[The effectiveness of rinorin introduced in the combined treatment of chronic adenoiditis in the children].

This study was designed to analyse the effectiveness of combined treatment of chronic adenoiditis in the children with the use of rinorin (Orion, Finland) in comparison with the traditional methods for the management of this condition either combined with irrigation therapy or without it. The results of the study indicate that the application of rinorin enhance the effectiveness of the treatment due to the substantial reduction of the manifestation of clinical symptoms and the frequency of relapses. The patients describe rinorin as a modern convenient-to-use preparation superior to the traditional medicines for the treatment of adenoiditis which improved medication compliance.

[Epidemiological aspects of congenital stridor].

The objective of the present work was to study epidemiology of congenital stridor as a leading symptom of laryngeal malformation. The continuous sampling method was employed to perform the retrospective analysis of the growth charts of the patients attending three children's polyclinics in Moscow (9.625 patients born between 2005 and 2009). In addition, the medical histories of 4.623 newborn and breast-fed babies under the age of 1 year admitted to the Department of Newborn and Neonatal Pathology, Saint Vladimir City Children's Clinical Hospital, and 347 patients of the Department of Reconstructive Laryngeal Surgery were analysed. The children with the history of tracheal intubation in the preceding period were excluded from the study. The frequency of congenital stridor annually diagnosed in the aforementioned polyclinics varied from 0.17 to 5.8% compared with 1.5% in the general population. It was 2.21 to 3.14% (mean 2.47%) among the children treated at the Clinical Hospital. In the children under the age of 1 year, congenital malformations accounted for 90.8% of all laryngeal diseases. The principal cause of stridor was shown to be laryngomalacia. This pathology was diagnosed in 91.9% of the cases included in this study. In 11.2% of the patients, this condition occurred in combination with other congenital pathologies. It is concluded that the diagnosis of congenital stridor is an indication for laryngeal endoscopy regardless of the children's age starting from the first day of life. Meeting this recommendation allows the cause of stridor to be established and the treatment strategy to be developed on an individual basis.

[The results of adjuvant therapy of juvenile recurring respiratory papillomatosis with the use of indole-3-carbinol].

The authors analyse the efficacy of anti-relapse therapy of juvenile recurring respiratory papillomatosis in 87 children aged from 2 to 15 years with the use of indole-3-carbinol. Prior to inclusion into this study, the patients underwent from 2 to 86 (mean 12 +/- 14) surgical interventions for the ablation of papillomas. The average interval between successive relapses of papillomas ranged between 2 weeks and 12 months (mean 4.9 +/- 2.33 months). The patients remained under observation in the clinic during 2 years--6 years 5 months (mean 44.8 +/- 15.93 months). The duration of therapy with indole-3-carbinol varied from 12 weeks to 2 years (mean 8.9 +/- 4.72 months). The stable remission of pathology was documented in 28.7% of the patients within the 2 to 6 year follow-up period. A significant (1.5-10-fold) increase in the duration of interval between successive relapses occurred in 41.1% of the children. In 29.9% of the patients, therapy produced no apparent clinical effect; 18.4% of them showed an insignificant shortening of the interval between relapses that remained unaltered in the remaining 11.5%. No adverse effects of the treatment were recorded. It is concluded that treatment with indole-3-carbinol can be recommended as a starting therapeutic modality for the management of juvenile recurring respiratory papillomatosis and the reduction of the intervals between relapses of the disease.

[Hoarseness patterns in children].

The objective of the present work was to study the structure of voice disorders in children depending on the methods chosen to diagnose dysphonia. Medical histories of 1,451 children at the age varying from 2 months to 16 years were analysed. All of them were patients hospitalized for the first time between 1997 and 2007 to treat hoarseness caused by vocal cord nodules, functional or mutational dysphonia, chronic laryngitis, vocal cord paresis/palsy, recurring respiratory papillomatosis, vocal cord cystitis, and cicatrical laryngeal stenosis. It was shown that vocal cord nodules and functional dysphonia diagnosed in 53.1% and 12.2% of the children were the main causes of voice disturbances. The former condition was especially common in boys aged from 7 to 12 years engaged in intense sports activities while the latter prevailed in 5 to 12 year-old girls studying singing. It is concluded that measures are needed to increase awareness of both parents and teachers of psycho-emotionally labile children about causes of hoarseness and methods of its diagnosis. The use of the fibrolaryngoscopic technique makes it possible to elucidate the cause of dysphonia in children of any age starting from the first days of postnatal life.

[Laryngeal ultrasound studies: potential, prospects, limitations].

In the last years, laryngeal ultrasound has been finding increasingly wide application due to the growing availability of relevant up-to-date equipment, apparent technical simplicity and non-invasive character of the study. However, poor knowledge of the physical basis of this method coupled to ungrounded self-confidence of the operators and uncritical treatment of the obtained findings may lead to the overestimation of the diagnostic potential of this sonographic technique. This paper is focused on disadvantages of ultrasound examination of the larynx and associated acoustic artefacts that can be taken for true abnormal structures. Attempts at qualitative and quantitative interpretation of such images are fraught with wrong conclusions.

[Recurrent respiratory papillomatosis: update review].

This paper updates information on epidemiology, etiology, clinical features, surgical and anti-relapse treatment of recurrent respiratory papillomatosis in children.

[Infection of the upper respiratory tract with human papilloma virus in children without clinical signs of respiratory papillomatosis].

The objective of this study was to evaluate the frequency of infection of pharyngeal mucosa, palatal and pharyngeal tonsils with types 6, 11, 16, 18, 31, and 33 human papilloma virus (HPV). A total of 57 children (30 boys and 27 girls) aged from 2 yr 10 mo to 14 yr 5 mo (mean 82+/-28.9 months) were examined. The patients were hospitalized for preplanned adenotomy, tonsillotomy or tonsillectomy. None of them exhibited clinical signs of recurrent respiratory papillomatosis. DNA of HPV was detected by means of the polymerase chain reaction (PCR assay) in mucosal cells obtained by scraping from the posterior pharyngeal wall (57 samples) and in biopsies from palatal (8 samples) and pharyngeal (52 samples) tonsils. The presence of HPV DNA was documented in 24 of the 57 (42.1%) children. In was found in ten (17.5%) samples from mucosal cells of the posterior pharyngeal wall, in pharyngeal tonsil biopsies from 16 of the 52 (30.8%) children, and in palatal tonsil biopsies from one of the 8 (12.5%) patients. Type 6 HPV was identified in 8 (14%) children, type 11 HPV in 1 (1.7%), type 16 HPV in 5 (8.8%), type 31 in 4 (7%), and type 33 in 12 (21%) patients. None of the samples contained type 18 HPV. Two types of HPV were simultaneously found in 4 (7%) children and three types in one patient. The frequency of HPV infection was comparable in children of preschool and school age.

[Gastroesophageal reflux disease and pharyngolaryngeal reflux in children with chronic laryngeal pathology].

A prospective non-randomized trial was made to evaluate incidence of gastroesophageal reflux disease (GERD) and pharyngolaryngeal reflux (PLR) in children with chronic laryngeal pathology. A total of 46 children aged 6 to 15 years were examined including 16 patients with recurrent respiratory papillomatosis, 15 patients with acquired laryngotracheal scarry stenosis and 15 patients with vocal nodules and functional dysphonia. Combination of GERD with PLR is a factor of risk for scarry laryngostenosis in a child with recurrent respiratory papillomatosis. If it is impossible to perform 24-h pH-monitoring of the esophagus for detection of GERD or PLR in patients with chronic laryngeal pathology, antireflux therapy is prescribed empirically. It is necessary to establish significant diagnostic criteria of PLR.

[Efficacy of indinol in antirecurrence therapy of juvenile respiratory papillomatosis].

The study of indinol efficacy in antirecurrence therapy of respiratory papillomatosis was performed in 46 children aged 2-14 years. The treatment lasted at least 12 weeks. Duration of a recurrence-free period before and after indinol administration was analysed. The response was observed in 30 (65.2%) patients. In 5 (10.9%) patients the remission continued from 2 to 3 years 10 months. In 25 (54.3%) patients recurrence-free period increased 1,5-6-fold. Side effects were not registered. Simple in use, cheap, well tolerated, usable with other treatments, indinol is recommended as a method of choice in antirecurrence treatment of recurrent respiratory papillomatosis.

[Papillomatosis of the lower respiratory tracts in children].

Papillomatosis of the trachea, bronchi and lungs was investigated in 40 children with papillomatosis of the lower airways in comparison with 408 children with laryngeal papullomatosis. All the patients were operated in 1988-2003 with histological verification of the diagnosis. Papillomas involved the lower airways because of tracheotomy (92.5%) or tracheal intubation (7.5%). Papillomatosis of the lower airways runs a more aggressive course than laryngeal papillomatosis, its treatment efficacy is worse. All the patients suffering from laryngeal papillomatosis with a history of tracheotomy need a regular endoscopic and x-ray control as papillomatosis of the trachea and/or lungs may develop in them several years after decanulation. Pulmonary papillomatosis has an invariably poor prognosis.

[Prevalence of human papilloma virus types and their influence on the course of the disease in children suffering from recurrent respiratory papillomatosis]. / Rasprostranennost' tipov virusa papillomy cheloveka i ikh vliianiia na techenie zabolevaniia u detei, stradaiushchikh retsidiviruiushchim respiratornym papillomatozom.

The type of human papilloma virus (HPV) was determined in 26 children aged between 1 year 10 months to 15 years 5 months suffering from recurrent respiratory papillomatosis (RRP). Polymerase chain reaction identified DNA of HPV type 6, 11, 16 and 18. HPV DNA was detected in all the patients including fifteen patients infected with HPV type 11; seven patients infected with HPV type 6; four children infected with HPV type 6 and 11. Types 16 and 18 of HPV were not detected. The analysis of RRP course has found that laryngeal papillomatosis runs a more aggressive course in cases with HPV type 11 infection than in those with HPV type 6.

[Immunity in children with aquired cicatricial stenoses of the larynx and cervical trachea. Communication 3. Condition of phagocyting immune system]. / Pokazateli immuniteta u detei s priobretennym rubtsovym stenozom gortani i sheinogo otdela trakhei. Soobshchenie 3. Sostoianie fagotsitiruiushchei sistemy immuniteta.

Macrophagal-phagocyting immunity was studied in 59 children with cicatricial acquired stenosis of the larynx and cervical trachea aged 1 year 9 months to 14 years 8 months. It was found that children with acquired cicatricial stenosis had a sharp depression of all functions of the cells of the macrophagal-phagocyting system (chemotaxis, absorptive, digestive, oxidation-reduction) as well as reduction of their number. This is, on the one hand, a defense reaction of the organism to continuous antigenic stimulation; on the other hand, this marks feasibility of progressive immunocomplex and/or autoimmune processes. The most prominent alterations were seen in patients with concurrent affection of the CNS.

[Immunity in children with acquired scarry stenosis of the larynx and cervical trachea. Communication 2. The status of T-cell immunity]. / Pokazateli immuniteta u detei s priobretennym rubtsovym stenozom gortani i sheinogo otdela trakhei. Soobshchenie 2. Sostoianie T-kletochnogo zvena immuniteta.

T-cell immunity was studied in 59 children (39 boys-66.1% and 20 girls-33.9%) with acquired stenosis of the larynx and cervical trachea at the age of 1 year 9 months to 14 years 8 months. Compromised T-cell immunity was revealed in the examinees, especially in those who had acute infectious-inflammatory diseases or CNS damage before critical care responsible for development of the stenosis. These changes in T-cell immunity should be considered as a factor of risk to develop immune and autoimmune diseases.

[Immunity in children with acquired scarred stenosis of the larynx and cervical trachea]. / Pokazateli immuniteta u detei s priobretennym rubtsovym stenozom gortani i sheinogo otdela trakhei.

Humoral immunity was studied in 63 children with acquired laryngotracheal stenosis 1 year 9 months to 14 years 8 months of age. The study discovered humoral immunity dysfunction which was most pronounced in patients who developed scary stenosis after critical care for acute stenotic laryngotracheobronchitis. It was found that if a child has allergy (atopy) in conduction of critical care requiring long-term nasotracheal intubation, he/she is at risk to develop scary stenosis.

[Clinical symptoms of vascular laryngeal tumors in children depending on their location]. / Osobennosti klinicheskoi simptomatiki sosudistykh opukholei gortani u detei v zavisimosti ot lokalizatsii.

To study peculiarities of clinical symptoms of laryngeal angiomas in children, 71 case histories for children with vascular tumor aged 27 days to 14 years have been analysed. The cases were divided into two groups by location of the tumor: group 1--with hemangioma located in the subvocal larynx (45 children admitted to hospital at the age of 27 days to 2 years); group 2--with laryngeal vascular tumor located in the vocal or supravocal larynx (26 children admitted to hospital at the age of 3 months to 14 years). It was established that the age of the first angioma symptoms and the symptoms manifestation depend on the tumor location. Subvocal hemangioma should be considered an independent nosological unit of the disease.

[Chlamydia infections in children with acquired cicatricial laryngeal and tracheal stenosis]. / Khlamidiinaia infektsiia u detei s priobretennymi rubtsovymi stenozami gortani i trakhei.

The examination for Chlamydial infection was carried out in 49 children aged from 1 year 10 months to 15 years (mean age 9 years 6 months +/- 3 years 8 months) with laryngotracheal cicatricial stenosis (CS) provoked by long nasotracheal intubation. Antibodies to C. pneumoniae in diagnostically significant titers were detected in 13 of 49 children (26.5%), to C. trachomatis--in 1 patient who had both infections. All the infected patients except the latter carried tracheal canules or were decanulated. Age of the patients with Chlamydial infection at the time of examination and development of CS was significantly older than of non-infected children. No significant difference was found between these patients by duration of the intubation and of the disease. Consideration of the fact that 12 of 13 children with C. pneumoniae infection carried tracheocanules suggests that the infection may be secondary.

[Characteristics of psychoemotional sphere in children with chronic laryngeal obstruction]. / Osobennosti psikhoémotsional'noi sfery u detei s khronicheskoi obstruktsiei gortani.

45 children from 10 to 14 years of age with chronic laryngeal obstruction were examined psychologically. 29 of them had recurrent respiratory papillomatosis, 16 ones had cicatrical laryngostenosis. The majority of the examinees (65%) showed symptoms of posttraumatic stress syndrome (PTSS). The children develop PTSS one-two years after onset of laryngeal obstruction. Later, the children underwent persistent specific maladaptation personality disorders. Thus, children with recurrent laryngeal papillomatosis, especially with cicatrical laryngostenosis, should undergo psychological correction.

[Age-specific and etiological aspects of acquired laryngo-tracheal cicatricial stenosis in children]. / Vozrastnye i étiologicheskie aspekty priobretennogo gortanno-trakheal'nogo rubtsovogo stenoza u detei.

453 case histories of children with acquired laryngo-tracheal stenosis (LTS) have been analysed. Etiological factors of the disease, age at the moment of respiratory lesion, duration of the intubation were examined. LTS developed in the majority of patients (58.3%) within the first 3 years of life. At this age boys suffer from LTS 2.5 times more frequently than girls. The stenosis was caused by tracheal intubation in 86.1% children. The intubation resulted from acute stenosing laryngotracheobronchitis (47.5%), craniocerebral trauma (13.2%), operations (12.8%), acute pathology of CNS (6.8%). LTS in boys develops 3.1 times more frequently in tracheal intubation for acute stenosing laryngotracheobronchitis and 2.9 times more frequently in intubation for acute CNS pathology. In intubation for other reasons the stenosis rate does not depend on the gender. The statistical data obtained by the authors require further clinico-immunological investigations.