conditions of the working environment in the etiology of respiratory diseases, including the upper respiratory tract, and comparison this information with published and regularly updated data from the International Agency for Research on Cancer (IARC). MATERIAL AND METHODS: Clinical recommendations from the heading of the Ministry of Health of Russia "Cancer of the laryngopharynx", "Cancer of the nasopharynx", "Cancer of the oropharynx", "Cancer of the nasal cavity and paranasal sinuses", "Cancer of the larynx", "Cancer of the trachea", "Cancer of the lung", and IARC data according to the List of Classifications by cancer sites with sufficient or limited evidence in humans dated 11/29/2019. RESULTS: The low level of registration of occupational cancer of the upper respiratory tract in Russia is due to an inadequate system of criteria for detecting this form of occupational pathology, a long latency period of diseases, and insufficient assessment of the history of information on the potential role of occupational carcinogens. The CGs developed to optimize the diagnosis and treatment of malignant neoplasms of the respiratory system do not contain up-to-date information on the role of professional potential carcinogens in the genesis of malignant neoplasms. CONCLUSION: Recognition of the professional nature of malignant neoplasms of the respiratory system implies, firstly, strengthening the role of otorhinolaryngologists in early diagnosis and rehabilitation of patients, and secondly, it has a pronounced preventive focus in the form of tasks facing the employer to reduce the carcinogenic load and develop preventive measures aimed to reduce and prevent the development of malignant tumors in workers, including the respiratory system.

[Medicinal products in the treatment and prevention of occupational diseases of the upper respiratory tract]. / Lekarstvennye sredstva v lechenii i profilaktike professional'nykh zabolevanii verkhnikh dykhatel'nykh putei.

Occupational diseases of the upper respiratory tract (URT) represent a significant section of occupational pathology of the respiratory system, since the mucous membrane of the nasal cavity and paranasal sinuses is the outpost that first comes into contact with inhaled agents (pollutants), including professional aerosols. The pathogenesis of occupational diseases of URT is based on long-term contact of pollutants with cells of the scintillating epithelium and violation of the function of the mucociliary system of URT. Occupational diseases of URT include: chronic catarrhal, subatrophic, atrophic, hypertrophic rhinitis, rhinopharyngolaryngitis; all forms of laryngitis, laryngotracheobronchitis, allergic diseases. Treatment and prevention of these diseases should be comprehensive with the use of personal respiratory protection equipment, mandatory preventive examinations and various local effects (inhalation, instillation, lavage, herbal medicine, etc.).

[STUDY OF THE POSITION TOWARDS HEALTH AND HEALTHY LIFESTYLE OF RAILWAY WORKERS].

PURPOSE: determination of the risk factors increasing the probability of development of non-communicable diseases at employees of the railway industry and also value of a condition of conditions for maintaining the healthy lifestyle by employees. MATERIALS AND METHODS: 13,595 people were interviewed (1.5% of the staff). The questionnaire contained 49 questions on the main components of healthy lifestyle, compiled on the basis of the STEPS toolkit. RESULTS: More than 93% of respondents agree that the person himself is responsible for his health, while only 11% of respondents correspond to the full extent of healthy lifestyle. The price factor when choosing products is decisive for 54% of respondents. 80% of the company's employees feed on what they brought from home. Less than half of the company's employees are engaged in physical education, sports, recreational gymnastics; would like to do, but now 40% do not do it. The proportion of persons involved in physical activity is slightly higher among young employees (54% versus 44% among workers aged 36 years and over). More than 2/3 of the survey participants do not smoke (while 30% smoked earlier, but were able to quit). Among women, the proportion of non-smokers is higher (86%) compared to men (64%). CONCLUSION: Based on the data obtained, it is possible to conclude that the company employees responsible attitude towards their health prevails. At the same time, a number of negative practices are quite widespread. These results point to the need to advance the values and practices of healthy lifestyle.

[Modern ideas about the professional suitability of employees of regulated professions with middle ear pathology and the possibility of their return to work (analytical review of the literature)]. / Sovremennye predstavleniya o profprigodnosti rabotnikov reglamentirovannykh professii s patologiei srednego ukha i vozmozhnosti ikh vozvrata k trudu (analiticheskii obzor literatury).

Fitness for work in persons with middle ear disease who are exposed to harmful work environment and their possible return to work was analyzed. Fitness for work expertise procedure in the Russian Federation is disclosed in detail. A list of medical contraindications to work in harmful and/or dangerous work environment according to hearing condition is given. Clinical aspects of middle ear diseases in the industry workers are presented and modern ideas about middle ear surgical treatment, it's functional results, documenting technique and outcome calculation are described in detail. Possibility of returning the employee to work is discussed based on all the analyzed materials.

[Upper respiratory tract infection with new COVID-19 coronavirus infection and aspects of occupational pathology examination]. / Porazhenie verkhnikh dykhatel'nykh putei novoi koronavirusnoi infektsiei COVID-19 i aspekty profpatologicheskoi ekspertizy.

The article discusses the issues of a new coronovirus infection CAVID-19, which suddenly appeared from the end of January 2020. in China and actively, widely spread around the world. The SARS-CoV virus is assigned to group II pathogenicity. The entrance gate of the pathogen is the epithelium of the VDP and epithelial cells of the stomach and intestines. The main source of infection is a sick person who transmits SARS-CoV-2 by airborne droplets and contact. There is a high risk of developing epidemic foci CAVID-19 in medical institutions in case of violation of sanitary and anti-epidemic regime and the risk of epidemic foci in groups of organizations with non-compliance with infection prevention measures. On the basis of the Decree of the President of the Russian Federation dated may 06. 2020 №313 of the Ministry of health of the Russian Federation, together with the FSS and Rospotrebnadzor, additional insurance guarantees are provided to doctors, middle and Junior medical personnel of medical organizations, drivers of ambulances who work directly with patients who have confirmed the presence of a new coronavirus infection (COVID-19). Insurance cases, when a one-time insurance payment is made, are persistent loss of working capacity by a medical worker as a result of complications after a previous illness caused by a new coronavirus infection (COVID-19), confirmed by laboratory research methods, if the disease occurred during the performance of their work duties.

[Key points of 'Noise-induced hearing loss' clinical guidelines]. / Osnovnye polozheniia klinicheskikh rekomendatsii 'Poteria slukha, vyzvannaia shumom'.

In this article we present the key points of 'Noise-induced hearing loss' clinical guidelines, which are included to the Clinical Guidelines Classifier of the Ministry of Health of Russia (2018). We give the definition of 'Noise-induced hearing loss', disclose the main causes and pathogenetic features of hearing impairment in employees who are affected by intensive noise at work. We state the main clinical and diagnostic criteria, treatment and rehabilitation principles; present the basics of primary and secondary prevention of hearing impairment in 'noise-hazardous' workers. We also disclose in detail the algorithm of expertise of hearing diseases connection with the profession on the stages of preliminary and final professional disease. Professional suitability issues are also discussed. Clinical guidelines contain a unified classification of noise-induced hearing loss severity complied with international approaches and medical and social expertise criteria.

[Medical and social rehabilitation of hearing impairment from occupational noise]. / Meditsinskaia i sotsial'naia reabilitatsiia lits s narusheniiami slukha ot proizvodstvennogo shuma.

The article presents the main provisions of medical and social rehabilitation of various hearing disorders caused by industrial noise. Two forms of hearing organ pathology in accordance with ICD-10 are distinguished: 'Adverse effects of industrial noise' - Z57.0 and 'hearing Loss caused by noise' - H83.3. The main methods of drug and non-drug rehabilitation of patients with signs of adverse effects of noise on the hearing organ and medical and social bases of rehabilitation of patients with severe clinical forms of hearing loss from noise are revealed. The basic principles of medical and social expertise in professional hearing loss: determination of the date of establishment and degree of loss of professional capacity for work, the need of the victim in medical, social and professional rehabilitation, recognition of the victim as a disabled person due to occupational disease, the development of the rehabilitation program of the victim in the workplace. References to the main Federal and industry documents of the Ministry of labor and the Ministry of health regulating medical and social rehabilitation are given.

[The importance of the quantitative assessment of the hearing impairment in the subjects employed under conditions of enhanced noise]. / Znachenie kolichestvennoi otsenki poteri slukha u lits, rabotaiushchikh v usloviiakh vozdeistviia povyshennoi shumovoi nagruzki.

The article describes the domestic modern diagnostic and expert approaches to the quantitative assessment of the hearing impairment in the subjects employed under conditions of enhanced occupational noise. It is concluded that the quantitative criteria for the determination of the severity of hearing loss in the workers of the 'noisy' professions adopted in this country are comparable with the respective international standards of and approaches to the medico-social examination practiced worldwide.

[The criteria for the relationship between hearing impairment and professional occupation and the criteria for professional suitability in terms of hearing among the aeronautical personnel engaged in civilian aviation]. / Kriterii sviazi narushenii slukha s professiei i kriterii profprigodnosti po slukhu u aviatsionnogo personala grazhdanskoi aviatsii.

This article describes the main clinical features associated with the development and manifestations of disturbed sound perception in the members of the aeronautical personnel engaged in the Russian civilian aviation. The main expert criteria for the relationship between the diseases of the organs of hearing (as exemplified by chronic sensorineural hearing impairment) and professional occupation have been developed based on the results of the clinical and diagnostic examination with the use of whispered and loud speech acumetry, tonal threshold audiometry, speech audiometry, impedancometry and evoked optoacoustic emission. Civilian aviation sectoral approaches to the evaluation of professional suitability in terms of hearing among the aeronautical personnel are considered in accordance with the criteria adopted by the International Civil Aviation Organization (ICAO), a specialized UN agency that sets the international standards for the civilian aviation and co-ordinates its development with the purpose of enhancing the safety and effectiveness of flights. The criteria are formulated for the solution of the expert problems arising from the relationship between the professional occupation and the diseases of the organs of hearing and for the evaluation of the professional suitability in terms of hearing among the aeronautical personnel engaged in civilian aviation.

[Contemporary methodic approach to evaluation of acoustic load on civil aircraft crew members.]

The article characterizes occupational factors including acoustic ones that influence work conditions of civil aircraft crew members, presents methodic basis to evaluate parameters of aviation noise inside cabin, with consideration of additional load from aviaheadsets. To specify scientifically based method for calculating acoustic load on civil aircraft crew members in cabins, the authors measured noise parameters inside cabins of aircrafts used at present in Russia, and noise-proof properties of domestic and foreign aviaheadsets. Normalized values suggested: equivalent level of A sound over a month (LA,,m), over a year (La); suggestions for reference values: equivalent level of A sound (Leg), over an arbitrary period of piloting length (L,r); coefficient of piloting load. Principles of these calculations are determined. The method is designed as an addition to sanitary rules and regulations 2.5.1.2423-08, determining hygienic requirements to work and rest conditions for civil aircraft pilots.

Influence of occupational noise on hearing: systematic review of foreign literature.

The article is aimed to systematically review evidence-based data published in foreign literature on influence of level and characteristics of occupational noise on hearing loss. Search of the literature was based on key words "occupational noise exposure, permissible exposure limit, dose-response relationship, acceptable noise level, noise-induced hearing loss" The authors studied 349 publications, 7 out of which were included into the present systematic review. Findings are that developed countries demonstrate a tendency to decreased prevalence of hearing loss among workers exposed to noise. Occupational groups with increased risk include workers of mining, machinery, light industries and agriculture. Lower occupational risk or no risk of hearing loss is seen in education, transport workers, musicians and other groups. Occupational noise level of 80 dB is a theoretically minimal exposure level resulting in no increase in hearing loss risk. Following normal noise level at 85 dB could decrease prevalence of hearing loss due to noise.

[The occupational risk of hearing impairment associated with cardiovascular pathologies in the subjects engaged in 'noisy' industries]. / Professional'nyi risk narushenii slukha na fone serdechno-sosudistoi patologii u rabotnikov «shumovykh¼ proizvodstv.

The objective of the present study was to analyze the structure of concomitant somatic pathology in the subjects experiencing the occupational hearing problems. The study demonstrated the increase in the frequency of concomitant chronic diseases and the prevalence of polynosological conditions with the increasing severity of hearing impairment. It was shown that cardiovascular pathologies tend to enhance the risk of hearing loss in the employees engaged in «noisy¼ occupations. The cause-and-effect relationships were elucidated as the contribution of the "vascular" factor to the formation of occupational pathology of the organs of hearing. The clinical audilogical features of co-morbid occupational hearing impairment associated with vascular pathology were characterized by the accelerated development and progression of the hearing disorders with the gradual disappearance of the audiological signs characteristic of noise-induced lesions.

[FEDERAL CLINICAL RECOMMENDATIONS IN DIAGNOSIS, TREATMENT AND PREVENTION OF HEARING LOSS DUE TO NOISE].

Noise induced hearing loss is a slowly developing hearing impairment, caused by occupational exposure to excessive noise levels, constitutes a lesion of the auditory analyzer and clinically manifested as chronic bilateral sensorineural hearing loss. Currently, there is not a treatment that provide a cure of sensorineural hearing loss. Regular, individually tailored treatment should be directed to the pathogenic mechanisms and specific clinical symptoms of hearing loss, as well as the prevention of complications. We recommend using non-drug therapies that can improve blood flow in labyrinth, tissue and cellular metabolism.

[The algorithm for the medical maintenance of the aircraft personnel suffering from chronic sensorineural impairment of hearing].

The present study was designed to systematize the causes underlying the development of chronic sensorineural impairment of hearing in the aircraft personnel engaged in commercial aviation of the Russian Federation. A detailed clinical and audiological picture of chronic sensorineural loss of hearing in the aircraft personnel is presented with special reference to the criteria accepted in the civil aviationfor the evaluation of professional suitability and occupational selection in terms of hearing conditions. The study has demonstrated the paramount importance of the aviation medical expertise for the flight safety control in civil aviation. We analyzed the results of the audiological examination of the aircraft personnel suffering from chronic sensorineural impairment of hearing and proposed the algorithm for the rehabilitation of such subjects taking into consideration the stage of the chronic process.

[The prevalence of hearing impairment in transport workers and peculiarities of management of occupational loss of hearing (as exemplified by the situation in the air and railway transport)].

This article presents data on the prevalence of hearing impairment among the workers engaged in the main means of transportation(air and railway transport). They show that the relative frequency of occupational loss of hearing in the cockpit members of commercial aviation amounts to one third of all cases of analogous diseases in this country. The main professional groups of transport works suffering from hearing impairment are constituted by the representatives of the so-called elite specialities, such as flying crew personnel, locomotive engineers, and their assistants. This fact constitutes an important aspect (not only of medical but also of socio-economic significance) of the problem under consideration. The high prevalence of professional hearing impairment among the transport workers is attributable to the high noise level in the cabins of locomotives and aircraft cockpits as well as to the inadequate expert and diagnostic work or imperfection of the regulatory documentation.

[The current problems of diagnostics and expertise of occupational diseases of the upper respiratory tract].

The objective of the present study was to systematize the main etiological factors as well as specific clinical, morphological, immunological, and microbiological features characteristic of the development of pathogenic changes in nasal cavity mucosa associated with occupational diseases of the upper respiratory tract (URT) of the subjects professionally exposed to the inhaled industrial aerosols (IA) with the special emphasis laid on the role of URT disorders in the development of occupational pathology of the respiratory system. The main clinical forms of occupational diseases of the upper respiratory tract are considered in accordance with the List of occupational diseases. Much attention is given to the criteria for the occupational origin of dystrophic and allergic diseases of the upper respiratory tract developing under the action of industrial aerosols.

[The prevalence and structure of ENT diseases in the children residing in the industrial regions].

The present study was designed to evaluate the state of the ENT organs in the children residing in the industrial regions characterized by the enhanced level of atmospheric pollution. The results of the correlation analysis of the data obtained confirm the strong cause-and-effect relationship between the pathologies of the upper respiratory tract (such as allergic and catarrhal rhinitis, chronic pharyngitis, sinusitis, inflammatory tonsillar diseases, and adenoid vegetations), impaired local immune reactivity, and the index of general air pollution including that with nitrous dioxide, phenols, and particulate matter. The results of the study suggest the necessity of more active detection of ENT diseases in the children at the early stages of their development together with regular medical examinations, and the implementation of purpose-oriented prophylactic, therapeutic, and health promoting measures.

[The system of prophylaxis in otorhinolaryngology].

This publication is focused on the modern basis behind the system for the prevention of acute and chronic ENT diseases with special reference to the compliance with the principles of primary, secondary, and tertiary prophylaxis. The special emphasis is laid on the role of the otorhinolaryngologist in the formation of the healthy lifestyle, organization of regular medical examination and rehabilitative treatment of the population. A detailed description of the activities of an otorhinolaryngologist in the framework of mass prophylaxis programs is presented. The main drawbacks of the current normative-regulatory documentation are discussed. It is concluded, based on the analysis of ENT morbidity among the Russian population, that the participation of otorhinolaryngologists is indispensable at the first, second, and third stages of regular medical examination. The modern regulations for the prophylaxis of occupational ENT diseases are considered.