[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.

[Modern approaches and prospective directions in treatment of acute sensorineural hearing loss following acoustic trauma]. / Sovremennye podkhody i perspektivnye napravleniya v lechenii ostroi sensonevral'noi tugoukhosti akutravmaticheskogo geneza.

The article presents a review of the literature on the treatment of acute sensorineural hearing loss, acoustic trauma in people exposed to impulse noise. Groups of the most used drugs for the pharmacological correction of hearing impairment in this pathology are present, such as glucocorticosteroids, antioxidants, nootropics, antihypoxants, and others, are covered. Particular attention is paid to use of drugs taking into account the main links of pathogenesis.

[The substantiation of the approach for endoscopic surgery of nasal liquorrhea].

The objective of the present study was to develop a rationale for the approach to be employed in endoscopic surgery of nasal liquorrhea. A total of 69 patients presenting with this condition were available for the observation. Traumatic liquorrhea accounted for 80% of the cases, iatrogenic liquorrhea for 10%, liquorrhea associated with malformations for 5%, and spontaneous liquorrhea for 5% of the cases. The diagnostic algorithms elaborated for the identification of liquor cartilages were used to develop the criteria for the choice of the operative approach. A total of 69 surgical interventions were performed including 54 transnasal, 20 transethmoidal, 29 transsphenoidal, 5 endonasal, and 15 transcranial operations. The liquor fistulas were closed using tissue fragments and artificial materials, viz. muscles, broad fascia of thigh, periosteum and cartilage of the nasal septum, the mucous membrane from the nasal cavity, TachoComb plates, hemostatic sponge, fibrin-thrombin glue, bone crumbs, elements of bone marrow, and stem cells. The study has demonstrated the advantages of transnasal surgical treatment of liquor fistulas. The principles of postoperative care for the patients have been developed.

[The substantiation of the rational otorhinolaryngological strategy for the treatment of the severe form of a combined head injury with the damage to the nasal sinuses].

The objective of the present work was to substantiate the rational otorhinolaryngological strategy for the treatment of the severe form of combined head injuries with the damage to the nasal sinuses. The theoretical support of the study was provided by the use of such methods as analysis and synthesis, generalization and comparison. The practical methods included the general clinical studies, tests for the functional state of the intranasal mucous membrane, evaluation of motor activity of ciliated epithelium and microbiological techniques. A total of 42 patients with a combined head injury were examined. Congestive processes in the system of nasal sinuses were shown to develop as early as the onset of artificial lung ventilation even in the absence of an injury to the paranasal sinuses. The functional activity of ciliated epithelium was compromised since the first day of artificial lung ventilation and continued to worsen with time. The restoration of the nasal breathing promoted the creation of conditions for the recovery of the functional activity of ciliated epithelium. The secondary site of infection in the nasal sinuses formed on days 3-5.

[The application of a CO(2)-laser for tonsillectomy in the patients presenting with chronic decompensated tonsillitis as an alternative to the traditional methods of surgical treatment].

AIM OF THE STUDY: to estimate the clinical efficiency and advantages of the surgical treatment of palatal tonsils with the use of a CO(2)-laser in comparison with the traditional methods of tonsillectomy. METHODS: A total of 175 patients presenting with decompensated tonsillitis were available for the observation of which 79 were operated with the use of a CO(2)-laser. The control group was comprised of the patients undergoing conventional tonsillectomy. RESULTS: The study confirmed the high clinical efficiency of the ablation of palatal tonsils using the CO(2)-laser and its advantages in terms of reduced duration of the postoperative period, requirements for analgesic and antibacterial medications, recovery of the swallowing function and speech.

[Analysis of the extra-aural dependence of hearing disorders in civic flight personnel].

The correlation of incidence of hearing loss and concomitant pathologies in civil pilots with auditory analyzer sensitivity to aviation noise and length of service was investigated with the use of two-factor variance analysis w/o repetition. As a result of screening, 335 people (group-1) had only trace of audiometric noise impact; 108 people (group-2) displayed a sustained loss of hearing (chronic sensorineural hearing loss). In the aggregate, data of the investigation evidences that incidence of cardiovascular diseases (atherosclerosis of aorta and coronary arteries, atherosclerotic cardiosclerosis) and sensorineural hearing loss depend reliably on both individual sensitivity to noise and length of service. As for other pathologies, none of factorial criteria revealed itself as the categorical cause of a pathology. The significance and unit input of causative factor into health disorders vary as in type of non-auditory pathology, so length of flight service, and suggest linkage with the time of incipient loss of hearing. The flight personnel with low noise sensitivity and sustained deafness were diagnosed for a broader variety of extra-aural pathologies than the group with incipient hearing disorders. Variation analysis w/o repetition is applicable to evaluation of the risks of somatic pathologies in flight personnel.

[Hearing loss as an occupation pathology in civil pilots].

Occupational hearing loss in civil pilots was analyzed, compared and contrasted with hearing pathologies in people of ground "noise" occupations. Analysis of medical check records of 609 pilots examined at the age from 26 to 68 yrs. revealed 431 cases of sensory deafness. Flight service of the pilots ranged from 8 to 44 years and chronic SD started developing after two to 40 years of service. It has been concluded that recently the SD incidence (15.76%) rose largely because of the growing number of elder pilots and reducing flight hours. Deafness in civil pilots ensues after 15 years of service, i.e. later than in people of ground "noise" occupations, and does not result in severe loss of hearing. Several cases of premature chronic SD diagnosis during the medical flight certification were found and attributed to the neglect of factors leading to temporary shifting of the hearing threshold. It is surmised that pathogenesis of pilots' deafness is linked with specifics of radio noise and impossibility to set limits of noise duration during flight duty. Concomitant pathology, considering the extra-aural noise effects, appears and progresses in parallel with chronic SD.

[Transsphenoidal surgery for large and giant pituitary adenomas by intraoperative video endomonitoring].

The paper analyzes the outcomes of surgical treatment of patients with pituitary adenomas on the basis of 614 performed transsphenoidal surgical appliances, of which there were 209 large and giant pituitary adenomas. The use of intraoperative video endomonitoring during these interventions could substantially reduced the number of complications, enhance the radicalism and selectivity of a surgical appliance. By using such advantages as endoscopy as powerful lighting, an endomicroscopic phenomenon, and a lateral view, at surgery we could precisely determine the borders of an adenoma, the site and sizes of non-removed tumors fragments. The lateral view of an endoscope permits removal of a tumor via the optimal access, prevention of traumatization of cerebral structures and the contents of cavernous sinuses. If there is intraoperative liquorrhea, the latter can be verified and eliminated. Thus, the accumulated experience allows the authors to recommend using intraoperative video endomonitoring during transsphenoidal surgery for pituitary adenomas.

[Clinical and statistical patterns of the hearing system lesions caused by explosive mine trauma]. / Kliniko-statisticheskie zakonomernosti porazhenii slukhovoi sistemy pri minno-vzryvnoi travme.

Mine-explosive trauma has become the predominant type of pathology in the structure of surgical sanitary losses. In 70-75% of the cases it is combined with acoustic injury that requires the improvement of diagnosis and prediction of acoustic injuries at the stage of qualified medical care. In 772 casualties with mine-explosive trauma admitted to the different departments of Kabul Central Hospital the conditions of explosive injury were identified and statistical analysis of acoustic injury dependence on the above-mentioned conditions was conducted. The quantitative patterns obtained could be used in prognosis of the possible value and structure of acoubarotraumatic losses in the mine-explosive injuries.

[The surgical procedure in blind gunshot wounds of the skull base]. / Khirurgicheskaia taktika pri slepykh orgnestrel'nykh raneniiakh osnovaniia cherepa.

Personal clinical observations during the recent years allow the authors to confirm the indisputable value of surgical experience got during the Great Patriotic War (1941-1945) and in particular, the "fourfold" scheme proposed by V. I. Voiachek for the diagnosis and treatment of blind gunshot wounds to the skull base. Computed tomography considerably increases the probability of detection of the exact localization of foreign bodies in complex anatomical structures of the skull and thus facilitates choosing the most rational surgical management. The use of the electro-optical transducer for the extraction of foreign bodies from almost inaccessible areas of the skull base decreases the risk of operation.

[The early diagnosis of the severity of blast trauma to the brain and auditory system]. / Ranniaia diagnostika tiazhesti vzryvnoi travmy golovnogo mozga i slukhovoi sistemy.

This paper presents the information on the early period of an explosive head trauma and trauma to the auditory system. Different types of hearing impairment, the staging of the pathological process were determined along with various immunological and biochemical changes occurring in this group of patients. The results of the study call for necessity of the early ENT observation of all patients in whom an explosive trauma is suspected.

[The diagnosis of damages to the auditory system in the early period of explosive mine trauma and the optimization of treatment for the victims]. / Diagnostika povrezhdenii slukhovoi sistemy v rannii period minno-vzryvnoi travmy i optimizatsiia lecheniia postradavshikh.

The wide use of the mine-explosive weapon in modern military conflicts is accompanied by high specific weight of mine-explosive traumas (MET), which achieve 30-40% of all traumas. In the departments of the hospital in 21.3-35.8% of the wounded with MET accompanying defeat of acoustical system with probable subsequent development of neurosensory hypoacusis and invalidism of the injured is established. It defines necessity of early ENT-inspections of all injured with such traumas. Steady up to 1-6 months reduction of hearing is accompanied by biochemical infringements of a cerebrospinal liquid.

[Methodological bases of studying vestibular reactions]. / Metodologicheskie osnovy izucheniia vestibuliarnykh reaktsii.

The paper outlines the current concepts of the physiological functions of the vestibular system and identifies their contradictions. It suggests that from the standpoint of the theory of functional systems and, in the biocybernetic context, the vestibular apparatus should be regarded as an individual component of the whole static and kinetic system that ensures the coordination of movements, the function of the vestibular apparatus as part of the common afferent current and somatic, sensory, and autonomic reactions as the ultimate result of the whole system's activity.

[Clinical vestibulometry: current status and future prospects]. / Klinicheskaia vestibulometriia: sostoianie i perspektivy razvitiia.

Rotation and caloric methods of vestibular stimulation proposed and adopted during the last decades have been reviewed in terms of their efficacy in differential and topic diagnosis, clinical practicability. Systemic and bio-cybernetics approaches to vestibular apparatus and function have been analyzed. The need of using neurophysiological and cybernetics methods for further progress in relevant research and most promising trends in advancing clinical vestibulometry have been determined.

[The reactions of the upper respiratory pathways to low doses of ionizing radiation]. / Reaktsii verkhnikh dykhatel'nykh putei na malye dozy ioniziruiushchego izlucheniia.

The state of upper respiratory tract, non-specific cell resistance and immune status were studied in persons who participated in liquidation of the Chernobyl APS disaster consequences. The prolonged influence of factors caused by small doses of ionizing irradiation leads to mucosa affection of upper respiratory tract, considerable reduction of phagocytic and antiviral activity of monocytes and worsening of the immune status of organism. The data obtained during researches explains the considerable increase of ARD among these persons.

[Characteristics of lesions of paranasal sinuses in patients with optic chiasm arachnoiditis]. / Osobennosti porazheniia okolonosovykh pazukh u bol'nykh optokhiazmal'nym arakhnoiditom.

The paper provides data on a comprehensive rhinological and x-ray examination of 201 patients suffering from optochiasmal arachnoiditis (OCA). Paranasal affection (as a rule polysinusitis) was disclosed in 75.6% of the examinees. The lesion occurred primarily in the sphenoidal sinuses and frequently combined with ethmoidal labyrinth and maxillary sinus involvement. Rhinological and x-ray symptoms in OCA are rarely prominent giving grounds to physicians for defining it as the syndrome of minor clinical signs. The latter hold importance for diagnosis which enables early cleansing of the paranasal sinuses in combined treatment of OCA.