[Lesions of the cortical part of the auditory analyzer in explosive injury]. / Narusheniya korkovogo otdela slukhovogo analizatora pri vzryvnoi travme.

A survey of 48 victims aged 19-36 years with explosive trauma and combined damage to the auditory system was conducted to assess the level of damage to nerve structures by analyzing the bioelectric activity of the cerebral cortex. All patients underwent electroencephalography (EEG). It is established that akubarotrauma of explosive genesis almost always leads to lesions of the function of the cortical part of the auditory analyzer. Desynchronized activity on the EEG after acubarotrauma is a favorable prognostic sign, indicating only functional disorders of the cortical part of the auditory analyzer. On the contrary, EEG changes of an organic type of cortical or stem nature are an unfavorable prognostic factor, usually accompanied by sensorineural hearing loss with prolonged and incomplete hearing recovery. Promising drugs for the treatment of otoneurological disorders are antihypoxants, in particular, derivatives of triazine indole, which affect the molecular mechanisms of hypoxia development.

[Complex disorders in children with sensorineural hearing loss - influence on the diagnosis of hearing pathology and hearing aid]. / Kompleksnye narusheniya u detei s sensonevral'noi tugoukhost'yu ­ vliyanie na diagnostiku patologii slukha i slukhoprotezirovanie.

The presence of additional disabilities (AD) in children with sensorineural hearing loss (SNHL) and influence of AD on age of hearing loss diagnosis and amplification were investigated. It was shown that 41% children with SNHL have different AD - pathology of the central neural system (including mental retardation, autism spectrum disorders, attention deficits), vision, motor and articulation impairments, cardiovascular, respiratory, urinary, digestive, endocrine diseases etc. 59% children among them have 2-3 AD. The most often combination of AD was pathology of central neural and motor systems. The genetic factor was revealed rarely in the group of children with AD than in children with SNHL only. The diagnosis of hearing loss before age 4 months was rarely in the group of children with AD. Possibly it is because of the most of such children got treatment in neonatal intensive care unit and didn't have access to universal newborn hearing screening. Moreover, SNHL might develop later as the outcome of their AD or their treatment. Suggestion about more late amplification in children with SNHL was confirmed. The cause might be wary relation of audiologists to amplification of children with AD and difficulties of this process.

[A meta-analysis of clinical studies in otorhinolaryngology]. / Metaanaliz klinicheskikh issledovanii v otorinolaringologii.

THE OBJECTIVE: Of the work was to describe the basics of a meta-analysis with features for evaluating models with fixed and random effects, to present principles for interpreting the graphical results of a meta-analysis (forest plot or blobogram) of comparative reviews of randomized clinical trials (RCTs). MATERIAL AND METHODS: To illustrate the possibility of efficient use of the R software environment for meta-analysis, we used the results of RCTs of various tonsillectomy methods already published in the Cochrane Database review. RESULTS: The article provides explanations for the calculation of effect size, heterogeneity statistic, and other meta-analysis statistics and their interpretation for evaluating RCTs and recommendations for choosing a model depending on the on the general research concept. CONCLUSION: The described method allows meta-analysis and gives an idea of the principles for preparing the results of clinical trials with the expectation of their subsequent use in systematic reviews and meta-analysis.

[Sequential bilateral cochlear implantation with long interval between surgeries in deaf-blind patient]. / Posledovatel'naia bilateral'naia kokhlearnaia implantatsiia s dlitel'nym intervalom mezhdu operatsiiami u slepoglukhogo patsienta.

The efficacy of sequential bilateral cochlear implantation with long interval between surgeries (18 years) was investigated in deaf-blind patient (22 years old man, lost hearing and vision after meningitis at the age 2.5 years). At the age 4 years he got cochlear implant at right ear. His speech skills completely disappeared before the implantation. Auditory-speech rehabilitation with cochlear implant was successful - patient has good auditory, language, speech, cognitive skills. At the age 22 years patient made decision to get cochlear implant at the left ear after breakdown of internal part of cochlear implant at right ear in spite of successful reoperation. After activation of new processor (all electrodes were activated) the patient got daily auditory training with cochlear implant at left ear (Concerto/Opus 2, Medel) on the base of 'auditory' method, in daily life patient uses 2 devices. After 1 month of using cochlear implant at left ear the patient recognized environmental sounds and music instruments, words and sentences in close set tests EARS battery, the score for OLSA test in quiet was 90%, but the perception in noise was complicated. The balance of parameters of fitting for 1-st and 2-nd processors and special auditory training with two cochlear implants provided the development of initial binaural interaction. Perilinqually deaf patients can achieve high effect after sequential bilateral cochlear implantation with long interval between surgeries. The necessary conditions are - preservation of electrical activity of auditory nerve, intensive structured auditory training with new 'ear', patient's motivation of using of cochlear implant at 'new' ear.

[Round window niche area anatomy in terms of cochlear implantation]. / Anatomiia oblasti nishi okna ulitki primenitel'no k khirurgicheskomu étapu kokhlearnoi implantatsii.

Cochlear implantation is the most effective method of rehabilitation of patients with a high degree of hearing loss and deafness. This is a complex, multi-stage way of rehabilitation that includes selection of candidates for surgical intervention, a surgical stage and postoperative long-term auditory rehabilitation. In carrying out the surgical stage of cochlear implantation the round window niche area is of great interest, since the variability of its anatomical features affects the access to scala tympani. The article presents the data obtained from study of the round window niche area anatomy on cadaveric temporal bones. Variations of structures important for cochlear implantation have been determined.

[The choice of the treatment strategy for the patients presenting with chronic tonsillitis of streptococcal etiology and subfebrility of long duration]. / Vybor lechebnoi taktiki u bol'nykh khronicheskim tonzillitom streptokokkovoi étiologii i dlitel'nym subfebrilitetom.

The objective of the present study was to develop the optimal therapeutic strategy for the management of the patients with chronic tonsillitis (CT) of streptococcal etiology accompanied by subfebrility of long duration (LDS). The clinical characteristic of the patients presenting with this condition is presented together with the results of their treatment by different methods. It is shown that bilateral tonsillectomy is the most efficient approach to the management of the patients presenting with chronic tonsillitis of streptococcal etiology and subfebrility of long duration.

[Allergic rhinitis: the modern aspects of therapy]. / Allergicheskii rinit: sovremennye aspekty terapii.

The main objectives of the present article were to systematize the modern views of the causes and risk factors of allergic rhinitis, to clarify the manner of its development, to define the leading etiological mechanism underling the pathogenesis of this condition, to consider the methods used for the diagnostics and the treatment of this disease, and to sum up the clinical experience with the use of Levocetirizine (Allerwey) for the management of allergic rhinitis. Special attention is given to the achievement and the maintenance of control of the persistent or intermittent forms of allergic rhinitis and to approaches to its treatment based on the medications registered in the Russian Federation.

[Topographic anatomy of the hook region and its significance for the choice of the surgical technique for the cochlear implantation]. / Topograficheskaia anatomiia oblasti 'rybolovnogo kriuchka' i ee znachenie pri vybore khirurgicheskoi tekhniki kokhlearnoi implantatsii.

The mode of the introduction of the active electrode of a cochlear implant into the cochlea remains a key issue as far as cochlear implantation is concerned. Especially much attention has recently been given to the relationship between the anatomical features of the basal region of the cochlea (the so-called 'fish hook') and the possibility to approach it. We have undertaken the attempt to optimize the approach to the tympanic canal (scala tympanica) of the cochlea with a view to reducing to a minimum the risk of an injury to the cochlear structures in the course of cochlear implantation. A total of 35 cadaveric temporal bones were examined to measure the fine structures of the hook region and evaluate the risk of their damages associated with various approaches to the tympanic canal.

EPIDEMIOLOGIC AND DEMOGRAPHIC FEATURES OF INTRACRANIAL OTO- AND RHINOSINUSOGENIC PYOINFLAMMATORY COMPLICATIONS IN RUSSIAN FEDERATION.

An analysis of demographic and epidemiologic situation was made in cases of otogenic and rhinosinusogenic intracranial complications on the area of 32 regions of Russian Federation at the period from 2009 to 2014. The state of ENT-service of examined subject is characterized by reduction of provision of during ENT-beds and lower level of hospitalization of population over indicated period. There was revealed a reliable correlated dependence of the main medical statistical indices from the intracranial complications with climatic and demographic factors, the rate of morbidity and activities of ENT-service in the area of this region.

COOPERATIVE MANAGEMENT OF NEUROSURGEON AND OTOLARYNGOLOGIST IN TREATMENT OF CHILDREN WITH OTORHINOGENIC SUPPURATIVE-INFAMMATORY BRAIN DISEASES.

This work analyzed 47 cases of oto- and rhinosinusogenic suppurative meningoencephalitis, abscesses and empyemas of the brain in children at the age from 3 months to 17 years old. The article presents the treatment strategy, results and the volume of diagnostic measures. On the basis of this research, the authors came to conclusion, that care of the children with otogenic and rhinosinusogenic suppurative diseases of the brain required an interdisciplinary approach and effective cooperation of a neurosurgeon, otolaryngologist, pediatrician, resuscitation specialist, infectionist and a clinical pharmacologist.

[The specific clinical features of otogenic intracranial complications: the current views].

The objective of the present study was to elucidate the specific clinical features of otogenic intracranial complications (ICC) encountered in the current otorhinolaryngological practice. The work is based on the results of the retrospective analysis of 106 adult patients presenting with otogenic intracranial complications admitted for the treatment to multidisciplinary clinics of Sankt-Peterburg and Krasnoyarsk. Forty six (42.5%) patients presented with acute otitis media. 90% of them had suppurative destructive mastoiditis. In sixty (56.6%) patients, chronic suppurative otitis media (epitympanophonia) was associated with the extensive destructive process spreading toward dura mater of the medial and posterior cranial fossae and onto the sigmoid sinus. The prevalence of intracranial complications among the adult patients suffering from suppurative otitis media and treated in the otorhinolaryngological clinics amounted to 3.17%. The overall structure of otogenic intracranial complications was as follows: meningitis 42.5%, brain and cerebellum abscess 24.5%, suppurative meningoencephalitis 19.8%, sinus thrombosis 5.7%, epidural and subdural empyemas 4.7%, the combined suppurative brain lesions 2.8%. Systemic inflammatory response syndrome (sepsis) was diagnosed in 33 (31%) patients with otogenic ICC. The high intrahospital mortality rate among the patients with this condition (20.8%) is emphasized. The main causes of the fatal outcome in the patients with otogenic intracranial complications are supposed to be brain oedema with the concomitant development of dyslocation syndrome and sepsis.

[FEATURES OF OTOGENIC INTRACRANIAL COMPLICATIONS AT THE PRESENT STAGE].

A retrospective analysis of treatment was made in 127 adult patients with acute and chronic otitis media complicated by suppurative-inflammatory pathology of the brain. Purulent meningitis was revealed in 52 (40.9%) of hospitalized patients. Meningoencephalitis was often diagnosed in the cases of acute otitis media (15.4%) and in cases of chronic otitis (22.7%). The otogenic brain abscess was detected in 13.5% of otitis media cases and it was noted to be twice frequent (33.3%) in cases of purulent otitis media. The patients 124 (97.6%) have been operated. An extended mastoidotomy and antromastoidotomy were performed in the acute purulent otitis media. An extended radical operation on the ear was applied in case of chronic otitis media. Performance of craniotomy and complete removal of the abscess using modern systems of neuronavigation showed a higher clinical efficacy as compared with transtemporal approach during sanitizing intervention on the ear including the opening and abscess drainage in surgery of otogenic abscesses of the brain.

[The modern epidemiological characteristics of oto- and rhinosinusogenic intracranial complications].

The objective of the present study was to survey epidemiology of oto- and rhinosinusogenic intracranial complications that are currently diagnosed at the territory of the Russian Federation. The work was based on the analysis of the official statistical reports together with the data obtained from the chief specialists responsible for the otorhinolaryngological services in 32 subjects of the Russian Federation during the period from 2009 to 2014. It was shown that the state of the otorhinolaryngological service in the period covered by the study was characterized by the reduction in the number of beds available for the patients presenting with ENT pathology by 14.0% and the lowering of the hospitalization rate for the general population by 6.3%. The frequency of oto- and rhinosinusogenic intracranial complications among the patients hospitalized to occupy the beds intended for the care of the patients suffering from ENT diseases was estimated at 0.03% and intrahospital lethality at 21.2%. The prevalence of pyogenic intracranial complications associated with the inflammatyory pathology affecting ENT was 0.61 per 100.000 population per year, with the mortality rate amounting to 0.17 fatal outcomes per 100.000 population per year. The study revealed significant correlation of the principal medico-statistical characteristics of high-frequency oscillatory ventilation (HFOV)---?? between themselves and with the parameters of ENT morbidity and activities of the otorhinolaryngological services at the territory of a given administrative territory. It is concluded that the improvement of the quality of healthcare for the population presenting with intracranial complications and inflammatory ENT diseases is possible only on the baseis of the combined and interdisciplinary approach to the solution of the problem.