[A case of acute purulent otitis media complicated by atypical mastoiditis on the background of an unverified HIV infection]. / Sluchai ostrogo gnoinogo srednego otita, oslozhnennogo atipichnym mastoiditom, na fone neverifitsirovannoi VICh-infektsii.

According to the literature, acute otitis media is complicated by mastoiditis in 0.15-1% of cases. In turn, mastoiditis can be complicated by meningitis, encephalitis, abscess of temporal lobe of brain and cerebellum, epidural and subdural abscesses, facial nerve paresis, labyrinthitis, phlegmon of soft tissues of neck, as well as subperiosteal abscess, which makes 7% in the structure of mastoiditis complications. Nowadays, when doctors have a wide range of antibacterial preparations at their disposal, a complicated course of acute otitis media and further mastoiditis is caused both by an aggressive atypical infectious agent and immunocompromised status of a patient. The article deals with a clinical case of a prolonged course of acute otitis media complicated by mastoiditis and subperiosteal abscess against the background of outpatient courses of antibacterial therapy. The examination revealed an atypical pathogen of otitis media Pseudomonas aeruginosa and HIV-positive status of the patient, previously unknown. Timely surgical intervention and the right combination of antibacterial drugs, meropenem and ciprofloxacin, prevented the development of intracranial and septic complications, despite the presence of multiple foci of bone destruction of the mastoid process and temporal bone pyramid, bordering the middle fossa and sigmoid sinus, according to multispiral head computed tomography. As a part of additional examination in the Center for AIDS and Infectious Diseases Prevention and Control, the patient was diagnosed with HIV infection, clinical stage 4C, progressing phase on the background of absence of antiretroviral therapy, and the necessary amount of treatment was prescribed.

[Clinical protocol: audiological assessment of infants in Russian Federation. Part II]. / Protokol audiologicheskogo obsledovaniya detei pervogo goda zhizni v Rossiiskoi Federatsii. Chast' II.

This is the second part of the previously published clinical protocol of audiological assessment in infants. The goal of the protocol is unification approaches to audiological diagnosis of the infants. The following sections were included in the second part of the protocol: behavioral testing in infants, testing sequence, duration of the examination and necessity in follow-up, hearing assessment in special cases (premature children, children with congenital infections, after meningitis, with external ear abnormalities, single-sided deafness, with hydrocephalus and shunts, with auditory neuropathy spectrum disorder, with mild hearing loss and otitis media with effusion), medical report.

[Clinical protocol: audiological assessment of infants in Russian Federation. Part I]. / Protokol audiologicheskogo obsledovaniya detei pervogo goda zhizni v Rossiiskoi Federatsii. Chast' I.

The clinical protocol of audiological assessment in infants was prepared by the workgroup of Russian pediatric audiologists from different regions. The goal of the protocol is unification approaches to audiological diagnosis of the infants. The protocol has been developed according the evidence based medicine principles, by reviewing current scientific publications on the topic and taking into account the order of providing medical services and other clinical practice guidelines. When direct evidence was not available, both indirect evidence and consensus practice were considered in making recommendations. This guideline is not intended to serve as a standard to dictate precisely how the child should be diagnosed. This guideline is meant to provide the evidence base from which the clinician can make individualized decisions for each patient. The first part of the protocol covers following sections: equipment, staff requirements, timing of the diagnostics, case history and risk factors, preparing the child for the appointment, sedation and general anesthesia, otoscopy, tympanometry and acoustic reflex, otoacoustic emissions, skin preparing, electrode montage, choosing the stimulators, auditory brainstem responses on broadband and narrow-band stimuli, on bone conducted stimuli, auditory steady-state responses, masking, combined correction factors.

[Choristoma of the middle ear]. / Khoristoma srednego ukha i sostsevidnogo otrostka.

Choristoma is one of the varieties of congenital developmental anomalies, where one or another normal tissue of the body is located in an atypical place for itself. The short literary review of choristoma of middle ear is presented in article. A rare clinical cases of salivary gland choristoma of the middle ear (5-year-old girl with left-sided conductive hearing loss of III degree) and glial choristoma of the mastoid (19-year-old man with signs of chronic suppurative otitis media of the right ear) are described.

[Cytokine profile of chronic rhinosinusitis without polyps]. / Tsitokinovyi profil' khronicheskogo rinosinusita bez polipov.

INTRODUCTION: Chronic rhinosinusitis (CRS) is the most common immunological ENT disease, which has several phenotypes. The heterogeneity of CRS is due to the peculiarities of their pathogenetic mechanisms - the system of cytokines plays the crucial significance. They are biologically active substances and present regulatory peptides that demonstrate an immunomodulatory and regulatory effects not only in the local level but the system level as well. OBJECTIVE: To determine specific features of the cytokine profile in blood serum among patients with CRS without polyps (CRSwP). MATERIAL AND METHODS: Serum cytokines (IL-1α, IL-1RA, IL-1ß, IL-2, IL-3, IL-4, IL-5, IL-6, IL-7, IL-8, IL-9, IL-10, IL-12p40, IL-12p70, IL-13, IL-15, IL-17, IFN-α2, IFN-γ, GM-CSF) were defined in 75 patients: 32 patients with CRSwP were operated (main group) - 17 with cyst of maxillary sinus, 15 with edema of the maxillary sinuses. The control group - 43 patients were under surgery for a deviated nasal septum (septoplasty). The groups were comparable to gender and age. RESULTS: The cytokines detection rate was different in all groups. IL-4 (detection rate 93.3-95.3%) and IFN-γ (79.1-86.7%) were measured nearly the all groups. IL-8 (73.3-76.5%) and IL-17 (76.5-80.0%) were often measured in the group with CRSwP; in contrast to the control group - these indicators were lower: 60.5% and 65.5%, respectively. IL-1α (82.4%) and IFN-α2 (76.5%) were often detected in CRS with cystic formations. IL-1ß, IL-5, IL-7, IL-9, IL-15 were measured in all groups in less than 30% of patients; IL-2 and IL-6 - in the group of CRS with cystic formation; IL-10, IL-12p40, IL-13 in the group with edema of maxillary sinuses. In a quantitative comparison of the concentration of cytokines. Significant differences in concentration of cytokines between the groups were not obtained (p>0.05) in terms of quantity. CONCLUSION: CRSwP with cystic formation is characterized by the development of T2 type immune response and a higher inflammation-related tissue damage.

[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.

[The influence of the vitamin D3 level in the blood serum of lactase gene polymorphism on the development of chronic polypous rhinosinusitis]. / Vliianie urovnia vitamina D3 v syvorotke krovi i polimorfizma gena laktazy na razvitie khronicheskogo rinosinusita s polipami.

The objective of the present study was to elucidate the possible correlations between the vitamin D3 level in the blood serum and lactase gene polymorphism (LCT-13910 T>C) in the patients presenting with chronic polypous rhinosinusitis (CPRS). The study included 50 patients with this condition and 14 subjects comprising the control group. The variants of lactase gene polymorphism (LCT-13910 T>C) were identified with the use of polymerase chain reaction (PCR) in real time. The total level of serum vitamin D3 (VD3) was determined by means of the immunochemical analysis (the electrochemiluminescence technique). In the group of patients presenting with chronic polypous rhinosinusitis, the level of VD3 in the blood serum ranged from 48 nm/l to 85 nm/l (mean 60 nm/l) compared with that in the patients of the control group (from 78 nm/l to 112 nm/l; mean 97 nm/l) . The level of vitamin D3 'below the normal values' was documented in 71% of the patients with CPRS in comparison with 7% in the control subjects. Lactase gene polymorphism (LCT-13910 CC, CT) suggesting pronounced and latent hypolactasia was identified in 94% of the patients with CPRS compared with 78.6% in the control group. The occurrence of the CC genotype in the patients of both study groups was virtually identical: 52% in the patients presenting with chronic polypous rhinosinusitis and 57% in the control group. CT polymorphism was identified in 42% of the patients with CPRS and in 21% of the control subjects. The significant difference between the patients of the two groups was documented for the occurrence of TT polymorphism: 6% among the patients with CPRS and 21% in the controls (i.e. much higher in the healthy subjects). There was no significant difference between the serum levels of vitamin D3 either among the patients with CPRS having LCT-13910 gene polymorphisms (CC, CT, TT) or among the control subjects. It is concluded that the study revealed the higher levels of vitamin D3 in the blood sera from the control subjects in comparison with that in the patients with chronic polypous rhinosinusitis. Moreover, the patients of the latter group more frequently exhibited the variant of the LCT CT-13910 gene polymorphism suggesting latent hypolactasia whereas the subjects comprising the control group more frequently had the variant of the LCT CT-13910 gene polymorphism indicative of the normal tolerance of lactose.

[Modern means of statokinetic improvement and vestibular rehabilitation].

The article presents the results of studying the effectiveness of the complex vestibular workouts based on non-invasive neuromodulation technology in 37 healthy patients aged 18-20 years who have symptoms of aerial sickness in 5 or less minutes. Non-invasive neuromodulation wire-familiarize with the apparatus for vestibular rehabilitation "Brain-Port" (USA), performing electric tactile stimulation of the tongue with biofeedback. An indicator of statokinetic stability was considered from time to tolerance to the vestibular load up to development of vegetative manifestations of aerial sickness. 'Improvement of statokinetic tolerability vestibular training confirmed by computed posturography and gait analysis. Increase of statokinetic stability accompanied not only by an increase in exposure, necessary for motion sickness, but also a decrease in autonomic manifestations, which are the main obstacle to the operator's military activities. Improving balance and gait performance after the swipe-of vestibular training course demonstrates the possible realization of two mechanisms of compensatory and restorative processes: sensory substitution equilibrium function and induction of neuroplasticity in short time.