[Piriform aperture as a cause of nasal obstruction. Part 2. A systematic review of the methods of surgical treatment]. / Grushevidnaya apertura kak prichina nazal'noi obstruktsii. Chast' 2. Sistematicheskii obzor sposobov khirurgicheskogo lecheniya.

The article presents a systematic review of publications on the methods of piriform aperture (PA) surgery in the treatment of nasal obstruction. Various surgical techniques are reviewed critically in terms of topographic anatomy and the effectiveness of the method. The contradictory opinions about the access to the piriform aperture and the methods of its correction are revealed. The topic of surgery of the PA as an area of the internal nasal valve in the treatment of nasal obstruction is equally interesting for ENT and plastic surgeons. The analysis of the literature showed the effectiveness and safety of operations to expand the PA. None of the authors in the studied works notes any changes in the appearance of the nose during observation in the postoperative period. The biggest challenge in understanding PA surgery, which has yet to be understood, is determining the indications for a particular method of surgery, which justifies the continuation of the search, taking into account the clinical features of the patient and the topographic level of the disorder. In the future, we need studies with objective measurements, control and long-term careful observation to better study the effect of the expansion of the piriform aperture on the relief of nasal obstruction.

[Piriform aperture as a cause of nasal obstruction. Part I. Anthropometric characteristics in different populations (systematic review).] / Grushevidnaya apertura kak prichina nazal'noi obstruktsii. Chast' I. Antropometricheskaya kharakteristika v razlichnykh populyatsiyakh.

The piriform aperture (PA) is anatomically an opening in the central part of the facial skull. To date, the piriform aperture, as an element of the static component of the internal nasal valve (INV) and as a possible cause of its dysfunction, has not received proper surgical attention. If PA is considered as a possible cause of nasal obstruction, then the main parameter is its width, which has a direct effect on the volume of the INV area. This parameter is the focus of the presented work. Despite the absence of generally accepted normative indicators for PA, we currently know the shape and size of the piriform aperture in different ethnic groups of the population, described in the article. As a result of the analysis of the presented research results, it was revealed that the width of the PA is influenced by the gender, age and ethnicity of the individual. The anthropometric data of the piriform aperture require further study, since they are of important reference value not only in the theory of medical research, but also in practical otorhinolaryngology, maxillofacial and plastic surgery, pulmonology.

[The septal tubercle: the state of the problem]. / Bugorok peregorodki nosa.

The septal tubercle is considered to be a thickened area of the nasal septum, which is located above the lower nasal concha and in front of the middle nasal concha. Taking into account its histological structure and location in the distal segment of the internal nasal valve, it is located and structured for secretory function and vasoactive regulation of the respiratory air flow. These histologically rich tissues with glandular elements are well adapted to the possible dryness that occurs under the influence of intense air flow during breathing, and the existence of a certain number of venous sinusoids of the blood confirms the connection with part of the extensive vascular tissues in the nasal cavity. It is believed that the tubercle of the nasal septum is more pronounced in patients with chronic inflammation of the sinonasal region, for example, with chronic allergic rhinitis or chronic rhinosinusitis. There is currently no consensus on the issue of surgery of the nasal septum body. Due to the lack of consensus among practitioners, many surgeons do not routinely perform operations on this structure and consider the surgical intervention too aggressive, and the effect on nasal obstruction is insignificant. However, according to the presented studies, the results of surgical reduction of soft tissues of the enlarged septal tubercle in the treatment of nasal obstruction using radiofrequency ablation, coblation or microdebrider seem promising, which requires additional study of this issue during long-term follow-up.

[The enhancement of the efficacy of early diagnostics of laryngopharyngeal reflux].

The objective of the present study was to improve early diagnostics of extraoesophageal reflux (EGER) disease encountered in the routine otorhinolaryngological practice. The questionnaire for rapid diagnostics of gastroesophageal reflux disease (GERDq), the heartburn severity scoring scale (HBSS), and the reflux symptom index (RSI) were used to estimate the conditions of 91 patients at the age varying from 17 to 72 years meeting the inclusion criteria. The patients were interviewed based on these three scoring systems during the initial consultation and after the test with a proton pipe inhibitor (PPI). The results were used to allocate the patients to two groups one of which was comprised of those with complaints of suffering from heartburn (n=61), the other included the patients free from the heartburn symptoms (n=30). The RSI scores suggested the statistically significant decrease in the symptoms of laryngopharyngeal reflux in the patients of both groups after the test with PPI. The GERD questionnaire was found to be insufficiently informative. It is concluded that the patients complaining of heartburn should be examined first with the help of the heartburn severity scale and then based on RSI. The latter approach should be employed to examine the patients presenting with the clinical symptoms of laryngopharyngeal reflux in the absence of heartburn. The PPI test makes it possible to confirm the presence of laryngopharyngeal reflux and a decrease in its clinical manifestations.

[The comparative study of the effectiveness and safety of various nasal packing techniques in the patients suffering nasal bleeding].

The objective of the present study was to improve the methods for mechanical nasal bleeding (NB) control. To this effect, the authors undertook a prospective comparative study of the effectiveness and safety of two mechanical techniques for nasal tamponade in the patients suffering from nasal bleeding. A total of 48 patients with NB and concomitant arterial hypertension were recruited for the study. In 20 of them, nasal bleeding was arrested with the help of an Epistop-3 three-balloon silicone catheter; in the remaining 28 patients, the gauze packs were used for the purpose. The conditions of the nasal cavity were assessed on the day when the pack was removed and during the next three days by the endoscopic technique and calculation of the mucociliary transport (MCT) time. The subjective assessment of the quality of life by the patients was taken into consideration. The study revealed no relapses of NB in the first group while hyperemia, oedema of nasal cavity mucosa, fibrinous pellicles and crusts were less manifested than in the control patients; moreover, the function of ciliated epithelium and the patients' quality of life were less affected (p<0.05). In the control group, recurrent NB episodes occurred in 42.9% of the patients. It is concluded that the application of the Epistop-3 catheter reduces duration of the rehabilitation period in the patients with NB. The device is fairly well tolerated by the patients; it is less injurious to the intranasal mucous membrane than the gauze pack.

[Laryngopharyngeal reflux as a possible cause of adenoiditis in adult patients].

The objective of the present study was to attract attention of practitioners to the possibility of involvement of pharyngel tonsils in the pathological process in the patients presenting with gastroesophageal reflux. Two clinical cases are reported to illustrate the possibility of development of adenoid vegetations in the adult subjects with laryngopharyngeal reflux. The use of the omeprazole test and the treatment with proton pump inhibitors produced the favourable outcome (adenoid regression) without the application of intranasl corticosteroids and the surgical intervention.

[The state of palatine tonsils in the patients presenting with the deviation of the nasal septum].

The objective of the present study was to further improve diagnostics and treatment of chronic tonsillitis (ChT). It included 100 patients presenting with disturbances of the nasal breathing that resulted in the deviation of the nasal septum and hypertrophy of the inferior turbinate bones. The signs of the simple form of chronic tonsillitis were detected in the 87 patients enrolled in the study. The patients who enjoyed the normalization of the nasal breathing after the surgical intervention had a more favourable clinical course of chronic tonsillitis compared with the patients given no such treatment. The results of the study provide an additional information concerning the relationship between the disturbances of the basal bleeding and the development of changes in palatine tonsils; moreover, they allow determining early indications for the surgical treatment for the correction of the deviation of the nasal septum.