[The clinical and functional evaluation of the combined treatment of vasomotor rhinitis in the children].

The objective of the present work was the comparative analysis of the results of the application of different methods for the treatment of the children presenting with vasomotor rhinitis. It was shown that the proposed combined approach including remedial therapy for the normalization of the function of the vegetative nervous system and the local application of fluctuating current to the nasal cavity mucosa has an advantage over the traditional modalities. Specifically, this newly developed simple and efficacious method for the combined conservative treatment of vasomotor rhinitis in the children has practically no contraindications for use, yields the most stable positive functional outcomes, and can by recommended for the application in both inpatient and outpatient settings to manage the patients with vasomotor rhinitis.

[The concept of the development of the otorhinolaryngological service in Moscow under conditions of modernization of the healthcare system and single-channel funding].

This paper highlights the complex of organizational and socio-economic measures designed to modify the healthcare system in the city of Moscow, improve the quality of medical aid, and ensure its availability for the urban population. The proposed methods were developed based on the results of analysis of the data obtained in the course of checking the work of the otorhinolaryngological services of the city, analysis of effectiveness of using the hospital stock in the therapeutic and prophylactic facilities of Moscow.

[A feedback method in clinical practice].

The authors reviewed a history of development of a feedback method, its physiological basis, essence, methodological aspects of its practical application and factors related to its effectiveness. This method may be used in studies of basic functional disorders, syndromes and diseases. Perspectives of its using in restorative and preventive health care are considered.

[Complex types of vertigo: diagnostic possibilities].

OBJECTIVE: To study diagnostic possibilities of a complex vestibular examination of patients with hard curable vertigo. MATERIAL AND METHODS: We studied 312 patients with complex types of vertigo. Neurologic and othoneurologic examination and some audio- and vestibulometry tests were carried out. RESULTS: The high frequency of comorbid lesions of the vestibular analyzer and coordination system was identified. CONCLUSION: Diagnostic and therapeutic approaches to hard curable vertigo are discussed.

[Basilar type migraine: clinical features, differential diagnosis].

The work is devoted to the description of neurological, vestibulometric and audiologic data obtained in the examination of 11 patients with basilar type migraine. The features of the disease (neck injuries before the disease, prolonged aura, protracted attacks, similarity with the clinical picture of stroke, occipital pain, cervical root syndrome, muscle-tonus phenomena and others) are described. A role of cervical pathology and labyrinthine hydrops in the disease pathogenesis as well as difficulties of differential diagnosis with Ménière's disease and Barre-Lieou syndrome are discussed.

[Hearing disorders in young subjects].

The objective of the present work was to study the state of the hearing function and the prevalence of ear pathologies in the applicants and students of a higher education institution. A total of 44.525 subjects at the age varying from 15 to 30 years were available for the examination of whom 42.829 ones were involved in the routine medical examination programs for the applicants and students; 1696 persons presenting with acute ear diseases and impairment of hearing passed the primary medical examination in the University polyclinic. The hearing function was evaluated with the help of the speech and tuning fork tests; in part of the patients it was evaluated by tonal threshold audiometry in both the standard and the extended frequency ranges, tympanometry, registration of the ipsilateral acoustic reflex, and a questionnaire study. Chronic ear pathology is known to occur in 1.77-2.09% of the young people; it is the third most frequent condition after diseases of throat, nose, and paranasal sinuses in the structure of chronic ENT morbidity. The structure of chronic ear diseases is dominated by Eustachian tube pathology (0.99-1.4%) followed by chronic middle and inner ear diseases (0.35-0.62% and 0.15-0.26% respectively). The commonest chronic disease of the middle ear is adhesive otitis media that is accompanied by the conductive impairment of hearing in 53.5% of the cases. Next in importance is chronic suppurative otitis media associated with the conductive or mixed-type loss of hearing in 91.7% of the patients. The subclinical form of sensorineural hearing loss was found in 11.7-15.1% of the young subjects Including minimal sensorineural hearing loss (enhancement of the hearing threshold by 1-3 frequencies) in 11.7-12.4% of the patients. A frequent cause of impaired hearing in the case of chronic sensorineural hearing loss is a single or repeated acoustic trauma.

[The role of neurobioregulation in the combined treatment of subjective tympanophonia and dizziness].

The objective of the present study was to evaluate the effectiveness of the biological control technologies applied in the framework of the combined treatment of the patients complaining of subjective tympanophonia and dizziness with concomitant changes in the psychoemotional status. It was shown that the disturbances in the psychoemotional sphere associated with complaints of subjective tympanophonia and dizziness took place in 81.4% of the patients included in the study although 17.2% of them had no signs of organic pathology in the central and peripheral regions of the auditory and vestibular apparatuses. It is concluded that the proposed therapeutic strategy can be recommended in the case of poor effectiveness of the medicamnetal treatment in the patients presenting with subjective tympanophonia and dizziness with concomitant changes in the psychoemotional status because it permits to eliminate clinical manifestations of the disease or reduce their severity.

[Cochleovestibular disorders in the patients suffering from migraine of the basilar type].

The objective of the present study was to improve diagnostics of basilar type migraine (BTM) based on the results of neurological, vestibulometric, and audiological studies of 11 patients. Peculiarities of the clinical picture of this disease and the medical histories of these patients are described. The pathogenetic role of labyrinthine hydrops and the difficulties encountered in diagnostics of Meniere's disease are discussed.

[The original splint-electrode for endonasal electrophoresis].

The objective of the present study was to improve the effectiveness of the treatment of the patients presenting with deflection of the nasal septum and vasomotor rhinitis by developing a method for endonasal electrophoresis in the postoperative period. The study involved 102 patients allocated to three groups. All of them underwent septoplasty including splinting of the nasal septum and submucous laser vaporization of the inferior turbinate bones. The patients of group 3 were treated with the use of an original septal stent with the integrated electrode that allowed to reduce the injurious effect of the procedure of nasal electrophoresis and thereby to decrease the duration of the rehabilitation period following the intranasal surgical intervention; moreover, this approach enhanced the effectiveness of surgery.

[The use of endonasal electrophoresis for the conservative rehabilitation of the patients presenting with septal perforation].

The treatment of perforation of the nasal septum (PNS) is one of the challenging problems currently facing otorhinolaryngology. The enhancement of the effectiveness of the conservative treatment of PNS was achieved through the three-stage development of the methodology including septal fixation in combination with targeted long-term drug application to the affected tissues. At the first stage of the study, characteristic features of the septal defects in patients with PNS were studied. At the second stage, we have developed the method for the conservative treatment of PNS based on the stenting of the nasal septum with the use of original heptangular splinters. At the third stage, the comprehensive comparative analysis was undertaken to estimate the effectiveness of the application of the original method of conservative treatment of the patients with PNS and traditional symptomatic therapy. It is concluded that the proposed original method for the treatment of patients with PNS based on the preventive stenting of the nasal septum original heptangular splinters one of which is equipped with a magnetic manipulation channel is an efficacious method for the conservative treatment of septal perforations. The method provides the basis for the new algorithm of management for the management of the patients suffering from PNS.

[Chronic tonsillitis in the students of a humanitarian higher school: incidence, diagnostics, and therapeutic strategies].

The objective of the present work was to study peculiar features of the nosological structure of chronic ENT pathology in the applicants and students of a higher education institution and perform a thorough analysis of the prevalence of various forms of chronic pharyngeal diseases. The study was based at the Polyclinic of Moscow State Institute of International Relations, Russian Ministry of Foreign Affairs, and lasted from 1998 to 2011. A total of 42 829 subjects aged between 15-30 years were examined including 32 186 applicants undergoing physical qualification by the medical evaluation board and 10 643 students subjected to routine annual medical examination. The latter group was characterized by the high prevalence of chronic ENT diseases predominated by pharyngeal pathology (39.6-59.8%). Chronic pharyngeal pathology was prevailed by chronic tonsillitis (32.7-50.6%) followed in the descending order by chronic pharyngitis (16.9-25.2%), papillomas affecting the soft palate, palatine arches and tonsils (0.8-1.5%), and adenoid vegetations (0.05-0.4%). It is concluded that regular medical check-up and treatment provide an effective tool for the prevention of CT progression and the development of its complications in the young subjects. 93.81% of the students were removed from dispensary observation due to improvement of health conditions or recovery. It is concluded that the surgical treatment of CT (bilateral tonsillectomy) should be more extensively applied in the absence of the desired effect of its conservative therapy.

[Diagnostics of endolymphatic hydrops].

The objective of the present work was to analyse the methods for diagnostics of endolymphatic hydrops associated with Miniere's disease most frequently employed in clinical practice using both the data from the world scientific literature and our own 25-30 year experience based on the observation of more than 500 patients. Camertonal studies of hearing acuity estimated from the results of air conduction measurements and relevant acoumetric curves were considered. The main methods of research are discussed including such as tonal threshold audiometry, ultrasound testing, loud sound lateralization, dehydration test, extratympanic electrocochleography, otoacoustic emission, and functional computed stabilometry. It is concluded that none of the above methods is as reliable as to yield the comprehensive information being sought. All the data obtained by the application of these techniques need to be supplemented by the medical history data, the patients' complaints, clinical signs and symptoms of the disease if the definitive diagnosis of endolymphatic hydrops is to be made.

[Application of the physiotherapeutic treatment in endonasal surgery].

The objective of this study was to enhance the effectiveness of the surgical treatment of the patients following septoplasty with the splinting of the nasal septum. An original septal stent with an integrated electron was developed that allows endonasal electrophoresis to be performed in a minimally traumatic manner. Thereby, this procedure permits to reduce the period of patients' rehabilitation after intranasal surgical intervention and to improve its effectiveness.

[The diagnostics and treatment of Minor's syndrome].

This publication was designed to describe the clinical manifestations of dehiscence of the superior semicircular canal (Minor syndrome), currently employed methods for its diagnostics, and the first case of this pathology reported in this country with the good outcome of the treatment. Also described are the historical background relevant to the problem, pathomorphological changes in the superior semicircular canal, clinical manifestations of the disease, the patients' subjective complaints, and the methods for diagnostics of dehiscence of the superior semicircular canal (Minor syndrome). The successful diagnostics and treatment of a female patient presenting with the aforementioned case of Minor syndrome is considered in much detail.

[Epidemiological characteristic of the patients presenting with cochleovestibular disorders associated with labyrinthine hydrops]. / Épidemiologicheskaia kharakteristika bol'nykh, stradaiushchikh kokhleovestibuliarnymi narusheniiami pri gidropse labirinta.

A total of 1,067 patients complaining of hearing impairment, dizziness, and tympanophony were admitted for the treatment to the Surdological Department of N.I. Pirogov City Clinical Hospital No 1 during the period from 2000 to 2010. As many as 326 (30.5%) patients were preliminarily diagnosed with Meniere's disease based on their medical histories, clinical condition, and the results of questionnaire studies. All of them were subjected to comprehensive audiologic and vestibulogic examination with the use of up-to-date techniques. The data thus obtained allowed to reveal labyrinthine hydrops in 275 (84%) patients. It is concluded that 101 (9.5%) patients presenting with the typical symptoms of Meniere's disease had labyrinthine hydrops.

[Betahistine in the treatment of vestibular and coordination disturbances in multiple sclerosis].

We present the results of the efficacy trial of betahistine (Vestibo) based on the complex clinical/instrumental examination (stabilometric, vestibulometric) in 40 patients with multiple sclerosis of different severity of vestibular and coordination dysfunction. We demonstrated the clinical efficacy and safety of using this drug as one of the areas of symptomatic therapy in treatment vestibular and coordination disturbances in multiple sclerosis.

[Peculiarities of ENT diseases in young subjects].

The results of outpatient medical examination of the applicants and students of the Moscow State Institute of International Relations carried out by otorhinolaryngologists during the past 12 years are reported. A total of 32,238 subjects aged from 15 to 25 years were recruited into the project. When appropriate, it was supplemented by a combination of audiological studies and microbiological analysis of naso- and oropharyngeal secretion. Protocols of preventive medical examination and treatment of young subjects presenting with acute and chronic inflammatory ENT diseases are proposed.

[Two-cavity (sectional) nasal hydrotamponade after endonasal surgical interventions].

This paper is focused on the problem of achieving post-operative hemostasis in patients undergoing endonasal surgical intervention. Analysis of 156 tamponades of the nasal cavity with three types of silicone hydrotampons gives evidence that the use of two separate balloons within a single block of an original sectional hydrotampon allows for differential mechanical impact on anteromedial and posterior nasal cavities to avoid unnecessary compression of the mucous membrane. Results of manometric measurements suggest that a combination of mechanical arrest of post-operative hemorrhage and selective hyperthermia in the choanal compartment of the hydrotampon permits to reduce tampon pressure on the mucous membrane in anteromedial and posterior nasal cavities by 6.0-9.3% and 10.3-24.7% respectively.

[Assessment of efficacy and tolerance of tanakan during treatment of sensorineural bradyacuasia and tympanophonia].

The objective of the study was to evaluate efficacy and tolerance of tanakan during treatment of neurosensory hearing loss and subjective tinnitis supposedly of vascular etiology. The secondary purpose was to analyse late results of 3 month courses of therapy and changes in the clinical course of the disease during treatment and within 6 months after its termination. Tanakan was first given at a dose of 40 mg thrice daily for 90 days. Results of the treatment were estimated on days 90, 180, and 240. The second course (40 mg thrice daily for 90 days) was initiated 180 days after the end of the first one. The final outcome was evaluated on day 360. It was shown that monotherapy with tanakan effectively improved the hearing function and had the most pronounced beneficial effect on subjective tinnitus. Results of the treatment remained stable throughout the entire observation period (12 months).