[Acute and chronic rhinosinusitis age characteristics]. / Vozrastnye osobennosti techeniya ostrogo i khronicheskogo rinosinusita.

Children's and adults' rhinosinusitis are two diseases that have both similarities and differences in anatomy, epidemiology, causes, pathogenesis, diagnosis and treatment. At the same rhinosinusitis is one of the most common in otorhinolaryngology's practice, both in children and adults. The of adults paranasal sinuses (PNS) anatomy differs from children's PNS anatomy. Although ostiomeatal complex occlusion is recognized as a major cause of poor ventilation and drainage of the adult paranasal sinuses, it does not have a strong effect on pediatric rhinosinusitis, but adenoids play a key role. Adenoids are bacteria and biofilms reservoirs that cause chronic refractory rhinosinusitis regardless of pharyngeal tonsil size. The prevalence of chronic rhinosinusitis (CRS) is lower in children than in adults. Diagnosis of children's rhinosinusitis is more difficult because nasal cavity endoscopic examination is performed rarely due to the occasional need of general anesthesia during the procedure. Moreover, it's necessary to take into account prevailing etiological role of viruses in ARS at children's age and chronic adenoiditis often accompanies pediatric CRS, which requires attention prescribing medical therapy as the basis of rhinosinusitis treatment. The DysheLORz based on Pelargonium sidoides roots is highly effective and safe for children's and adults ARS and CRS treatment, both as monotherapy and in combination with topical steroids and antibiotics. This herbal medicine immunomodulatory effect is mediated mainly by stimulating the production of TNF-α, IL-1, IL-12 and IFN-γ. It activates macrophages and improves their phagocytic activity. IL-12, together with TNF-α, enhances NK and cytotoxic CD8+ lymphocytes' activity against infected cells. IL-12 effect on Th1 lymphocytes maturation provides a link between innate and adaptive immunity. This is also increasing MCP-1, IP-10 and MIP-1ß chemokines synthesis and decreasing MIP-1α, ENA-78, GROα and IL-8 production in PNS and nasal mucosa. This leads to decrease of neutrophils chemotaxis to the inflammation site, and decline of serine proteases concentration (neutrophils main enzymes), that increases mucous membrane epithelial barrier permeability, reducing bacterial infections risk. Additionally, Pelargonium sidoides increases epithelial cells beating cilia frequency and inhibits hemagglutinin and neuraminidase present on influenza virus surface. The drug increases antimicrobial peptides production as defensins, human neutrophil peptides (HNP) and bactericidal permeability-increasing protein (BPI), which is also important for rapid inflammation regression in rhinosinusitis. It causes bacterial adhesion to epithelial cells inhibition, phagocytosis stimulation, nitric oxide (NO) release and oxidative burst. The medicine had a direct effect on Streptococcus pneumoniae, Staphylococcus aureus, Neisseria, Moraxella catarrhalis and Haemophilus influenza. Based on these data, it is possible to explain the high effectiveness and safety of the drugs based on Pelargonium sidoides in ENT organs inflammation treatment, for both adults and children over 1 year old.

[Etiopathophysiological mechanism of systemic and local allergic sensitization in the development of chronic rhinitis and chronic rhinosinusitis]. / Etiopatofiziologicheskii mekhanizm obshchei i mestnoi allergicheskoi sensibilizatsii v razvitii khronicheskogo rinita i khronicheskogo rinosinusita.

The persistence, development and exacerbation of chronic rhinitis and chronic rhinosinusitis all involve sensitization to respiratory allergens. The allergic response in question is the IgE-mediated mechanism of rhinitis, which often leads to a complex of etiopathophysiological malfunctions in various organs and systems. For clinical classification and further management of patients, it is important not to miss the detection of both systemic allergic sensitization to aeroallergens (which is achieved by conducting skin prick test or detecting the allergen-specific immunoglobulin E in the blood) and local sensitization (which can be confirmed by conducting nasal provocation test or detecting the nasal-specific immunoglobulin E in nasal mucosa). Before a full examination is conducted and both systemic and local sensitization are ruled out, the diagnosis of non-allergic rhinitis and the management of a patient with non-allergic nasal inflammation may be premature.

The Relationship between p53-Positive Neurons and Dark Neurons in the Hippocampus of Rats after Surgical Interventions on the Nasal Septum.

The study evaluates the dependence of p53 protein expression on the appearance of dark neurons (DNs) in the hippocampus in rats during experimental modeling of septoplasty. Septoplasty simulation was carried out on 15 sexually mature male Wistar rats. We studied histological sections of the hippocampus stained with Nissl toluidine blue and antibodies to the p53 protein. In the CA1 subfield, the number of p53-positive neurons significantly increased on the 2nd, 4th (p < 0.001) and 6th days (p < 0.05). In the dynamics, the peak of the growth of p53 protein expression in the cytoplasm of CA1 and CA2 neurons fell on the 2-4th day after the operation, and on the 6th day the number of these neurons decreased (p < 0.001). In the cytoplasm of CA3 neurons in all periods after surgery, an increase in the expression of the p53 protein as compared to the control group was noted. In the CA1 pyramidal layer, the number of DNs decreased on the 6th day (p < 0.001). In CA2, after 2 days, a minimum of DNs as compared with the 4th day (p < 0.001) was noted. In CA3, on the 4th day, there was a peak in DNs as compared with the rest of the days (p < 0.001). A positive strong association was found in all periods of assessment and in all subfields of the hippocampus between an increase in the number of dark and p53-positive neurons. The appearance of dark and p53-positive neurons in the hippocampal formation in rats after simulating septoplasty are typical responses of nervous tissue to stress. It is obvious that the expression of the p53 protein is associated with the basophilia of the cytoplasm of neurons, their morpho-functional state. Presumably, the p53 protein can trigger not only the activation of damaged neurons in the hippocampus but also play a neuroprotective role. Upcoming studies should determine the role of the p53 protein in the further fate of damaged neurons in the pyramidal layer and differentiate the mechanisms of its expression.

[Dynamics of vowel acoustic space indicators in patients with long-term hearing loss]. / Dinamika pokazatelei akusticheskikh treugol'nikov glasnykh zvukov u patsientov, stradayushchikh dlitel'nym narusheniem slukha.

New procedure of vowel acoustic space (VAS) (of vowel acoustic triangles) transformation for the purpose of characterization of vowel production in individuals with long-term hearing loss (HL) was developed. OBJECTIVE: To characterize VAS of adult Russian speakers with long-term HL using newly developed acoustic indicators. MATERIAL AND METHODS: Recordings of sustained Russian cardinal vowels /a/, /i/, /u/ of 10 women and 10 men with long-term HL were acoustically analyzed. For each participant, two first formants of each vowel were measured and log-transformed (logF1, logF2). VAS was transformed into right triangles, their /u/ corners were moved to the origin, and their legs were aligned with axes. VAS was almost symmetrical, equal and have a maximum size in the control group consisted of subjects without hearing impairment while these of long-term HL group VAS size tended to have reduced and VAS stretched along one axis. RESULTS: Our study showed that a new VAS normalization approach can distinguish at least three groups of people with long-term HL. CONCLUSION: There are those with vowel triangles stretched along logF1-axis, with vowel triangles stretched along logF2-axis, and with symmetrical vowel triangles. Causes of the VAS differences require further investigation.

[Herpangina. Clinical case]. / Gerpeticheskaya angina ­ aktual'naya problema otorinolaringologicheskoi praktiki.

Enterovirus infections are a group of acute infectious diseases caused by enteroviruses (including Coxsackie A and B viruses, ECHO viruses), which clinically present symptoms of damage to the central nervous system, cardiovascular system, gastrointestinal tract, muscular system, mucous membranes and skin, fever. This article presents a clinical case of patient L., 12 years old, who admitted to an otorhinolaryngologist with clinical manifestations of herpangina. The diagnosis was confirmed by PCR. The patient was prescribed, adequate rehydration, diet with the exclusion of salty, spicy and fried foods, restriction of physical activity, exclusion of thermal procedures, Benzydamine Spray (Oralsept) 0.255 mg/dose, 6 doses 3 times/day, topically, on demand and inosine pranobex (Groprinosin) in a daily dose of 50 mg/kg of body weight: 1 tablet 500 mg 4 times a day for 7 days (at the rate of 1 tablet of 500 mg per 10 kg of body weight; for a patient weighing 41 kg - 4 tablets per day). On the 10th day from the onset of the disease, the docter noted a complete regression of clinical symptoms and the patient was discharged with recovery.

Low-Intensity Laser Therapy As a Method to Reduce Stress Responses after Septoplasty.

The aim of the study was to evaluate the effectiveness of the use of photobiomodulation therapy (PBMT) to minimize acute pain in the early postoperative period in patients after septoplasty. In total, 62 patients underwent septoplasty under general anesthesia (40 men and 22 women, 18-44 years old) followed by nasal tamponade. Patients of the 1st group did not undergo PBMT, and patients of the 2nd group received PBMT 3, 6, and 24 h after septoplasty (infrared pulsed laser radiation, λ = 0.890 µm, P = 10 W, 2 min in the projection of the wings of the nose). After 48 h, after the removal of tampons, intranasal PBMT with a nozzle in the red range, with λ = 0.63 µm, P = 8 mW, 2 min. ULF, HF, LF, and total power of heart rate variability (HRV), pain syndrome was assessed. ULF, LF, HF, total HRV power were significantly lower in group 2, compared to group 1. In the period from 6 to 24 h after septoplasty, patients of group 1 experienced higher pain than patients with PBMT (p < 0.001). The use of PBMT after septoplasty against the background of nasal tamponade helps to reduce the severity of pain syndrome and the inflammatory response to surgical stress and, consequently, leads to less pronounced changes in the autonomic nervous system in response to surgical stress.

Changes in the Time-Domain of Heart Rate Variability and Corticosterone after Surgical Trauma to the Nasal Septum in Rats.

The aim of the work was to study changes in the time range of heart rate variability (HRV) against the background of changes in the concentration of corticosterone in blood plasma in rats after surgical trauma to the nasal septum. Septoplasty was simulated in 30 mature male Wistar rats weighing 210-290 g. ECG was recorded with subsequent analysis of the time domain of HRV, as well as blood sampling to estimate changes in the concentration of corticosterone in the blood plasma was performed. As a result, SDNN significantly increased in comparison with the control on days 2 and 3 (p < 0.001) but decreased on days 4-5 (p < 0.001) and 6 (p < 0.01). rMSSD changed in waves with two irregular peaks on days 1 and 6. SDNN/rMSSD, in comparison with the 1st day of the postoperative period, increased on the 2nd day, continued to increase (p < 0.05), and then began to decrease on day 4 (p < 0.01). The total HRV power of was low throughout the postoperative period (p < 0.001), except for day 3, when it was equal to the control data. The increase in the total power index fell on day 3 after the operation (p <0.01), after which its decline was observed again. The concentration of corticosterone in the blood plasma in rats was significantly higher than before (p < 0.001). On postoperative day 2 to 4, its plateau was determined. Simulation of septoplasty leads to changes in the time range of HRV, an increase in the concentration of corticosterone in the blood plasma in rats with its maximum at the time of surgery and 24 h later, and the formation of a "plateau" on postoperative days 2 to 4, which coincides with the changes in HRV.

Comparison of the Effects of Septoplasty and Sinus Lifting Simulation in Rats on Changes in Heart Rate Variability.

The effects of septoplasty and sinus lifting simulation in rats on changes in the frequency domain of heart rate variability were compared. In the early postoperative period, the low-frequency component increases, and the high-frequency component decreases. The VLF range also increased. This indicates an increase in the activity of the sympathetic nervous system and a shift in metabolism under the influence of post-surgical inflammation.

Influence of Surgical Trauma in the Nasal Cavity on the Expression of p53 Protein in the Hippocampus of Rats.

The aim of the study was to determine the role of the stress effect of septoplasty modeling on p53 protein expression in the hippocampus of rats under conditions of sensory olfactory deprivation. Simulation of septoplasty was carried out on 30 sexually mature male rats. A quantitative assessment of the apoptosis of neurons in the pyramidal layer of the hippocampus in the subfields CA1, CA2, CA3, and dentate gyrus (DG) on days 2, 4, and 6 after surgery was carried out. Histological sections were stained by the immunohistochemical method with antibodies to the p53 protein. An increase in the number of p53-positive neurons was noted in all subfields; the maximum increase in the number of apoptotic neurons was noted on day 4 after surgery. The stress effect of modeling septoplasty in rats, accompanied by sensory deprivation of the peripheral part of the olfactory analyzer, provoked the expression of p53 and the initiation of apoptosis mechanisms in various subfields of the hippocampus.

Study of the Role of Hearing Aid on the Area of the Acoustic Field of Vowels.

The method of transformation of acoustic vowel triangles (AVT) /a/, /i/, /u/ was used for an objective assessment of the acoustic features of vowels in the speech production of 20 persons with long-term hearing impairment (LHI). The logarithm of the values ​​of the first two formants of each vowel (logF1, logF2) was determined for each subject. AVTs were transformed into the right-angled triangles, the vertices of the sound /u/ of which were moved to the origin of coordinates and the legs were aligned with the coordinate axes. In patients with LHI, the size of the triangles usually decreased, and they were stretched along one of the axes, which probably depends not only on the hearing loss severity but also on the duration of hearing aid use. The presented approach to the normalization of AVTs makes it possible to distinguish at least three groups of persons with LHI: in the first group, vowel triangles are stretched along the logF1 axis; in the second group, vowel triangles are stretched along the logF2 axis; and in the third group, AVT are symmetric.

[Widespread of Scleroma. A rare clinical case]. / Skleroma, rasprostranennaya forma. Redkoe klinicheskoe nablyudenie.

Scleroma is a chronic infectious disease characterized by developing inflammation nye granulomas, mainly of the upper respiratory tract, with subsequent scarring. The reasons for the development of scleroma remain unclear, but it is generally accepted that the gram-negative coccal bacterium Klebsiella rhinoscleromatis (pas-Volkovich's loch - Frisch) is the causative agent of this disease. Endemic in the spread of scleroma is considered There are tropical and temperate zones such as Africa, Asia, Eastern Europe, South America and Central America. Features of development scleroma in the present case and the complexity of the diagnosis caused by atypical, the rapid development of the disease, the greater prevalence of the process (including the orbit), with the transition to the soft tissues of the cheek bone and upper jaw, which is not typical for scleroma. The process was primarily localized in the left maxillary sinus and mimicked sinusitis. The presence of radicular cysts and darkening of the left maxillary sinus on radiographs, taking into account the clinical picture of the disease, were interpreted incorrectly, which led to the establishment of an incorrect diagnosis and subsequent surgical interventions. More targeted and consistent examination of histo-the logical material obtained after three surgical interventions made it possible to identify the characteristic signs scleroma, establish the correct diagnosis and prescribe effective treatment. In our case, we applied Ciprofloxacin course for 3 months at a maximum daily dose of 2000 mg in combination with probiotics. During treatment, it was noted a significant improvement in the patient's well-being, facial pains became less intense, a decrease in the volume of ma tissues of the left cheek and improved nasal breathing.

The Effect of Surgical Trauma in the Nasal Cavity on the Behavior in the Open Field and the Autonomic Nervous System of Rats.

In this article, the effect of surgical damage to the nasal mucosa in rats under the action of general anesthesia was investigated. The motor activity and heart rate variability (HRV) of rats were studied before and 2 days after the surgery. After surgical exposure, motor activity decreased, the time of fading and grooming increased, VLF increased, and HF decreased. Surgical trauma of the nasal septum in rats at the early postoperative stage promotes a pronounced stress response in the form of a sharp shift in the balance of the autonomic nervous system towards the sympathetic level and causes a decrease in exploratory activity, an anxiety, and a depressive-like state in rats.

[A rare observation of amyloidosis of the larynx simulating a tumor]. / Redkoe nabliudenie amiloidoza gortani, simulirovavshego opukhol'.

Presented a clinical case of a rare localization amyloidosis of the larynx, simulating a tumor. Considered the features of diagnosis and treatment of this disease.

[A mucosal melanoma of the larynx (a case report)]. / Nabliudenie melanomy slizistoi obolochki gortani.

In this article describe the clinical case of treatment of melanoma of the larynx mucous membrane.Presented the clinic, immunohistochemistrydiagnostics and methods of surgical treatment.

[The observation, diagnostics, and treatment of a patient presenting with a vascular branched tumour of the external ear]. / Sosudistaia vetvistaia opukhol' ushnoi rakoviny.

This article describes the observation of a clinical case of a vascular branched tumour (hemangioma) of the external ear with special reference to the clinical features and diagnostics of this condition and the methods for its surgical treatment.

[Septoplasty and tonsillectomy: acute stress response as a measure of effectiveness of local anesthetics].

AIM: To compare the effectiveness of lidocaine and articaineused as local anesthetics in septoplasty and tonsillectomy based on the physiological stress response. PATIENTS AND METHODS: The study included 125 patients with nasal septum deviation (NSD) and chronic tonsillitis (CT). The patients presenting with NSD were divided into two groups. Those comprising group 1A (n=32) were treated with a 2% lidocaine solution for local infiltration analgesia (LIA), the patients of group 1B (n=30) were given 2%articaine as LIA. Group 2A contained 32 patients with CT treated with lidocaine, group 2B consisted of 31 patients given articaine. In all the patients, the overall heart rate variability (HRV) including its high, low, and very low components was measured. RESULTS: Evaluation of HRV revealed a certain degree of disadaptation in the patients of groups 1B and 2A. High dispersion of SDANN, SDNN index, andrMSSD in group 1Bas well as SDANN values in group 2A indicates the sympathetic/parasympathetic imbalance. The high-frequency component was augmented in group 2B which suggested the prevalence of parasympathetic tone, but its high dispersion was just aswell indicative of disadaptation. CONCLUSION: Local analgesia with articaine during septoplasty leads tosympathetic/parasympathetic imbalance during the early postoperative period. Lidocaine analgesia for tonsillectomy does not prevent disadaptation induced by surgical stress.

[The specific features of the vestibular function in the patients presenting with sensorineural hearing loss of vascular genesis].

The authors consider the specific features of the vestibular function in the patients with sensorineural hearing loss of vascular genesis. The study included 60 patients at the age from 28 to 75 years presenting with sensorineural impairment of hearing of vascular genesis. All of them were examined with the use of the extended otoneurological method. The data obtained were compared with the structural changes and hemodynamic characteristics of vertebral arteries (VA) and internal carotid arteries (ICA) and with the results of magnetic resonance imaging (MRI) of the brain.

[The use of the Surgitron radiowave scalpel for the surgical treatment of external ear neoplasms].

The objective of the present study was to elucidate etiology and clinical picture of the tumours of the external ear as well as to evaluate the effectiveness of their radiowave surgery. We sought to optimize the surgical strategy for the treatment of tumour-like masses, benign and malignant neoplasms of the external ear with the use of the Surgitron radiowave scalpel.

[The application of the lyophilized xenodermoimplants for the plastic correction of the external auditory canal and nasal septum perforation].

The objective of the present work was to improve the effectiveness of the treatment of atresia of the external auditory canal (EAC). Atresia of external acoustic meatus is a result of a mechanical or thermal injury but can also develop after a surgical intervention for the removal of foreign bodies, benign and malignant tumours. This condition is frequently associated with the narrowing and obliteration of EAC leading to the marked impairment of hearing despite preservation of the middle ear structures. Plastic correction of the external auditory canal for the purpose of its broadening does not always produce the desired result. To improve the efficiency of such intervention, we made use of the lyophilized xenodermoimplants based on porcine skin. Such preparation were applied in 19 patients; patency of the external auditory canal was restored in 16 cases.