[Epidemiology and modern methods of treatment of non-traumatic nosebleeds]. / Epidemiologiya i sovremennye metody lecheniya netravmaticheskikh nosovykh krovotechenii.

Data on the detection incidence of nosebleeds (NBs) of non-traumatic origin in the population show considerable variability in statistical indicators, and NBs treatment and consequences depend on the localization of hemorrhage source, the volume of blood loss, patient's general condition, the presence and nature of comorbid pathology and a number of other factors. There are some differences in the choice of NBs treatment options, evaluation of their clinical and economic efficiency, which indicates the need to analyze and systematize the results of such studies. OBJECTIVE: To analyze data on prevalence and current treatment approaches of non-traumatic nosebleeds. MATERIAL AND METHODS: The search for publications (articles and related abstracts) on the subject of the study, presented in the PubMed database, has been conducted. The choice of material was made according to the following key words: non-traumatic nosebleeds, causes, incidence, methods of stopping nosebleeds. RESULTS: The literature data show a significant prevalence of NBs in the population, their potential hazard to the life of patient and the importance of clinical and demographic characteristics of persons for determining treatment tactics in each case. In practical terms, primary and secondary NBs should be distinguished. In case of primary NB, the use of coagulation and nasal packing is recommended after determining the place of bleeding. In secondary NB it is necessary to establish its cause in order to assess risk factors and apply appropriate topical or systemic drug therapy. The so-called difficult (difficult-to-treat) NBs deserve special attention. As a rule, these cases involve bleeding from the posterior parts of nose. The analysis of publications shows a high (90%) efficacy of surgical interventions, used as first-line treatment. Effectiveness of embolization in such cases was 75% and of anterior/posterior nasal packing was 62%. CONCLUSION: The literature data show a significant prevalence of nosebleeds in the population and their potential hazard to the life of patient. The existing differences in the assessments of treatment options for this pathology, their clinical and economic efficiency are the basis for further research, in particular, to clarify the causes of nosebleeds' occurrence and recurrence, the impact of treatment methods on quality of patients' life.

[Combined method of treatment of synechiae of the nasal cavity]. / Kombinirovannaya metodika lecheniya sinekhii polosti nosa.

Diseases of the nasal cavity and paranasal sinuses lead to the development of clinical symptoms, among which difficulty in nasal breathing is among the most common complaints of patients in the practice of otorhinolaryngologists. To prevent the development of synechiae of the nasal cavity in surgery, the following principles are defined: 1) to reduce tissue injury, which is achieved by using modern equipment (endoscopic, laser, radio frequency, etc.); 2) to create a barrier between nearby areas of the nasal mucosa by introducing various intranasal splints; 3) to improve the process of tissue regeneration with the help of medicines (regenerants, reparants, etc.). Currently, there is no single approach to the surgical treatment of synechiae of the nasal cavity. The high frequency of postoperative relapses indicates the need to develop effective methods for the prevention of synechiae of the nasal cavity. The choice of surgical tactics is usually carried out taking into account the localization and extent of synechiae of the nasal cavity. All known methods of surgical treatment, depending on the instruments used for excision of synechiae of the nasal cavity, can be conditionally divided into cold and hot. The Sverzhevsky Research Clinical Institute of Otorhinolaryngology has developed a method of complex treatment and prevention of synechiae of the nasal cavity using laser technologies, silicone splints and a hydrogel material based on sodium alginate with derinate.

[Rhinolith - diagnosis and treatment features]. / Rinolit ­ osobennosti diagnostiki i lecheniya.

Exogenous foreign bodies enter the nasal cavity through the nostrils or in some cases through the choana and usually get stuck in the lower or middle nasal meatus. An alien body that has been in the nasal cavity for a long time serves as a nucleus around which calcium and magnesium salts, organic components, are deposited from the nasal secretions, and contributes to the formation of rhinolith (nasal stone, from Greek rhino - nose, lithos - stone). Endogenous material (thick mucous secret or a blood clot drying into the crusts, desquamated epithelium, an atypically located tooth, products of cellular lysis and necrosis of the mucous membrane) can also serve as a potential nucleus for salt deposition. Narrowing of the nasal passages due to the curvature of the nasal septum, hypertrophy of the nasal conchae, violation of mucociliary transport and inflammatory changes in the mucous membrane in chronic rhinitis or rhinosinusitis can lead to a delay in the mucous discharge in the nasal cavity, pH changes, excessive saturation of the secretion with crystalloids, initiate crystallization around the nucleus and deposition of salts. This article presents the results of clinical examination and surgical treatment of a patient with rhinolith formed by prolonged inhalation of construction dust.

[The method of instrumental dilatation of the anastomosis of the sphenoid sinus in the surgical treatment of chronic sphenoiditis]. / Metod instrumental'noi dilatatsii soust'ya klinovidnoi pazukhi pri khirurgicheskom lechenii khronicheskogo sfenoidita.

Features of the location of the sphenoid sinus determine the possibility of developing severe intraoperative complications in the surgical treatment of patients with chronic sphenoiditis. Technical difficulties during sphenoidotomy may arise at the initial stage of expansion of the natural anastomosis with its anatomical narrowness and the impossibility of inserting biting forceps. PURPOSE OF THE STUDY: To study the clinical efficacy and safety of the proposed original method of dilatation of the sphenoid sinus fistula in the surgical treatment of various forms of chronic sphenoiditis. MATERIAL AND METHODS: The study included 68 patients of both sexes older than 18 years with chronic sphenoiditis, who are indicated for surgery on the sphenoid sinus. Patients of the 1st group (n=36) underwent expansion of the fistula of the sphenoid sinus using the traditional method. Patients of the 2nd group (n=32) underwent dilatation of the anastomosis of the sphenoid sinus using the tool developed by us. Intraoperatively, the quality of visualization of the surgical field, the time of the operation, and the presence of complications were assessed. In the postoperative period, the number of complications, relapses of the disease and the condition of the sinus were recorded according to the results of computed tomography 3-4 months after the operation. RESULTS: The use of the method of dilated expansion of the anastomosis of the sphenoid sinus using special forceps developed by us helps to reduce the duration of the operation, improve intraoperative visualization of the sphenoid sinus and improve the results of treatment according to endoscopy and control computed tomography. When using the developed tool, the number of episodes of intraoperative bleeding that hindered visualization and necessitated coagulation was lower than when using an alternative technique. CONCLUSION: The technique of endoscopic dilatation of the anastomosis of the sphenoid sinus using the developed tool can be used both independently and as a preliminary step for expanding the anastomosis of the sphenoid sinus, followed by the use of a shaver or Kerrison forceps.

[Hereditary hemorrhagic telangiectasia (Rendu-Osler syndrome)]. / Nasledstvennaya gemorragicheskaya teleangiektaziya (sindrom Randyu­Oslera).

The analysis of publications is carried out and current data concerning the etiology, pathogenesis, diagnosis, and principles of treatment of hereditary hemorrhagic telangiectasia are presented.

[New approach to treatment of polypous rhinosinusitis]. / Novyi vzlyad na lechenie polipoznogo rinosinusita.

ANNOTATION: Polypous rhinosinusitis (PRS) is a hardly treatable disease due to the unknown etiology and recurrent course. Standard treatment regimens are aimed at removing polyps and reducing the activity of inflammation, while little attention is paid to pathogenesis factors such as oxidative stress and mucociliary insufficiency. OBJECTIVE: To improve the combined treatment of PRS. MATERIAL AND METHODS: The study involved 98 patients (50 people - the study group, 48 people - control group). The structure of the comorbid pathology of patients in the control group was selected so as to correspond to the pathology in the study group. Patients of both groups received combined treatment, including surgical treatment in accordance with the FESS principles, followed by the prescription of 200 mcg mometasone furoate in each half of the nose for 6 months. The treatment of patients of the study group also included the drug N-acetylcysteine - 3 ml (300 mg) in each maxillary sinus intrasurgicaly, then 600 mg orally in the morning after meals for 6 months. Survey methods included a questionnaire survey using the SNOT-22 questionnaire, the prevalence of the polypous process was assessed by endoscopy (Claus Bachert scale) and CT (Lund-Mackay scale), and mucociliary function was also evaluated by performing a saccharin test. The results were compared with each other before surgery and after 6, 12 and 24 months after surgery. RESULTS: Patients who have been taking N-acetylcysteine for a long time have a more pronounced and long-term improvement in their general condition (according to SNOT-22, an average by 1.7 times, p<0.05) compared with patients in the control group. Also, the frequency of relapses decreases and the effectiveness of surgical treatment increases (according to the Lund-Mackey scale - 5.02 in the experimental group and 10.75 in the control; according to S. Bachert - 1 point and 3 points, respectively). CONCLUSIONS: Long-term use of N-acetylcysteine in PRS increases the effectiveness of surgical treatment, reduces the frequency of relapses, and also improves the general condition of patients.

[Modification of the method for closing the defect of the medial wall of the maxillary sinus]. / Modifikatsiya sposoba zakrytiya defekta medial'noi stenki verkhnechelyustnoi pazukhi.

Pathological ventilation of the maxillary sinus (MS) is one of the risk factors for the formation of chronic maxillary sinusitis. PURPOSE OF STUDY: Is to evaluate the effectiveness of the method of restoring the medial wall of the MS with an autograft - a quadrangular cartilage of the nasal septum using the butterfly technique (Patent Application No. 2018140468, priority of 11/19/2018). MATERIAL AND METHODS: The study included patients who underwent septoplasty, endoscopic surgery on the MS with plasty of the medial wall of the MS (1st, main group, n=136), as well as patients who underwent surgery according to Caldwell-Luc with the formation of persistent nasoantral anastomosis in the lower nasal passage (2nd, control group, n=56). The criteria for the inclusion of patients in the study were as follows: the presence of MS fungal body; inverted papilloma with lesions of the MS; cysts and/or a foreign body of the MS with localization in the alveolar bay without involving the natural anastomosis in the pathological process; concomitant 3rd or 4th, or 5th or 6th types of curvature of the nasal septum according to R. Mladina (1987). An objective assessment of the condition of the patients was carried out using the SNOT-22 clinical questionnaire, and for analysis the state of aerodynamics of the nasal cavity and MS in patients of various groups after surgical treatment used the method of computational aerodynamics. RESULTS: In patients with nasoantral ostium in the lower nasal meatus, the pathological maxillary sinus aeration one was observed. It is recommended to close the nasoantral ostium to prevent violations of the aerodynamics of the nasal cavity and the maxillary sinus during surgery through the lower nasal meatus. CONCLUSION: Our proposed method for closing a defect in the lower nasal passage is effective. The autograft is well established, contributes to the speedy restoration of normal sinus aerodynamics.

[CFD simulation study of aerodynamics in nasal cavity in a case of septal perforation]. / Vychislitel'naia aérodinamika vozdushnykh potokov v polosti nosa pri perforatsii peregorodki nosa.

Perforation of the nasal septum remains an actual problem. The success of surgical closure of perforation of the nasal septum depends not only on the surgeon's skill, but also on the degree of disturbance of the nasal cavity physiology. Traditionally, CFD studies of nasal septal perforations are dedicated to the analysis of changes in speed value of the inhaled air depending on the size and localization of perforation of the nasal septum. But there is a lack of studies about warming and moistening of the inhaled air in a case of nasal septal perforation. These studies are necessary not only for studying the pathophysiology of perforation of the nasal septum, but also for planning surgery.

[Biophysical mechanisms of dehydration of nasal cavity secretion in inflammatory diseases of the upper respiratory tract]. / Biofizicheskie mekhanizmy degidratatsii sekreta polosti nosa pri vospalitel'nykh zabolevaniiakh verkhnikh dykhatel'nykh putei.

The purpose of the study is an experimental-theoretical study of the mechanisms of structuring the secretion of the nasal cavity, in the process of its dehydration in inflammatory diseases of the upper respiratory tract. The work shows the general patterns of dehydration of natural biological fluids and their model solutions. Simulation of dehydration of the secret allowed us to identify the most informative parameters of changes in its composition in pathology and to develop criteria for diagnosing the inflammatory process of the VDP using the wedge-shaped dehydration method. The study clarified the mechanisms of dehydration of biological fluid, which expanded the possibilities of diagnosing diseases of the VDP.

[Retention cysts: a new approach to treatment]. / Retentsionnye kisty: novyi podkhod v lechenii.

In 2017-2018, the authors examined and operated on 35 patients aged 20 to 39 years (19 women, 16 men) with cystic maxillary sinusitis. The study included patients who were diagnosed with retention cyst of the maxillary sinus, located on the lower walls of the maxillary sinus and dealing with no more than 2/3 of the maxillary sinus volume, according to CT of the paranasal sinuses. The operation was performed using the following method: two punctures of the sinus were performed simultaneously in a typical place in the lower nasal passage - using a Kulikovsky needle and using a 2.8 mm trocar. The fiber of the Ho-laser was inserted into the Kulikovsky needle, and an endoscope was inserted into the trocar in parallel with the 0, 30 or 45°. Then, under the control of the endoscope, the fiber was inserted into the cyst and given a series of impulses before its 'explosion'. The parameters Ho:YAG-radiation had the following values: power - 14.4 W, pulse energy - 1.2 Jol, pulse frequency - 12.0 Hz. All patients were discharged from the hospital on the 2nd day. In the long-term period (up to 14 months), according to the endoscopic examination, an objective examination and CT of the paranasal sinuses showed no recurrence of the cyst in any patient, no pathological changes were recorded in the area of the lower nasal passage.

[Angioneurotic edema. Classification, diagnosis, prophylaxis, treatment tactics]. / Angionevroticheskii otek. Klassifikatsiia, diagnostika, profilaktika, taktika lecheniia.

The article highlights the current understanding of the etiology and various mechanisms of development, patterns of angioneurotic edema. Detailed clinical and laboratory picture of allergic and non-allergic forms of angioedema are presented.

[Peculiarities of the ENT-organ condition in hypothyroidism]. / Osobennosti sostoianiia LOR-organov pri gipotireoze.

BACKGROUND: The interrelationship of thyroid pathology and ENT organs is one of the least studied aspects of iodine deficiency diseases. Diseases of this localization are distinguished by a variety of their causes, high prevalence, a tendency to prolonged and chronic process, resistance to drug therapy and a negative effect on the quality of life of patients. AIM: To study the state of ENT organs in hypothyroidism in the iodine-deficient region of Eastern Siberia (Irkutsk Region). MATERIAL AND METHODS: The main group consisted of 302 patients with hypothyroidism, and the control group - 116 people without thyroid pathology. All patients who participated in the study were on replacement therapy (Levothyroxin). An objective study of the ENT organs was performed using an endoscope and a microscope. The SF-36 questionnaire was used to study the indicators of quality of life. A questionnaire was used to assess the symptoms of rhinitis, which provided clarification of the severity of symptoms on a visual analogue scale. RESULTS: Among patients with thyroid dysfunction, various changes characteristic of chronic pathology of the pharynx, larynx, and ear were found with almost the same frequency as among those examined without thyroid pathology. Chronic rhinitis in hypothyroidism is characterized by manifest edematous-hypertrophic changes in the turbinate, intense hyperemia of the nasal mucosa, the presence in the nasal passages of viscous, thick mucous discharge. The most important integral indicators of health components are physical (PH) and psychological (MH) patients with chronic rhinitis were reduced (50.6±1.96 and 53.0±2.08 respectively). CONCLUSION: The symptoms of rhinitis are leading in the structure of the pathology of the upper respiratory tract in hypothyroidism and have a significant negative impact on the patient's quality of life indicators.

[Optimization of the method for the postoperative treatment following rhinoplasty]. / Optimizatsiia metodiki vedeniia posleoperatsionnogo perioda posle rinoplastiki.

This article was designed to report the results of analysis of the dynamics of oedema of the soft tissues of the external nose and the adjacent facial structures in different periods following rhinoplasty. The metric characteristics were calculated and the integral index of tissue oedema was determined for 374 patients allocated to two groups. The main group was comprised of 286 (86.5%) patients who underwent the postoperative rehabilitative treatment making use of the proposed method. The remaining 88 (23.5%) patients constituted the group of comparison. The analysis of the data obtained has demonstrated that the compliance with the newly developed algorithm for the postoperative rehabilitation permits to considerably reduce the severity of the inflammatory reaction of the organism to the post-surgical trauma and to shorten the duration of the postoperative rehabilitation.

[The substantiation for simultaneous rhinoplasty and correction of the intranasal structures in the patients presenting with the combination of pathology of the nasal cavity and disfigurement of the shape of the nose]. / Obosnovanie odnomomentnoi rinoplastiki i korrektsii vnutrinosovykh struktur u patsientov s sochetannoi patologiei polosti nosa i narusheniem formy nosa.

The objective of the present work was to evaluate the effectiveness of rhinoplasty performed in the combination with the correction of the intranasal structures. The study included the comparison of intra- and post-operative characteristics of rhinoplasty carried out with and without correction of the intranasal structures in 374 patients presenting with the combination of pathology of the nasal cavity and disfigurement of the shape of the nose. It was shown that the simultaneous surgical interventions are not accompanied by a significant increase in the frequency of intra- and post-operative complications in comparison with rhinoplastic surgery alone; nor do they require additional time expenditures. At the same time, the absence or the inadequate performance of septoplasty and/or the correction of the inferior turbinated bone during rhinoplasty in the patients presenting with the combination of pathology of the nasal cavity and disfigurement of the shape of the nose is fraught with the poor aesthetic outcome of the treatment and persistent disturbances of the respiratory function.

[The potential of physiotherapy after rhinoplasty]. / Vozmozhnosti fizioterapii posle rinoplastiki.

This article presents the results of the evaluation of the effectiveness of physiotherapy during the postoperative period following rhinoplastic surgery based on the analysis of the dynamics of the clinical symptoms in 374 patients divided into two groups. The main group was comprised of 286 (86.5%) patients who had undergone the comprehensive postoperative rehabilitation with the use of the chosen physiotherapeutic procedures while the group of comparison consisted of 88 (23.5%) patients treated othrerwise. The method in question included the microcurrent lymphatic drainage, the magneto-laser treatment, and ultraphonophoresis. The data obtained give evidence of the significant differences between the two groups of the patients in terms of reduction of oedema of the nasal and facial soft tissues on days 10-12 and 30-35 after the treatment as well as of subcutaneous hemorrhage and pain in the external nose on days 10-12. These effects were more pronounced in the patients of the main group. The local subcutaneous compaction was documented in both groups (though it was more pronounced in the patients of the comparison group; p<0.05) after the disappearance of the bulk of the swelling approximately on days 10-12. It is concluded that the results of the study confirm the effectiveness of the staged performance of various physiotherapeutic procedures during the postoperative period after rhinoplasty.

[The influence of rhinoplasty on the physical and mechanical properties of the skin of the external nose]. / Rinoplastika i fiziko-mekhanicheskie svoistva kozhi naruzhnogo nosa.

This article was designed to report the results of the measurement of the surface acoustic wave velocity in the skin of the external nose following rhinoplastic surgery based on the analysis of the postoperative conditions in 374 patients. The patients were divided into two groups, one comprised of 286 (86.5%) patients who underwent the newly developed rehabilitative treatment and the group of comparison composed of 88 (23.5%) patients who received a different treatment during the postoperative period. The analysis has demonstrated the significant reduction in the velocity of the surface acoustic waves in the skin of the external nose of the patients of the main study group within 1 and 6 months after the surgical intervention. The change was especially well apparent at the sites with the relatively thicker skin underlain by the subcutaneous adipose tissue. This result can be regarded as giving evidence of the effectiveness of the proposed physiotherapeutic treatment that allowed to achieve the rapid decrease of postoperative oedema and prevent the subsequent excessive cicatrization.

[Secondary closed rhinoplasty in the patient presenting with post-injurious deformation of the external nose]. / Vtorichnaia zakrytaia rinoplastika u patsienta s posttravmaticheskoi deformatsiei naruzhnogo nosa.

The authors describe the process of the surgical treatment of a patient presenting with the displaced fracture of the nasal bones involving the left orbital wall. The correction was performed by means of secondary closed rhinoseptoplastic surgery. The special emphasis is laid on the importance of computer-assisted modeling for the planning and achievement of the favourable surgical outcome.

[Treatment with the use of microcurrent lymphatic drainage physiotherapy during the postoperative period following rhinoplastic surgery]. / Mikrotokovaya limfodrenazhnaya fizioterapiya v posleoperatsionnom periode pri rinoplastike.

The objective of the present study was to evaluate the effectiveness of the combined treatment of the patients who had undergone either primary or secondary rhinoplastic surgery with the use of photo- and magnetic therapy in comparison with the effectiveness of phototherapy in the combination with microcurrent therapy. The patients were divided into four groups depending on the type of the surgical intervention and the mode of the combined physiotherapeutic treatment. All the patients were given combined physiotherapeutic treatment in addition to the standard pharmacotherapy starting from the second day of the postoperative period. The patients of groups 1 and 3 received phototherapy in the combination with magnetic therapy while those in groups 2 and 4 were treated by phototherapy in the combination with microcurrent lymphatic drainage physiotherapy. It was shown that the different combinations of physiotherapeutic modalities during the postoperative period following primary «closed¼ rhinoplasty were not different significantly in terms of effectiveness. After secondary «closed¼ rhinoplasty, the combination of phototherapy with the application of microcurrents looks more preferable. It is concluded that microcurrent lymphdraining physiotherapy should be regarded as the priority component of the combined physiotherapeutic treatment during the postoperative period following secondary «closed¼ rhinoplasty.