[Neurofibromatosis type 2 in the otorhinolaryngological practice]. / Neirofibromatoz 2-go tipa v praktike vracha-otorinolaringologa.

Neurofibromatosis type 2 (NF2) is a rare autosomal dominant disease (frequency 1 in 25-90 000) characterized by the formation of tumors of the central nervous system due to a mutation in the NF2 gene on chromosome 22q12. Bilateral vestibular schwannomas are recognized as absolute diagnostic criteria of NF2 and occur in 95% of patients, are accompanied by hearing impairment, manifest at the age of 18-24 years. Skin manifestations can precede vestibular schwannomas for several years and predict the course of the disease: neurofibromas, cafe-au-lait macules, hypopigmented spots, recently described mesh capillary malformations. Despite the benign nature of schwannomas, they can lead to hearing loss, vestibular dysfunction, facial nerve paralysis, gait disorders, pain and convulsions, there is a risk of early death from compression of the brain stem. The probability of progressive hearing loss is partly determined by the type of mutation. We described a clinical case of NF2 in a 21-year-old patient with bilateral vestibular schwannomas without hearing loss, whose skin examination by ENT specialist revealed this disease. The importance of the presented observation is that the doctor should assume neurofibromatosis type 2 in a young patient with bilateral vestibular schwannomas. It is necessary to undertake a further examination of this patient, including: skin examination for the identification of characteristic neurofibromas and cafe-au-lait macules, consultation with an ophthalmologist, neurologist, MRI of the brain and spinal cord with contrast, genetic analysis - for timely initiation of therapy that prevents hearing loss and vestibular disorders.

[Ultrasonography for peritonsillar abscess diagnosis: benefits and drawbacks]. / Ul'trazvukovaya diagnostika paratonzillyarnogo abstsessa: preimushchestva i nedostatki.

In 2 clinical cases the neck soft tissues ultrasound in the young and old patients allowed to solve the main diagnostic tasks: to determine the presence of peritonsillar abscess cavities, their sizes and localization; to exclude the fit of large vessels near to abscesses and the presence of abnormal vessels; to conduct differential diagnosis of abscesses from a tumor and allergic angioedema. Ultrasound with external access did not require any special preparation, was easily tolerated by the patient, was informative, but it was difficult to determine the puncture place. Intraoral ultrasound was more difficult to conduct, because the transducer should be small in size to enter the patient's mouth. If the patient had a pronounced trismus, intraoral ultrasound couldn't be done. On the one hand in a case of children use the standard transducer cannot fit in the mouth as well and may be damaged by teeth. But on the other hand, the abscess puncture site can be more easily determined by intraoral examination. Compared to multi-slice computed tomography with contrast, the ultrasound method is cheaper, more accessible, faster, more informative and there is no radiation exposure associated with this method. CONCLUSION: Ultrasound of the peritonsillar region by external and intraoral methods is informative for detecting peritonsillar abscess, especially in difficult diagnostic cases.

[Diagnostic efficiency of transcutaneous ultrasound scanning and Dopplerography in laryngeal pathology]. / Diagnosticheskaya effektivnost' ul'trazvukovogo skanirovaniya i doplerografii pri patologii gortani.

OBJECTIVE: To assess the efficiency and the place of grey scale ultrasound and color Doppler sonography of the larynx in the diagnosis of laryngeal pathology. MATERIAL AND METHODS: A prospective blind cohort examination in B-mode laryngeal ultrasound (LUS) and color Doppler imaging (CDI) with linear scanning transducer 7-15 MHz was performed in 120 patients aged from 6 months to 52 years (average age 7.6±5.8 years, Me 6 year) and in 40 patients without laryngeal pathology (average age 7.0±5.0 years). The patients presented with complaints of voice and/or stridor. The diagnosis was verified by followed laryngoscopy. RESULTS: Laryngeal papillomas, hemangiomas, scarring and vocal fold's nodules were identified as hyperechoic formations. Color Doppler sonography made it possible to visualize them better: small formations were highlighted in color and the space around the large ones was colored. There were paradoxical movements of the hyperechoic arytenoid cartilages during inspiration to the anterior commissure in patients with laryngomalacia. Color Doppler ultrasonography revealed changes during phonation in patients with functional dysphonia. The sensitivity and specificity of LUS were 58% (95% CI 48-66) and 98% (95% CI 87-99) compared with laryngoscopy in the detection of laryngeal pathology, but laryngeal CDI - 81% (95% CI 72-87) and 98% (95% CI 87-99) respectively. CONCLUSION: Ultrasound of the larynx in B-mode has a diagnostic efficiency of 67.5%, and in CDI mode - 85% for ruling in laryngeal pathologies compared to laryngoscopy. So, this method is a modern affordable, non-invasive and informative diagnostic tool for the detection of laryngeal diseases, especially in those cases, when it is impossible to carry out a laryngoscopy.

[The effect of various types of nasal septal deviation, concha bullosa and hypertrophic inferior turbinate on the development of sinusitis]. / Vliyanie razlichnykh tipov deformatsii nosovoi peregorodki, concha bullosa i gipertrofii nizhnikh nosovykh rakovin na razvitie sinusita.

OBJECTIVE: To determine the impact of various types of unilateral nasal septum deviation (NSD), concha bullosa (CB) and hypertrophic inferior turbinate (HIT) on the development of sinusitis. MATERIAL AND METHODS: This study was conducted in the Irkutsk State Medical University and the Irkutsk City Clinical Hospital No. 1 from October 2017 to November 2018. By continuous sampling retrospective analysis of 1300 protocols of paranasal sinuses MSCT of adult patients was performed. We used MSCT scanners Somatom Emotion 16 Siemens and GE BrightSpeed 16. The studies were carried out on the patients lying on the back with the subsequent reconstruction on a graphical station in the coronal and axial projections using the slices around 1 mm in the thickness. Inclusion criteria: unilateral or absence NSD. Exclusion criteria: bilateral NSD, chronic polyposis or allergic rhinitis. We have analyzed 272 protocols: 70 without NSD and 172 with unilateral NSD, on the right side - 89 (52%) and on the left - 83 (48%). 108 (44.6%) patients were male and 134 (55.4%) were female with average age 38.5±12 years. All patients were divided into 4 groups by R. Mladina' classification (1987): with NSD types 1, 2, 3, and 5. The results were evaluated using the Yates corrected chi-square and the Fisher's exact test by Statistica 10.0. RESULTS: There were 34 patients with NSD type 1: 12 with sinusitis; 9 had CB: 6 with sinusitis, 3 without it; HIT was in 27 cases: 33% with sinusitis, 67% without it. There were 69 patients with NSD type 2: 12 had sinusitis; 22 had CB: 5 with sinusitis, 17 without it; HIT was in 42 cases: 26% with sinusitis, 74% without it. There were 43 patients with NSD type 3: 26 had sinusitis; 15 had CB: 6 with sinusitis, 9 without it; 30 had HIT: 57% with sinusitis, 43% without it. There were 26 patients with NSD type 5: 11 had sinusitis; 9 had CB: 3 with sinusitis, 6 without it; 24 had HIT: 42% with sinusitis, 58% without it. NSD type 2 was statistically significant prevailed in patients without sinusitis (p=0.000005); NSD type 3 (p=0.03) and the combination of NSD type 1 with contralateral CB (p=0.04) prevailed in patients with sinusitis. CONCLUSION: NSD type 3 (by R. Mladina), as well as the combination of type 1 with contralateral CB are have influence to the development of sinusitis. CB and HIT are statistically significant prevailed on the contralateral side to unilateral NSD, but do not affect to development of sinusitis.

[Bilateral temporal bone xanthoma associated with hyperlipidemia]. / Dvustoronnyaya ksantoma visochnoi kosti, assotsiirovannaya s giperlipidemiei.

Presented clinical observation of a 42-year-old patient with bilateral xanthoma of the temporal bone, who has been treated for a long time for bilateral external otitis media, repeatedly mastoiditis. In this case, hyperlipidemia was detected only after the diagnosis of xanthoma was established. In this case, histological and clinical data helped to diagnose xanthomas and exclude chronic otitis media: the preservation of the auditory ossicles and hearing despite a large destruction of the temporal bone; satisfactory condition of the patient for many years in the presence of volumetric formations in both temporal areas extending into the cranial cavity, spreaded from the brain substance and not accumulating contrast according to computer and magnetic resonance imaging; normalization of hearing against the background of prolonged heating of the body - 'melting' of fats and opening the ear canal. Fistulas, through which a yellowish secret stood out either in the external auditory canal or in the behind-the-ear area, served as a kind of 'whisper valve', which made it possible to stop the pain syndrome and did not lead to the development of cerebral symptoms.

[Evaluation the velocity of vocal fold movements in adults by duplex Doppler scanning]. / Otsenka skorosti dvizheniia golosovykh skladok s pomoshch'iu dupleksnogo dopplerovskogo skanirovaniia.

AIM: To evaluate the velocity of vocal fold movements by duplex Doppler scanning in adults during breathing, talking and phonation. METHODS: Twenty healthy volunteers (18 women and 2 men) without of voice problems were investigated with scanners Logic-7 or Aloka 1100 by the linear transducer 7-10 MHz. The thyroid cartilage was used as an acoustic window. The dependence between the vocal fold velocity and volume and pitch of the voice were estimated using Spearman correlation. RESULTS: The velocity of movements of the vocal folds during breathing was from 5 to 16 cm/s, during talking and phonation - from 9 to 110 cm/s. Coefficient of Spearman correlation between the voice pitch and the vocal fold velocity was +0.9±0.1 an average, between volume of the voice and the vocal fold velocity was - 0.7±0.1. CONCLUSION: Duplex Doppler ultrasound scanning of the larynx allows measuring the velocity of vocal fold's movements during breathing, conversation and phonation. The fold's velocity increases with increasing of the voice volume and decreases with increasing the voice pitch. Duplex Doppler ultrasound scanning may be useful for early detection of disorders of mobility of the vocal folds.

[A case report of amyloidosis of the larynx in a 13-year-old girl]. / Sluchai amiloidoza gortani u 13-letnei devochki.

Amyloidosis of the larynx is rare in the pediatric age group. We present a clinical case of laryngeal amyloidosis manifesting as false vocal fold bulging in a thirteen-year-old girl with hoarseness and with initial suspicion of laryngeal tumor. Computed tomography and ultrasound scanning of the larynx were useful in determining the laryngeal process size along with fibro laryngoscopy. There was performed a microsurgical removal of the larynx formation. The results of Congo red staining of the formation were characteristic of amyloid. Systemic manifestations of the disease were not revealed.

[The injuries to the nose and paranasal sinuses in the children resulting from shooting an air rifle]. / Povrezhdeniia nosa i okolonosovykh pazukh u detei pri strel'be iz pnevmaticheskogo oruzhiia.

This article reports two clinical cases of the successful treatment of the gunshot wounds in the nasal cavity and paranasal sinuses of the children resulting from the careless use of the pneumatic weapons. Despite the fact that the shots were fired from a close distance, the intracranial structures and the eyeballs remained unaffected. The bullets were localized in the nasal septum of one child and in the frontal recess of the other as is typical of the injuries inflicted to the nose and paranasal sinuses by the shots from the air rifles. Multi-slice spiral computed tomography (MSCT) is known to have a number of important advantages over the roentgenological examination for determining the location of the bullets. Bullets for pneumatic rifles are manufactured in the form of the balls either from lead or copper-coated steel; therefore, they are a priory can not be removed with the use of a magnet.

[The clinical classification of acute otitis media with special reference to tympanometry]. / Klinicheskaia klassifikatsiia ostrogo srednego otita s uchetom timpanometrii.

We have developed a new clinical classification of acute otitis media (AOM) based on the previously proposed classifications of V.T. Palchun with co-workers (1997) and J. Jeger (1970) in which the letter near the stage of the pathological process roughly corresponds to the type of the tympanogram as follows: stage I (acute tubootitis): A, B, C; stage II (acute catarrhal otitis media): A, B, C; stage III (acute purulent otitis media, perforation stage); stage IV (acute purulent otitis media, post-perforation stage); stage V (resolution of otitis media): A - convalescence or recovery, B1 - exudate present in the tympanic cavity; B2 - persisting perforation; C - block of the auditory tube, O - the development of complications. This classification implies the necessity of tympanometry at the stage of diagnostics of AOM although it is not mandatory because the detection of exudate as a result of paracentesis at any of the stages of otitis media will allow to designate the stage of otitis either by letter A, B or C. The application of the new classification described in this article permits to more accurately than before determine the character of the pathological process in the middle ear during the course of acute otitis media which is of special importance in the clinical pediatric practice for the timely and adequate treatment of the children.

[On the 90th anniversary of the Department and Clinic of Otorhinolaryngology, Irkutsk State Medical University].

Teaching otorhinolaryngology in East Siberia based at the Medical Faculty of East-Siberian Medical University dates back to 1922. The first lecturer was A.D. Bolotov who represented the Moscow medical school headed by professor von-Stein. The Department of Clinic of Otorhinolaryngology were founded in 1924. The building of the Irkutsk Clinic of diseases of the ear, throat and nose and of the Moscowvon-Stein Hospital was financed by Bazanovs, the family of Russian merchants and gold producers. During different periods, the Department Otorhinolaryngology at the Irkutsk State Medical University was headed by associate professor A.S. Nikolaev, professors A,T, Bondarenko, I'V. Gol'dfarb, and Krukover, associated professor A.P. Misharin, V.A. Filenius, professors A.G. Shanturov and E.V. Nosulya, candudates of medical sciences S.V. Dudkin and M.V. Subbotina. The authors describe the main stages in the development of the Department of Otorhinolaryngology of the Irkutsk State Medical University the special reference to its key activities and achievement.

[pH values in the pharynx of the patients presenting with compromised nasal breathing of inflammatory and non-inflammatory genesis concomitant with gastroesophageal reflux disease].

The objective of the present study was to estimate the influence of gastroesophageal reflux disease (GERD) on the pH values in the pharynx and nose. It included 87 patients at the age varying from 18 to 81 years admitted to the Irkutsk-based Railway Clinical Hospital and allocated to four groups. Group 1 was comprised of 25 patients presenting with gastroesophageal reflux disease and chronic rhinosinusitis (CRS), group 2 consisted of 29 patients with CRS in the absence of GERD, group 3 included 22 patients with nasal septum deformations (NSD) and GERD, group 4 included 11 patients with NSD and motor rhinitis without GERD. The control group was formed from 10 volunteers. pH was measured by the contact method with the use ofEkokhim indicator paper. Gastroesophageal reflux disease was diagnosed following the recommendations of the Montreal consensus. It was shown that pH values in the pharynx of the patients with compromised nasal breathing of any origin in combination with GERD were lower than in the absence of GERD and in the healthy volunteers. The study groups did not differ in terms of pH values in the nasal cavity. It is concluded that pH values 4 or lower may serve as the criterion for pharyngo-laryngeal reflux (PLR) concomitant with HERD while pH 5 occurs more frequently in the patients with compromised nasal breathing of any etiology, regardless of the presence or absence of GERD.Disordered nasal breathing of any genesis in the patients presenting with gastroesophageal reflux disease was associated with the feeling of the lump in the throat, congestion of the respiratory tract and the nose, pain in the ears, cardialgia, and irregular heartbeat. It isrecommended to use pH measurements as a criterion for diagnostics of pharyngo-laryngeal reflux in the patients presenting with gastroesophageal reflux disease.

[ESPECIALLY CHRONIC RHINOSINUSITIS ASSOCIATED WITH GASTROESOPHAGEAL REFLUX DISEASE].

OBJECTIVE: to study the clinical and laboratory features of chronic rhinosinusitis (CRS) associated with gastroesophageal reflux disease (GERD). MATERIALS AND METHODS: The study involved 87 patients with complaints of difficulty in nasal breathing and 30 healthy volunteers with no pathology ENT and GERD. The diagnosis of CRS met the criteria EPOS 2012. Diagnosis of GERD was performed based on the recommendations of the Montreal consensus. All investigated conducted a survey for the presence of esophageal and extraesophageal manifestations of GERD, fibroesophagogastroduodenoscopy, LOR examination with the use of endoscopes, rhinoscopy, laryngoscopy, computed tomography of the paranasal sinuses, pH-metry mucous secretions of the nose and pharynx using visual test - strips, microbiological examination of discharge from the middle of the nose stroke. Association of CRS with GERD with GERD compared with impaired nasal breathing inflammatory and non-inflammatory genesis in the absence of GERD and healthy volunteers accompanied by a large variety and frequency of symptoms, endoscopic signs of laryngitis back, reducing the pH of the pharynx, the change in quantitative and qualitative characteristics of the microflora of the nasal mucosa and paranasal sinuses.

[The use of sinupret in the combined treatment of acute otitis media in children].

This controlled prospective study included 40 children (18 boys and 22 girls) hospitalized for the treatment of acute suppurative otitis media. Mean age of the patients was 4.5 years. Their condition was evaluated after cessation of purulent discharge and closure of perforation while acoustic impedancometry still revealed the presence of exudate in the tympanum. The treatment included administration of nasal decongestants, systemic antibacterial therapy, sanation of the nasal and pharyngonasal cavities by transposition or puncture of maxillary sinuses. Some patients (study group) were given sinupret in age-adjusted doses. Signs of exudates disappeared within a mean of 4.2 days after the onset of therapy compared with 7.7 days in the control group (p<0.01). It is concluded that the inclusion of sinupret in the combined treatment of acute suppurative otitis media promotes rapid and efficacious sanation of the tympanic cavity and hearing restoration.