[Assessment of the structural features of the hard palate in endonasal surgery]. / Otsenka anatomii tverdogo neba v khirurgii peregorodki nosa.

Data on the features of the anatomical structure of the hard palate are little described in the scientific literature, and therefore are not taken into account when planning surgical treatment. One of the intraoperative complications during intervention on the lower part of the nasal septum is perforation of the bottom of the nasal cavity, which can develop during a christotomy. This complication mainly depends on the features of the anatomical structure of the hard palate. OBJECTIVE: To study the anatomical structure of the hard palate from the point of view of rhinosurgery, using vector analysis of multispiral computed tomography (MSCT), and to establish anatomical features that should be taken into account when performing surgical interventions on the nasal septum. MATERIAL AND METHODS: 107 patients (30 men, 77 women) were examined without congenital cleft palate and surgical interventions on the structures of the nasal cavity and hard palate. All patients underwent MSCT of the nose and paranasal sinuses (PNS) followed by multiplanar image reconstruction. The key point relative to which the measurements were carried out was the posterior wall of the incisor canal from the side of the nasal cavity. The line corresponding to the bottom of the nasal cavity was chosen as the main vector. In the work, measurements of the thickness of the hard palate (THP) at the level of the palatal suture and the width of the palatal suture (WPS) were carried out. RESULTS: Statistical analysis of the obtained results showed that the THP is 1.74 mm [min 0.28; max 6.46], the WPS is 0.9 mm [min 0.2; max 2.51] (conditional norm). In 19 patients (17.8%), the THP was 0.82 mm, in 2 patients (1.9%) - 0.2 mm. In 3 patients (2.8%), the WPS was equal to 2.5 mm. CONCLUSION: Thus, the data obtained by us indicate that the surgical anatomy of the hard palate is characterized by significant variability, while in some patients the THP can be reduced by 8.8 times, and the WPS increased by 2.7 times compared to normal values. Such anatomical features of the structure of the hard palate should be taken into account when planning septoplasty, since this contingent of patients has an increased risk of developing iatrogenic perforation of the nasal floor during surgical intervention on the lower floor of the nasal septum.

[Epidemiology of spontaneous nasal, ear and throat bleedings]. / Epidemiologiya spontannykh krovotechenii iz ukha, gorla, nosa.

Bleeding is a life-threatening condition, requiring an urgent care. The first line of treatment this kind of patients is ambulance doctors (emergency medical team). Spontaneous bleeding (SB), in this case, don't have a traumatic agent (including surgical trauma). STUDY OBJECTIVE: The purpose of this study was to evaluate spontaneous bleeding epidemiological profile of Moscow city emergency service. METHODS: Study included statistical reports of Moscow city emergency services medical teams (EMT) were servicing adults. We analyzed total number of calls and number of EMT calls to pa-tients with SB during the period between 2015 and 2019. The excluding criteria was EMT re-calls to patents with SB. RESULTS: In a study, it was found that over five-year period of observation, EMT made 15 709 862 calls, included 215 840 calls (1.37%) to patients with SB. It was found that the most frequency sources of SB were: the gastrointestinal tract (33.18%), the nasal cavity (28.14%) and the vagina with the uterus (23.91%). There is the proportion of patients suffering of SB from ENT organs is 28.52% in structure of Moscow city Emergency Medical Service. There are the proportion of epistaxis 98.65%, ear bleeding - 0.89%, throat bleeding - 0.46% in structure of SB from ENT organs. We analyzed, that spontaneous epistaxis most frequent between October and April. This period characterized with 70.6% EMT calls from the total EMT calls to patients with SE.

[Approximation analysis in the study of the epidemiology of the epistaxis]. / Approksimatsionnyi analiz v izuchenii epidemiologii nosovykh krovotechenii.

Epistaxis or nosebleeds (NB) are the most common emergency pathology that otorhinolaryngologists have to deal with. Purpose of the work: to study the prevalence of patients with NB in the otorhinolaryngological departments of hospitals in Moscow from 2003 to 2019. The reports of the heads of the ENT departments of the city clinical hospitals in Moscow were studied. Inclusion criteria were hospitals working with an adult contingent of patients. An approximation analysis was carried out and trend indicators of the prevalence of NB were studied. RESULTS: 2003 to 2019 the total number of patients treated in ENT hospitals was 563 189 people, 20 623 (3.7%) patients were treated with NB, of which 52 (0.25%) died. The average age of the deceased was 64.7 years, men are 73.7% more prevalent than women. In 96.2% of patients, epistaxis was a complication of the underlying disease, and in 3.8%, it was regarded as a concomitant condition. In 30.8% of the deceased, NB recurred with the background of malignant lesions of the nose and nasopharynx, in 69.2% - posthemorrhagic anemia aggravated diseases of other organs and systems. Over the past 17 years, there has been a tendency for the growth of treated patients with diseases of ENT organs and patients with nosebleeds by 58.5% and 51.1%, respectively. The studied approximation of the relative prevalence and mortality rates in patients with NB showed that for the period from 2003 to 2019. trend values are practically at the same level with the minimum multidirectional linear dynamics - -0.24% and +0.04%, respectively.

[Prospects for a passive acoustic research method in otorhinolaryngology]. / Perspektivy passivnogo akusticheskogo metoda issledovaniya v otorinolaringologii.

The authors of the article reviewed acoustic research methods in otorhinolaryngology. All acoustic diagnostic methods are divided into active and passive. Active acoustic methods are based on the emission of acoustic vibrations, in some cases with the subsequent reception and processing of reflected vibrations. Passive acoustic research methods are based on the recording and analysis of sounds arising during the physiological functioning of the studied organs and systems. In otorhinolaryngology, active acoustic methods of studying the ENT organ are more widespread: audiometry, acoustic impedance measurement, ultrasound examination of hearing, auditory evoked potentials, sonotubometry, acoustic rhinometry, ultrasound examination of soft tissues of the neck and paranasal sinuses. Among passive acoustic research methods, the greatest development in clinical practice in otorhinolaryngology was obtained by computer acoustic analysis of the voice - an assessment of the phonatory function of the larynx. Using similar technologies, a technique for acoustic analysis of nasal breathing was developed - a functional assessment of the external nasal valve. Separate groups of authors have carried out an experimental study of the sounds that occur when the auditory tube is opened. Achievements in acoustics and the introduction of advanced technologies in medicine create prerequisites for improving existing and developing new methods of acoustic analysis of the work of ENT organs.

[Quincke's edema or angioedema. A contemporary view of the problem]. / Otek Kvinke ili angionevroticheskii otek. Sovremennyi vzglyad na problemu.

The article describes statistical data on patients with angioedema (AE) in the structure of ambulance services and four large multidisciplinary hospitals with otorhinolaryngological departments of the city of Moscow for 2017. The ratio of the number of calls to the NSR in Moscow for AE to the total number of calls was analyzed; the ratio of the number of calls to the ambulatory system for AE to the total number of calls to patients with allergic reactions; the ratio of patients with AE among the total number of treated patients in 3 hospitals in Moscow; the ratio of patients with AE of the upper respiratory tract (URT) among the total number of patients with AE; the ratio of patients with AE URT among the total number of patients with ENT pathology. As a result of the study, it was found that the share of AE in the structure of emergency calls of ambulance teams (n=3 070 491) was 0.7% (n=20 040) and 38.4% of the total number of calls for allergic reactions (n=giant urticaria 52 153). Patients with AE make up 0.34% (n=919) of the total number of treated patients in hospitals (n=269 980). The proportion of patients in whom AE was manifested with a lesion of URT among patients with AE is 1 1.5%. The frequency of occurrence of AE URT among patients hospitalized with pathology of ENT organs (n=14 395) is 0.7% (n=106).

[Eustachian tube drug delivery to the tympanum in patients with otitis media with effusion]. / Otsenka transtubarnoi dostavki lekarstvennykh preparatov v barabannuyu polost' pri ekssudativnom srednem otite.

There are no reliable data on the volume of the drug reaching the affected tympanic cavity during the catheterization of Eustachian tube (ET). Objective: to conduct an experiment and to study the effectiveness of administering a drug into the tympanic cavity of the middle ear using an original ear catheter, which allows catheterization of ET in the direction of its lumen. The study included patients with unilateral OME (n=21, the duration of the disease from 2 to 3 months), who were recommended for the ventilation tube insertion. The main inclusion criterion was 3 degree of patency of the ET. The experiment was performed under endotracheal anesthesia. ET was catheterized before insertion of the ventilation tube, with a 0.9% saline in a volume of 7 ml, which was previously tinted with Brilliant Green. A syringe with a contrast solution was connected to an ear catheter and the drug was injected into the middle ear by the air-liquid substitution method. Otoscopically evaluated the following parameters: the volume of the injected drug (in ml) for the initial (V1), partial (V2) and complete filling of the tympanic cavity (V3). As a result, it was found that 18 patients (85.7%) achieved full or partial filling of the tympanic cavity with a stained preparation: V1=2.25 ml, V2=7.0 ml in 11 (52.4%) patients, V3=4.29 ml - in 7 (33.3%) patients. In this case, the minimum loss of the liquid form of the drug during CT catheterization is 1:2. In 3 (14.3%) patients there were no endoscopic signs of contrasting of the tympanic cavity.

[ENT care in the context of the new coronavirus infection COVID-19]. / Aktual'nye voprosy okazaniya spetsializirovannoi lor-pomoshchi v usloviyakh novoi koronavirusnoi infektsii COVID-19.

The spread of the pandemic of the new coronavirus infection COVID-19 inevitably makes adjustments to the medical care. Given that the main route of transmission is airborne, otorhinolaryngologists are at increased risk of infection. Based on the literature data of leading otorhinolaryngologists, as well as their own experience working with patients with the new coronavirus infection COVID-19, the authors present relevant recommendations on the organization of specialized otorhinolaryngological care in the context of the COVID-19 pandemic. The authors consider the etiology, pathogenesis, and clinical manifestations of COVID-19. The features of the examination of ENT, diagnostic and therapeutic procedures, including the use of silicone hydrotamps to stop the front and rear nose bleeds, developed in L.I. Sverzhevskiy OHRIM, and indications for hospitalization in the ENT hospital. Features of operations on the otorhinolaryngological profile during a COVID pandemic are also described. Summing up, the authors indicate that during the pandemic of the new coronavirus infection COVID-19, otorhinolaryngologists need to adhere to two fundamental principles aimed at preventing the spread of infection: the use of modern effective personal protective equipment and the use of examination methods (surgical treatment methods) that prevent the formation of biological aerosols.

[Persistant dysfunction of the eustachian tube: solving the problem].

Each person experienced an unpleasant sensation of congestion of the ear during a flight or in rhinorrhea, which is caused by dysfunction of the Eustachian tube (ET). People with persistent ET dysfunction live with this sensation for months and years. Persistent ET dysfunction in children reaches 40%, in adults it is up to 5%. Most of the pathological conditions of the middle ear, leading to socially significant hearing loss, and the main reasons for failures in hearing-improving operations are associated with persistent ET dysfunction. The effectiveness of various methods of treating this pathology, despite their large quantity, still remains doubtful due to the lack of clear criteria and golden standard for diagnosis, indications for specific methods and long-term results of treatment. According to the aim of the study a diagnostic and treatment algorithm was developed for persistent ET dysfunction in adults and children. We researched this problem for more than 10 years, and the effectiveness of the proposed diagnostic and therapeutic measures has been statistically proven, both by a large sample of patients and by a long period of observation. Researchers of L. I. Sverzhevsky Research Institute of Otorhinolaryngology have developed a diagnostic algorithm for persistent ET dysfunction, optimized the treatment of persistent dysfunction and recurrent concomitant secretory otitis media, and also determined the indications and methods for conducting ET balloon dilatation in adults and children with persistent ET dysfunction. We improved the functionality results of hearing-improving operations (tympanoplasty) in patients with persistent ET dysfunction. All of the above allowed us to reduce the treatment time for this group of patients by up to 50%, to achieve high clinical efficacy in up to 100%, and to obtain a lasting functionality in hearing-improving operations in 93% of cases.

[Features of thermal effect at high-frequency laser impact on biological tissue (experiment). Technique of laser ablation of a pharyngeal tonsil]. / Osobennosti termicheskogo éffekta pri vysokochastotnom lazernom vozdeistvii na biologicheskuiu tkan' (éksperiment). Metodika lazernoi abliatsii glotochnoi mindaliny.

In the conditions of the experiment the peculiarities of thermal influence of Ho:YAG on biological tissue in the ablation mode were studied. In the experiment we used: surgical laser system LUMENIS VersaPulse PowerSuite 20, universal thermal imaging camera FLIR SC7000. The biological object (turkey meat) was remotely, at a distance of 5 mm, affected by a Holmium laser (E = 0.9 J and R = 12 Hz) for 6 seconds. The maximum temperature (Tmax, °C) in the ablation zone was measured in real time. As a result, it was found that laser ablation of a biological object is characterized by thermal effects, which largely depend on the state of irradiated tissue: the temperature of the irradiated object rises to critical values equal to 100.07-111.24 ° C, after which the surface layer of biological tissue is charred, and the process of laser "removal" stops; intact biological tissue reaches critical heating after 3.48 s, while under the influence of a high-frequency laser on the previously irradiated biological tissue development period It was also established that in order to continue laser ablation with controlled thermal effect it is necessary to remove charred areas of biological object. On the basis of the obtained data the method of laser ablation of pharyngeal tonsils was developed.

[Diaphanoscopy palatal tonsils with use of the diode laser]. / Diafanoskopiia nebnykh mindalin s primeneniem diodnogo lazera.

For the purpose of decrease in intraoperative blood loss during a tonsillectomy the technique of a laser diaphanoscopy (DS) of the palatal tonsil (PT) and paratonsil space is developed. In the conditions of a transillumination of tissues of throat vessels paratonsil space which are preventively coagulated by the holmium laser are visualized. In carrying out DS of structures of a throat the 'pilot' red laser of the surgical laser LUMENIS Versa Pulse Power Suite 20W system was used. In a research there were 60 patients with chronic tonsillitis. Laser DS was carried out before tonsillectomy, at the same time 120 PT were subjected to raying. As result of the conducted research established that 60% of PT (n=72) anatomic were deeply shipped in a sidewall of a throat, 44,2% of PT (n=53) - had the expressed top pole, 0,8% of PT (n=1) - an additional segment. Also it was established that laser transillumination of paratonsil space is possible in the conditions of infiltration of fabrics isotonic physiological NaCl solution of 0,9%. Carrying out preventive coagulation of vessels of paratonsil space of Ho:YAG laser in the conditions of DS allows to reduce the volume of intraoperative blood loss to 4,17±0,37 ml that is 10,1 time less in comparison with the tonsillectomy which is carried out on traditional techniques.

[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.

[The application of contrast-enhanced X-ray salpingography for the evaluation of the effectiveness of catheterization of the acoustic tube with the use of the Eustachian catheters]. / Rentgenokontrastnaia sal'pingografiia v otsenke éffektivnosti kateterizatsii slukhovoi truby ushnymi kateterami.

The objective of the present study was to evaluate the effectiveness of the administration of a medication into the middle ear structures during catheterization of the acoustic tube (AT) in the course of the contrast-enhanced X-ray salpingographic investigation. The study included 18 patients (18 ears) presenting with chronic otitis media and the perforated tympanic membrane without the disturbances of the ventilation function of the auditory tube. All the patients were allocated to two groups depending on the type of the Eustachian catheters being used. Group 1 was comprised of 9 patients treated with the use of traditional Giyot's catheter, group 2 was composed of another nine patients who were treated with the use of the Eustachian catheters having an original shape with a specific configuration of its distal part. The X-ray studies were carried out before and after catheterization of the acoustic tube with the administration of 1 ml of the hypaque contrast medium. The study has demonstrated that the X-ray contrast agent did not penetrate into the inner structures of the middle ear of the patients comprising group 1 whereas in the patients of the second group the contrast medium reached as far as the bony portion of the acoustic tube.

[Identification of the specific topographic features of the neck vessels for the prevention of bleedings during tonsillectomy]. / Identifikatsiia osobennostei topografii sosudov shei v profilaktike krovotechenii pri tonzilléktomii.

The objective of the present work was to study syntopy of the large neck vessels in relation to the capsule of palatine tonsils with the use of the MRI technology. A total of 109 patients (218 palatine tonsils) presenting with chronic tonsillitis were available for the examination including 64 women and 45 men at the age varying from 15 to 54 years. All of them underwent MRI-guided vascular visualization in the paratonsillar region together with the measurements of the vessels extending to the capsule of the palatine tonsils at the level of the upper and lower poles, and also close to the mid-third of each palatine tonsil. The distance from the external carotid artery to the upper and lower poles of the palatine tonsils was found to be 17.1±1.01 mm and 10.3±0.18 mm respectively and in the mid-third the palatine tonsil 10.7±0.12 mm; the distance from the internal carotid artery to the upper and low poles of the palatine tonsil amounted to 14.5±0.84 mm and 16.8±0.77 mm respectively while that to the mid-third of the palatine tonsil was 15.3±0.07 mm. The branches of the external carotid artery feeding the palatine tonsils are the most frequent sources of bleedings; the following measurements were obtained: the maxillary artery 16.4±0.43 mm (17.4%) - the upper pole 9.6±0.02 mm (46.2%), the mid-third of the palatine tonsil 18.5±0.74 mm (29.5%) - the lower pole; the lingual artery 4.7±0.02 mm (6.8%) - the mid-third of the palatine tonsil, 6.2±0.82 mm (56.8%) - the lower pole; facial artery: 4.2±0.01 mm (0.76%) - the mid-third of the palatine tonsil; the occipital artery 25.6±0.12 mm (19%) - the upper pole; 14.8±0.11 mm (18.9%) - the mid-third of the palatine tonsil 9.56±0.12 mm (3.8%) - the lower pole; the tonsillar artery 1.88±0.01 mm (9.8%) - the upper pole; 2.51±0.01 mm (23%) - the mid-third of the palatine tonsil; 2.12±0.01 mm (11%) - the lower pole. The distance from the internal jugular vein to the capsule of the palatine tonsils in the region of the upper pole of the palatine tonsil was 28.3±1.01 mm, in the lower pole region 26.6±1.54 mm, and in the region of the mid-third of the palatine tonsil 22.7±1.24 mm. It is concluded that the results of the present study may be useful for the planning of the surgical strategy for the treatment of the patients presenting with chronic tonsillitis and for the prevention of hemorrhagic complications of tonsillectomy.

[Sintopy of the distal end of the nasolacrimal duct detected by means of the vector analysis of the CT-identified anatomical features of the nasal cavity]. / Sintopiia distal'nogo kontsa nososleznogo kanala po dannym vektornogo analiza KT-anatomii polosti nosa.

The objective of the present work was to study syntopy of the distal end of the nasolacrimal duct based on the results of the vector analysis of the CT-identified anatomical features of the nasal cavity and the paranasal sinuses in 102 patients (204 nasolacrimal channels). The main criterion for inclusion in the study was the absence of traumatic injuries and inflammatory changes in the nasal cavity and the paranasal sinuses. X-ray studies of the distal end of the nasolacrimal duct (NLD), turbinate crest (crista conchalis), the edge of the nasal aperture, and the floor of the nasal cavity were carried out. The vector and angle measurements were made with respect to the bottom of the nasal cavity in the perpendicular and parallel planes. The study has demonstrated that the distal end of the nasolacrimal duct was located 3.49 mm above the level of crista conchalis of the maxillary bone 19.77 mm and 22.04 mm apart from the edge of the aperture of the nose in the individuals younger than 20 years and in the older subjects respectively. Syntopy of the distal end of NLD relative to the bottom of the nasal cavity did not depend on the sex and age of the patients and was localized at a depth of 13.93 mm from the edge of the aperture of the bone and 11.86 mm above the bottom of the nose.

[The original method for the endonasal surgical access to the maxillary sinus through crista conchalis of the maxillary bone]. / Original'nyi metod éndonazal'nogo khirurgicheskogo dostupa k verkhnecheliustnomu sinusu cherez crista conchalis verkhnecheliustnoi kosti.

The objective of the present work was to develop a technique for the endonasal surgical access to the maxillary sinus through crista conchalis of the maxillary bone and to evaluate the effectiveness and safety of the surgical treatment by this method. A total of 210 patients underwent the CT-assisted examination of the paranasal sinuses. The data obtained made it possible to characterize the detailed anatomical structure of crista conchalis of a maxillary bone that forms the anterior part of the medial wall of the maxillary sinus. The syntopy in relation to the distal end of the nasolacrimal canal and the cavity of the maxillary sinus was investigated. The results of the study were used to develop the original technique for endonasal antrotomy that included the 0.5-1.0 cm long vertical section of the mucous membrane at the level of the anterior end of the inferior turbinated bone approximately 1 mm from the edge of the bone aperture of the nose which exposed crista conchalis up to the place of fixation of the inferior turbinated bone. Then, the diamond drill burr was use to carry out trepanation of the medial wall of the maxillary sinus in the region of crista conchalis of the maxillary bone; sanitation of the of the sinus was followed by the apposition of the edges of the incision and their fixation with two sutures. The safety of the proposed surgical technique was confirmed by results of the repeated CT examinations of the paranasal sinus and its effectiveness by the clinical follow-up observations.

[Preoperative MRI diagnostics of the topographic features of neck arteries in the patients presenting with chronic tonsillitis]. / Predoperatsionnaia MRT-diagnostika topografii sosudov shei u patsientov s khronicheskim tonzillitom.

The objective of the present study was to determine the frequency of abnormalities of the major neck vessels and elucidate the specific features of blood supply of palatine tonsil based on the results of MRI performed in the vasculature-targeting regimen. A total of 109 patients presenting with chronic tonsillitis (including 64 women and 45 men at the age varying from 15 to 54 years) were available for the examination. All the patients underwent the MRI diagnostic study of the neck vessels by way of the preliminary evaluation of their condition at the pre-hospital stage. Abnormalities in the internal carotid artery were documented in 11.9% of the cases (including C- and S-shaped tortuosity of internal carotid artery in 6.88%, kinking and coiling of internal carotid artery in 4.13% and 0.92% of the patients, respectively). The majority of the detected abnormalities were located above the upper pole of the palatine tonsil which allowed to avoid the risk of the injury to the main neck vessels and prevented possible hemorrhage. One patient (0.46%) presented with kinking of the right internal carotid artery located in the immediate proximity to the capsule of the palatine tonsil close to its mid-third portion. There was no evidence that the present study gave rise to any malformation of the internal carotid artery and internal jugular vein. The proposed diagnostic method makes it possible to detect a rare anatomical feature of the development of the internal carotid artery discovered in a single patient (0.04%) out of the 2398 operated ones. This finding is of clinical significance and needs to be borne in mind when preparing the planned surgical intervention for the treatment of chronic tonsillitis. The results of the present study should be taken into consideration when prescribing the surgical treatment to the patients suffering not only from chronic tonsillitis but also from other ENT diseases, in the first place pharyngotympanic tube pathology.