[Risk factors and clinical features of the course of recurrent acute otitis media in children]. / Faktory riska i klinicheskie osobennosti techeniya retsidiviruyushchego srednego otita u detei.

This article discusses the problem of recurrent acute otitis media (RAOM) in children. OBJECTIVE: To study the risk factors and the clinical course of RAOM in children. MATERIAL AND METHODS: 148 children (81 boys and 67 girls) from 1 to 14 years old were examined with a diagnosis of recurrent otitis media. The work was carried out in the ENT departments of Pediatric Clinical Hospital No. 13 named after N.F. Filatov, Pediatric Clinical Hospital named after Z.A. Bashlyaeva. The average age of the children was 4.1±1.5 years.All children underwent a clinical study, a laboratory study on the content of the main metabolite of vitamin D - 25(OH)D3 (25-hydroxyvitamin D, or calcidiol) in blood serum. RESULTS: Our clinical examination of children with RAOM allows us to identify the main risk factors for this pathology. Thus, the most significant risk factors for the development of RAOM in children included in the study were: early visits by children to preschool institutions (50.6%), allergic history (39.1%), pathology during pregnancy (28.3%), mixed (38.5%) or artificial (27.7%) feeding in the first year of life, frequent upper respiratory tract diseases (41.2%), burdened heredity in close relatives according to RAOM (33.7%), smoking in the family of one of the parents (65.5%) presence in the family of one more child (34.4%). CONCLUSION: It was shown that the absolute number of children (96%) with RAOM is characterized by a reduced level of 25(OH) vitamin D in the blood serum, which can increase the likelihood of developing episodes of acute otitis media in children and requires therapeutic correction.

[About the safety of application of nasal decongestants in the practice of pediatricians]. / O bezopasnosti primeneniia nazal'nykh dekongestantov v pediatricheskoi praktike.

Undesirable effects of the application of the intransal vasoconstricting medications are a frequent occurrence in the pediatric practice. The objective of the present study was to evaluate the role of the intranasal vasoconstricting medications in the structure of the means and methods currently available for the treatment of toxicological pathologies based at a multi-field clinical hospital. The retrospective analysis of the medical histories of the patients admitted to the toxicological department and annual reports for the period from 2015 to 2016 was undertaken. The study has demonstrated that intoxication associated with the use of the intranasal vasoconstricting medications was the most common cause of hospitalization of the children in the toxicological departments. Intoxication of this origin accounted for 15-20% of the total number of toxicological pathologies among the children. The cases of intoxication are most frequently documented in the group of children at the age between 1 and 3 years. The risk of the undesirable serious complications is especially high after the application of naphazoline-based intranasal vasoconstricting medications (71.7-77.4% of all the cases of intoxication with these products). It is concluded that the use of intranasal vasoconstricting medications in the pediatric practice should be carried out under the strict control, with the naphazoline-based preparations being totally excluded from the application.

[The application of different non-steroidal anti-inflammatory drugs for the elimination of pain syndrome during the early postoperative period in the children following the surgical interventions on palatine tonsils]. / Ispol'zovanie nesteroidnykh protivovospalitel'nykh sredstv dlia kupirovaniia bolevogo sindroma posle tonzillotomii u detei.

The present clinical study included 120 children at the age varying from 6 to 18 tears who had undergone radiowave tonsillotomy followed by symptomatic therapy during the early postoperative period with the application of different non-steroidal anti-inflammatory drugs. All the patients were randomly allocated to four groups each comprised of the equal number of patients. Those of group 1 were treated with ketoprofen lysine salt (КLS) in the form of a solution for oral intake in case of complaints of severe pain in the throat. The patients of group 2 received courses of ketoprofen lysine salt therapy per os thrice daily during 3 days after the surgical intervention. The patients of group 3 were given ibuprofen per os up to three times every day in case of complaints of severe pain in the throat. The patients of group 4 were treated with ketoprofen lysine salt in the form of a solution for the local application twice daily during 3 days after the surgical intervention. The results of the analysis with the use of the analog-visual scale have demonstrated that a decrease in pain intensity within 24 hours after surgery was much more pronounced in the patients of group 2 in comparison with those of the remaining three groups (р<0.05). The difference of pain intensity in the throat evaluated based on the analog-visual scale between the patients of groups 1, 3, and 4 was insignificant (p>0.05). None of the children exhibited the signs of bleeding throughout the entire observation period. It can be concluded that a course of therapy with the use of ketoprofen lysine salt for oral intake during the early period after the surgical intervention for radiowave palatine tonsillotomy has some advantages over a single intake of the analogous preparation (for alleviation of strong pain in the throat), an ibuprofen syrup or a ketoprofen lysine salt solution for throat wash.

[Polypous rhinosinusitis in the children].

We present an overview of the modern literature concerningpolypous rhinosinusitis (PRS) in the children. The information thus derived is compared with the available results of the clinical investigations involving the adults patients with this pathology. Allergic diseases and mucoviscidosis appear to be the pathological conditions most likely leading to the development of polyps in the nasal cavity. The patients suffering from rhinosinusitis associated with the disorders of arachidonic acid metabolismare very rarely encountered in the pediatric practice unlike those among the adult population. Intranasal glucocorticosteroids (INGCS), especially in the form of the mometasonefuroate nasal spray, are considered to be the most promising medications for the treatment of the children presenting with PRS. However, further clinical studies are needed to confirm the effectiveness and safety of this therapeutic modality.

[Use of Myrtol standardized in the treatment of children with acute rhinosinusitis].

The present study included 60 children at the age from 6 to 10 years undergoing a course of out-patient and in-patient treatment of acute rhinosinusitis (ARS). Thirty of these patients were given Myrtol standardised in the dose of 120 mg thrice daily for 7 days, in addition to traditional therapy.With convincing objective data for acute bacterial rhinosinusitis (in accordance with the criteria of EP3OS 2012), antibacterial preparations were prescribed to the children. The remaining patients received either conventional (symptomatic, irrigation) therapy or systemic antimicrobial agents. The analysis of characteristics of the visual-analog scale reflecting the severity of rhinorrhea, basal congestion, and coughing has demonstrated a significant (р<0,05) difference between the two groups of children in terms of manifestations of the clinical symptoms within days 7 and 14 after the onset of the treatment. For basal congestion, the difference was apparent as soon as day 3 after the beginning of therapy. The duration of the treatment with intranasal vasoconstrictive medications used for symptomatic therapy by the patients given Myrtol standardized was 2.2±0.4 days in comparison with 3.6±0.5 days in the control group. None of the patients treated with GeloMyrtol exhibited any adverse reaction attributable to the action of the medication in being studied. The study has demonstrated that using Myrtol standardized for the treatment of the uncomplicated forms of acute rhinosinusitis in children is clinically effective, safe, and convenient method for the management of ARS in children. And it can be recommended for the wide practical application.

[Immunoprophylaxis of infections of the upper respiratory tract in the frequently ill children].

The review of the clinical studies designed to evaluate the prophylactic effectiveness of ribosomal immunization is presented. It is shown that the application of the ribosomal vaccine ribomunyl causes a significant reduction in the occurrence of acute respiratory infections in the frequently ill children, lowers the frequency of exacerbation of chronic diseases of the upper respiratory tract, and allows to decrease the use of antibiotics. The authors emphasize the high therapeutic effectiveness and safety of preventive measures against respiratory infections in the frequently ill children with the use of the anti-influenza vaccine in combination with ribosomal immunization.

[Prophylaxis of chronic adenoiditis in the children].

This study was undertaken with the purpose of improving the effectiveness of the preventive treatment of chronic adenoiditis in the children. The open randomized comparative study included 219 children aged from 6 to 7 years presenting with clinical and anamnestic signs of chronic adenoiditis. The study group was comprised of 113 patients given the Streptococcus salivarius K12-based probiotic complex during 30 days in combination with the nasal-douche. The control group consisted of 106 patients treated with the nasal douche alone. The analysis of the results of the study has demonstrated that episodes of exacerbation of adenoiditis on day 30 after the onset of the treatment occurred in 56 (49.6%) children of the study group compared with 95 (88.7%) patients of the control group. Three months later, acute sinusitis was diagnosed in 4 (3.5%) children of the study group compared with 14 (13.2%) ones in the control group. Acute otitis media was documented in 2 (1.8%) and 5 (4.7%) children of the study and control groups respectively. It is concluded that the treatment with the use of the Streptococcus salivarius K12-based probiotic complex permits to decrease the frequency of exacerbations of chronic adenoiditis and its complications in the children and reduces the requirement for medication therapy.

[The possibilities for the treatment of exudative otitis media in the children presenting with chronic adenoiditis].

The objective of the present study was to improve the effectiveness of medicamental therapy of exudative otitis media in the children with recurrent and chronic adenoiditis. It was shown that the use of fluifort (carbocysteine lysine salt) for the treatment of exudative otitis media in the children presenting with chronic adenoiditis is a more effective approach in comparison with the expectant management. It is concluded that the application of carbocysteine lysine salt in combination with the mometasone furoate nasal spray ensures the rapid elimination of the symptoms of adenoiditis and significantly accelerates the resolution of exudative otitis media compared with the monotherapeutic treatment.

[Halitosis concomitant with chronic ENT pathology in children].

The objective of the present study was to estimate the potential of gas chromatography as a tool for diagnostics of chronic ENT pathology in the children. A total of 37 patients aged between 5 and 18 years with chronic ENT diseases and complaints of foul breath were available for the examination. Thirty one children presented with chronic tonsillitis, 3 with chronic adenoiditis, 2 with chronic rhinosinusitis, and 1 with subatrophic rhinitis. It was shown with the use of gas chromatography that the exhaled air from 34 (91.9%) patients contained cadaverin at a concentration of 0.004-0.0009 mg/ml. Three (8.1%) children exhaled methyl mercaptan (0.01-0.025 mg/m3) and hydrogen sulfide (0.002-0.006 mg/m3), and 2 (5.4%) patients exhaled the air containing dimethyl disulfide (0.009-0.002 mg/m3). The volatile sulfur-containing compounds were detected only in the children aged above 14 years. It is concluded that chronic tonsillitis is the leading etiological factor responsible for the development of the extraoral form of halitosis in the children. The foul breath in the children unlike that in the adults is most frequently due to the enhanced cadaverin concentration in the exhaled air rather than the production of volatile sulfur-containing compounds.

[Local therapy of infectious complications of allergic rhinitis in the children].

The objective of the present investigation was to estimate the effectiveness and safety of rinorin used for the prevention and treatment of infectious complications of allergic rhinitis in the children. A total of 70 children varying in the age from 5 to 15 years and presenting with the mild and moderate-to-severe form of seasonal allergic rhinitis were included in the study; they were divided into two groups. The study failed to reveal statistically significant difference between the groups in terms of adverse reactions to the treatment with rinorin. During the 21 day study period, infectious rhinitis was diagnosed in 2 (5.7%) children given rinorin compared with 5 (14.3%) ones in the control group (p>0.05). However, the patients of the latter group suffered a more severe form of this infectious complication of allergic rhinitis. It is concluded that rinorin is characterized by a high level of safety even though the antimicrobial potency of benzalkonium chloride, its active ingredient, needs further studies and evaluation.

[A novel view of prophylaxis and treatment of chronic adenoiditis in children].

The present clinical study had the objective to evaluate the role of a hypertonic solution of sterile water from the Adriatic Sea in the prevention and treatment of chronic adenoiditis in children. It included 30 children aged from 2.5 to 15 years. The control group was comprised of 30 children treated by intransal drop infusion of physiological saline followed by irrigation of the nasal cavity with framicetin as recommended by the manufacturer. The study failed to reveal a significant difference (P > 0.05) between dynamics of the symptoms of chronic adenoiditis in the patients of either group assessed based on the 10-point analog visual scale. However, the frequency of relapses of adenoiditis during the observation period (3 months) was significantly lower in the patients treated with the hypertonic solution of sterile seawater. Microbiological investigations of the material from the pharyngonasal cavity showed no difference between the occurrence of tansient bacterial microflora in the patients of the study and control groups.