[Antibacterial therapy for acute streptococcal tonsillopharyngitis: results of a randomized comparative clinical trial with amoxicillin + clavulanic acid EXPRESS].

BACKGROUND: Acute tonsillopharyngitis is one of the most common types of respiratory tract infections. In case of bacterial etiologies of the disease, penicillin antibiotics are prescribed, in particular amoxicillin + clavulanic acid. Dispersible forms of antibiotics have a number of advantages over film-coated tablets and are characterized by better pharmacokinetic parameters that increase the effectiveness and safety of treatment, as well as patient compliance. AIM: To compare the effectiveness and safety of Amoxicillin + Clavulanic acid EXPRESS in the form of dispersible tablets and amoxicillin with clavulanic acid in film-coated tablets in the treatment of acute streptococcal tonsillopharyngitis. MATERIALS AND METHODS: A randomized comparative clinical study involved 60 adult patients diagnosed with acute streptococcal tonsillopharyngitis. Group 1 (n=30) received the Amoxicillin + Clavulanic acid EXPRESS, dispersible tablets, 875+125 mg 2 times a day at the beginning of meals. Group 2 (n=30) received Amoxiclav, film-coated tablets, 875+125 mg 2 times a day at the beginning of meals. The duration of the treatment was 10 days. The following procedures were performed to all participants: general clinical and otorhinolaryngological examinations, an express test to detect group A streptococcal antigens in a smear from the posterior pharyngeal wall (streptatest), assessment of symptoms of acute tonsillopharyngitis on the McIsaac scale, severity of sore throat, difficulty swallowing, swelling of the throat, measurement of body temperature, assessment of the clinical global impression of the therapy, adherence to treatment, frequency of the adverse reactions before treatment, 3 days after the beginning of therapy and after the course completion (day 10). RESULTS: Recovery occurred in 96.6% of patients in group 1 according to examination on the 10th day of treatment and in 93.3% of patients in group 2. The rate of fever regression was higher in group 1 - on the 3rd day of treatment, normalization of temperature was observed in 36.6% and 30% of patients in the comparison group. Pain syndrome, symptoms of throat swelling and difficulty swallowing significantly (p<0.01) regressed by the 10th day in patients of both treatment groups. The incidence of adverse reactions on the 10th day of treatment in group 1 was 10%, in group 2 - 33.3% (p=0.03). CONCLUSION: Amoxicillin + Clavulanic acid EXPRESS has high therapeutic efficacy in the treatment of acute streptococcal tonsillopharyngitis, comparable to the Amoxiclav in film-coated tablets. At the same time, dispersible tablets of Amoxicillin + Clavulanic acid EXPRESS demonstrated a significantly higher safety profile compared to the simple tablet form.

[Olfactory impairment in patients of the older age group with COVID-19 in the acute period and in the period of convalescence.]

Complete or partial loss of sense of smell significantly reduces the quality of life and in some cases is life-threatening. A new coronavirus infection in some cases leads to hypo- or anosmia. The defeat of the olfactory epithelium, swelling of the mucous membrane, the presence of discharge in the nasal cavity complicate the effect of odorants on the neuroepithelium. With COVID-19, anosmia may be the first and leading symptom. The restoration of the sense of smell occurs more often during the first weeks, but in some cases it is persistent. A special group of patients are older patients, older than 60 years. The course of a new coronavirus infection due to concomitant pathology proceeds in a more severe form. We present the experience of olfactory training with a set of essential oils (juniper, turmeric, eucalyptus and rose). Aromatherapy was preceded by irrigation of the nasal cavity with isotonic saline solution. In the absence of a clear clinical effect for 3 weeks, the set of oils was changed to fir oil, rosemary oil, monarda and lavender. The course of treatment continued for an average of 2 months. The technique included physiotherapy (endonasal electrophoresis with 0,25% zinc sulfate solution № 10), zinc preparations, pumpkin seeds 20-30 g per day, B vitamins (B6 and B12).

[Halitosis. Multidisciplinary approach]. / Khalitoz ­ mezhdistsiplinarnaya problema.

Halitosis is a common complaint among patients. Up to 50% of people worldwide claim to have persistent or intermittent bad breath. Often, bad breath not only disrupts the social life of patients, but is also a symptom of systemic diseases. An important step in the treatment of halitosis is the localization of the source and possible cause of the unpleasant smell. Most often, the problem of halitosis is solved by dentists, because intraoral halitosis accounts for up to 90% of all cases, but doctors of many specialties should deal with the differential diagnosis of its causes. This article considers the main causes of halitosis in patients with diseases of various organ systems.

[Possibilities of differential diagnosis of chronic diseases of the nasal cavity after surgical treatment and topical antibiotic therapy]. / Vozmozhnosti differentsial'noi diagnostiki khronicheskikh zabolevanii polosti nosa posle khirurgicheskogo lecheniya i topicheskoi antibakterial'noi terapii.

OBJECTIVE: The study was performed to assess the endoscopic state of the nasal mucosa after the use of local anti-inflammatory and antibacterial therapy, in particular, Polydexa nasal spray with phenylephrine containing Dexamethasone sodium metasulfobenzoate + Neomycin + Polymyxin B + Phenylephrine, and for the treatment of granulomatosis with polyangiitis. MATERIAL AND METHODS: The study included 940 patients who underwent examination and treatment for chronic rhinosinusitis in the clinic of otorhinolaryngology of I.P. Pavlov SPbSMU surgical treatment of the paranasal sinuses underwent 907 patients. In the postoperative period, the first group (211 patients) underwent toileting of the nasal cavity. The second group (307 patients) received irrigation therapy. The third group (389 patients) received a topical treatment combined of Polydexa with phenylephrine. The dynamics of the condition was assessed on the 1st, 3rd and 7th days of treatment, the evaluation of the effectiveness of the treatment was carried out on the 3rd and 7th days. Differential diagnosis with granulomatosis with polyangiitis was carried out in 33 patients. All patients with granulomatosis with polyangiitis showed signs of chronic rhinosinusitis. Patients were prescribed local anti-inflammatory and antibacterial therapy with Polydexa with phenylephrine for 7 days with endoscopic control of the nasal cavity. CONCLUSION: The use of the combined topical drug Polydexa with phenylephrine in patients with chronic rhinosinusitis and in patients with granulomatosis with polyangiitis has a positive effect, which reduces the clinical manifestations of chronic rhinosinusitis.

[Features characteristics of the sphenoid sinus disease in elderly patients.]

The aim of the study was to identify the features of diagnosis and treatment of sphenoid sinus diseases in patients over 60 years old. Clinical manifestations, results of endoscopic and radiological examination methods, and surgical intervention tactics were compared between elderly patients and younger patients (aged 18-59 years) who sought treatment for sphenoiditis in I.P.Pavlov Saint-Petersburg First State Medical University. The study analyzed 51 patients with isolated sphenoid sinus pathology, of which 9,8% were over 60 years old. The most common symptom in elderly patients was headache. Surgical treatment was required in 80% of patients over 60 years old. Endoscopic endonasal surgery of the sphenoid sinus can be safely performed by a specialized surgical team in patients over 60 years old with low anesthesiological risk. The results of our study showed that there were no statistically significant differences in the length of hospital stay between patients in both groups. This indicates that caring for elderly patients with sphenoid sinus pathology does not necessarily lead to prolonged hospitalization or increased economic burden on healthcare systems. Further research is needed to better understand the causes of the disease and to develop more effective approaches to the diagnosis, therapy, and prevention of sphenoid sinus pathology in elderly people.

[Beta-blockers for reducing intraoperative bleeding during rhinosinusosurgical operations in elderly and senile patients.]

With the ineffectiveness of conservative therapy of chronic rhinosinusitis in all age groups of patients, functional rhinosinusosurgical endoscopic interventions are now often used to do. The minimal bleeding is a necessary condition for their realization. There are reports of the use of beta-blockers for reducing surgical bleeding, but the possibility of their intravenous use in older patients has not been sufficiently studied. The aim of the work was to evaluate the effectiveness of intravenous metoprolol to reduce the bleeding intensity (BI) during rhinosinusosurgical interventions under general anesthesia in elderly and senile patients. The BI was assessed on the Fromme-Boezaart Score scale at different stages of the operation from the 10th to the 60th minute in two groups of patients: without (WM) and using metoprolol (M). It was shown that at the 30th minute of the operation BI was significantly lower in M group. Multivariate analysis of hemodynamic parameters demonstrated a direct relationship between heart rate (HR) and the development of bleeding. In the WM group, the probability of significant bleeding was 8,6 times higher. It has been shown that intraoperative intravenous use of metoprolol reduces the intensity of local bleeding during endoscopic rhinosinusosurgical operations.

[Aging nose (presbinasalis) in the practice of an otorhinolaryngologist.]

Population aging, increasing in duration of active life dictate to keep the level of health and create conditions for prolongation and preservation of ability to work. An otorhinolaryngologist often has to deal with age-related changes occurring in the nasal cavity and paranasal sinuses. The study of age-related features occurring in the nasal cavity and paranasal sinuses at the level of not only function, but also structures providing maintenance of mucous membrane protective mechanisms, preserving nasal architectonics, becomes a topical issue. Detailed consideration can be the key to understanding what is a natural process over time, and what should be viewed as pathology. These processes are often interrelated. For example, cartilage aging and nasal tip ptosis may trigger pathophysiologic mechanisms that create an obstacle to normal nasal breathing in older patients. Nasal aging accompanied by increasing dryness, rhinorrhea in some cases, postnasal drip in others, decreased sense of smell, reduces the quality of life, which will also need the involvement of an otorhinolaryngologist. In otorhinolaryngology, some of the terms used to describe age-related changes in the ent organs have been known and used since ancient times - presbyacusis (decreased hearing), presbyosmia (decreased sense of smell), presbyathacsia (ability to maintain equilibrium). Others are relatively recent, such as presbynasalis - an aging nose.

[The effectiveness of the use of local antibacterial drugs in the postoperative period in a patient with a neoplasm of the external auditory canal]. / Effektivnost' ispol'zovaniya mestnykh antibakterial'nykh preparatov v posleoperatsionnom periode u patsientov s osteomoi naruzhnogo slukhovogo prokhoda.

This article presents clinical case of external auditory canal osteoma and postoperative management of this patients. In this publication the etiology of this pathology, as well as the clinical manifestations that accompany this pathological condition are described. We present a literature review and our own experience of treatment this group of patients.

[Experimental research of the diode 970 nm laser thermal effect in order to develop a method for reduction of nasal swell body]. / Eksperimental'noe issledovanie termicheskikh effektov diodnogo lazera s dlinoi volny 970 nm s tsel'yu razrabotki metodiki lazernoi reduktsii vozvysheniya peregorodki nosa (NSB-nasal swell body).

OBJECTIVE: To evaluate the thermal effects of a 970 nm diode laser and select the modes necessary for the safe and effective use of this laser to reduce the nasal septum elevation (NSB) in volume in vitro. MATERIAL AND METHODS: Laser exposure was carried out through a quartz fiber with a diameter of 400 µm in a continuous contact mode at a power from 2 W to 10 W with a step of 2 W. Three linear cuts 1 cm long were applied to the specimens. The distance between the cuts was 0.5 cm. The initial temperature of the fragments was 25.6±1.6°C. Temperature control was carried out from the side of the fragments opposite to the laser action using a certified and verified thermometer with a contact sensor. RESULTS: In the course of the experiment, it was noted that the optimal power for effectively and safely reducing the area of the nasal septum elevation is 4 W. The maximum heating temperature reached 38.6±4.7°C. CONCLUSIONS: A semiconductor laser with a wavelength of 970 nm can be used to reduce the elevation of the nasal septum, as it leads to predictable results, allowing you to control thermal effects and damage to surrounding tissues.

[Functional endoscopic sinus surgery in a patient with cystic fibrosis after lung transplantation]. / Funktsional'naya endoskopicheskaya khirurgiya pazukh nosa u patsientki s mukovistsidozom posle peresadki legkikh.

Cystic fibrosis is genetic multisystem disorder with a predominant lesion of the respiratory tract. The duration and quality of life of these patients depends on the state of respiratory function. Progressive lung dysfunction is still the leading cause of mortality patients with cystic fibrosis. End-stage lung diseases in patients with cystic fibrosis, lung transplantation is a viable method of treatment. It has the ability to prolong life of these patients. Survival in cystic fibrosis has steadily increased medical treatment and post-transplant. Chronic rhinosinusitis (with nasal polys and without) impacts almost all cystic fibrosis patients, leading to significant reductions in quality of life. Chronic rhinosinusitis with nasal polyps is prevalent in the cystic fibrosis patients, and it is often a recalcitrant infection with multidrug resistant organisms. Medical therapies such as nasal irrigations, nasal steroids, and antibiotics are critical for managing symptoms, but functional endoscopic sinus surgery is necessary for refractory cases. The unified airway hypothesis suggests that sanitation bacterial infection in the upper airway can also decrease bacterial burden in the lungs. The article presents a clinical case of successful endoscopic sinus surgery in a 15-year-old patient with chronic rhinosinusitis with nasal polyps and cystic fibrosis after lung transplantation. The intervention was performed under General anesthesia and controlled hypotension. Bilateral antrostomy, ethmoidectomy and Draf IIb frontal sinusotomy were performed by endoscopic endonasal approach. There were no intra - and post-operative rhinosurgical or lung complications. The follow-up period was 18 months. At present, there is no relapse of chronic polypous rhinosinusitis, and there are no indications for revision intervention.

[Quality of life in the elderly with an acquired single-sided deafness.]

The study aimed to assess a negative impact of an acquired single-sided deafness on quality of life of the elderly. Prospective analysis of outpatient records was carried out to identify elderly patients with single-sided deafness using pure tone audiometry. The main inclusion criteria were age over 60, ≥90 dB threshold of an affected ear, ≤30 dB threshold of an intact ear, an acquired single-sided hearing loss with sudden onset and deafness duration less than 5 years. Taking inclusion criteria into account two groups were formed: the main group with single-sided deaf patients (n=25) and the control group of normal hearing patients (n=25). All participants were surveyed with PSQ, HHIE, THI questionnaires. There were revealed some changes in psychological status in the group of patients with single-sided deafness in comparison with the group of normal hearing participants. The scores of the questionnaires showed increased stress and anxiety levels and deterioration in quality of life. Patients with single-sided deafness complained about severe tinnitus in an affected ear, worse speech intelligibility in noisy environment and a constant need to adapt to the different acoustic situations that in turn badly affected psychoemotional homeostasis, intensifying stress severity, and quality of life.

[Airway support for endoscopic endonasal surgery in gerontology.]

Airway patency during ENT surgery in general anesthesia is a serious problem. It is important to manage the degree of intraoperative bleeding to improve the visibility of the surgical site and reduce the risk of complications. Airway management may affect the severity of intraoperative bleeding. We have shown that the use of a laryngeal mask during endoscopic endonasal rhinosinus surgery during general anesthesia reduces the severity of the hemodynamic response, which is expressed in an increase in heart rate, mean arterial pressure and intraoperative bleeding, and also reduces the risk of surgery.

[Modern views of rehabilitation after septoplasty]. / Sovremennye predstavleniya o reabilitatsii posle septoplastiki.

After septoplasty procedure and removing of nasal packing, numerous symptoms usually appear that result from inflammation. OBJECTIVE: To evaluate the effect of nasal spray Polydexa with phenylephrine on the postoperative period and bacterial contamination in the nasal cavity after septoplasty and inferior turbinectomy. MATERIAL AND METHODS: There were 40 people observed, who underwent septoplasty and inferior turbinectomy followed by nasal packing. RESULTS: After removing the tampons from the nasal cavity, the growth of coagulase-negative staphylococci was most often observed in 50%, Enterococcus faecalis - 22.5%, Staphylococcus aureus - 20.0%. In patients who received intranasally Polydexa with phenylephrine drug in the postoperative period, we observed decrease in inflammation in the nasal cavity, an improvement in the quality of life, as well as a significant (p<0.05) decrease in bacterial growth (both in the presence of flora and in intensity growth of microorganisms). The absence of intranasal antibacterial drugs in the scheme of postoperative management of patients contributes to the growth of pathogenic flora, in particular S. aureus.

[Methods of maxillary sinus foreign bodies removal]. / Sposoby udaleniya inorodnykh tel verkhnechelyustnykh pazukh.

THE AIM: To characterize methods of extraction of foreign bodies of maxillary sinuses, features of postoperative treatment of patients. MATERIAL AND METHODS: The experience of treatment of patients with maxillary sinuses foreign bodies in the clinic of ENT of PFSMU of St.Petersburg is presented. In 2019 124 patients undergo treatment of maxillary sinus foreign bodies in our clinic. All surgeries are done by endoscopic endonasal method, mostly via inferior nasal passage. Clinical case of maxillary sinus foreign body removal is presented. RESULTS: Almost any kind of foreign body can be removed from the maxillary sinus endoscopically through the nasal cavity. The most reliable method to diagnose foreign body is computed tomography. In most cases local antibacterial therapy is enough in postoperative period.

[Bilateral synechiae obstruction of the nasal cavity]. / Dvustoronnyaya sinekhial'naya obstruktsiya polosti nosa.

This article presents the clinical case of a woman aged 61 years with massive bilateral synechial obstruction of the nasal cavity after anterior tamponade with clinical manifestations in the form of a significant deterioration in nasal breathing, nasal congestion, postnasal nasal congestion and recurrent sinusitis. The stages of diagnosis of pathology, including differential, are presented and the most rational method of surgical treatment is selected.

[Conducting bilateral tonsillectomy in patients after kidney transplantation. Clinical observation]. / Provedenie dvustoronnei tonzillektomii u patsientov posle transplantatsii pochki. Klinicheskoe nablyudenie.

The experience of performing bilateral tonsillectomy under general anesthesia for two patients with a transplanted kidney receiving immunosuppressive therapy is presented. In both patients after surgery, pain and inflammatory changes in the postsurgery wound were minimal. However, in the postsurgery period, infection was observed in patients, this required the prescription of systemic antibacterial drugs. On the background of immunosuppressive therapy, the clinical course of chronic tonsillitis proceeded without severe symptoms, despite the decompensation of the chronic process in the tonsils. Due to severe concomitant renal pathology and with a transplanted kidney, such patients need to be examined and treated in a multidisciplinary hospital. Indications for surgical treatment of these patients should be substantiated together with nephrologists, otolaryngologists and anesthetists.

[Conservative treatment of exacerbation of chronic purulent otitis media]. / Konservativnoe lechenie obostreniya khronicheskogo gnoinogo srednego otita.

THE PURPOSE OF THE WORK: Is to study the efficacy of treatment of exacerbation of chronic tubotympanic purulent otitis media with Otofa drug with the active substance Rifamycin. MATERIAL AND METHODS: Performed a retrospective analysis of 37 medical histories of patients who applied to the otorhinolaryngology clinic with a diagnosis of exacerbation of chronic purulent tubotympanic otitis media in the period from January 2019 to December 2019. RESULTS: Noted relief of symptoms such as throbbing noise and pain in patients receiving the topical Otofa drug (active ingredient Rifamycin) by the 3th day of therapy. Otofa also reduced otorrhea by the 5th day of therapy. CONCLUSION: The study showed the high clinical efficacy of Otofa ear drops containing the Rifamycin antibiotic.

[Prevention of frontal pocket stenosis after endoscopic transnazal surgery on the frontal sinus and endoscopic septoplasty in acute and chronic pathology of frontal sinuses]. / Profilaktika stenozirovaniia lobnogo karmana posle éndoskopicheskoi transnazal'noi operatsii na lobnoi pazukhe i éndoskopicheskoi septoplastiki pri ostroi i khronicheskoi patologii lobnykh pazukh.

The main idea of our manuscript is prevention of frontal recess stenosis after endoscopic endonasal frontal sinus surgery and septoplasty during to acute and chronic frontal sinuses pathology. PURPOSE: To offer an effective method to prevent postoperative frontal recess stenosis after endoscopic endonasal frontal sinus surgery and surgical correction of intra-nasal structures. MATERIAL AND METHODS: In our manuscript we analyzed 274 cases of endoscopic endonasal frontal sinus surgery: postoperative treatment (local and systemic). All of them were operated by endoscopic endonasal approach both initially and repeatedly for acute and chronic frontal sinusities in the ENT department Pavlov First state medical university of Saint Petersburg from 2013 to 2019. RESULTS: In 10 cases, patients with previous endoscopic endonasal frontal sinus surgery underwent revision endoscopic procedure due to frontal recess obstruction, in 4 cases - due to a recurrence of the polypous process involving the frontal sinus, in 6 cases - without visible provoking factors contributing to restenosis of the frontal recess. First step in all cases was a correction of the nasal septum. It is necessary to assess the factors that contribute to restenosis of the frontal recess. Careful endoscopic care of the nasal cavity and the frontal recess in the postoperative period can reduce the risk of restenosis of the latter. Local antibacterial nasal therapy is recommended for the prevention of purulent processes in the nasal cavity in the early postoperative period.

[Endoscopic septoplasty as a stage of endonasal dacryocystorhinostomy]. / Endoskopicheskaya septum-operatsiya kak etap endonazal'noi dakriotsistorinostomii.

Endoscopic endonasal dacryocystorhinostomy (EN-DCR) is a modern and effective method for the surgical treatment of distal part obstruction of lacrimal pathway. Unsuccessful outcome and dacryocystitis relapses may be associated with concomitant rhinological pathology. Deviation of the nasal septum in the surgical area can affect the operation and contribute to stenosis. Additional correction of the nasal septum is necessary to obtain free surgical approach to the lacrimal sac. Endoscopic septoplasty provides high-quality surgical approach to the lateral wall of the nasal cavity. OBJECTIVE: To evaluate simultaneous endoscopic septoplasty when performing EN-DCR. METHODS: A retrospective analysis patients clinical data was conducted who were operated at the ENT department of Pavlov First Saint Petersburg State Medical University between January 2014 and December 2019. RESULTS: 232 EN-DCR were performed in 212 patients (21 men, 191 women). The average age at the time of the operation was 54.3 years (range 19-87). Of the 212 people 192 underwent unilateral surgery, 20 - bilateral EN-DCR. Simultaneous endoscopic septoplasty was required in 36 (15.5%) cases. CONCLUSION: Performing a simultaneous endoscopic septoplasty provides comfortable surgical access and contributes to the final successful outcome of EN-DCR.

[Inferior turbinate neoplasms]. / Osteoma nizhnei nosovoi rakoviny.

INTRODUCTION: The main aim of the work was to describe a rare clinical case of osteoma of inferior turbinate. The interest of the case is that such tumors are extremely rare. RESULTS: A female patient of 63 years old attended an ENT clinic. She complained on absence of nasal breath at the right side and headache. After a full ENT-examination, anamnesis, and a thorough analysis of the radiation examination results (computed tomography data), a decision was made to surgical treatment. Under general anesthesia, controlled hypotension surgery was done. First step was septoplasty, then the dense bone tumor was reduced and removed. At the control examination in 3 months, the complete removal of the formation of the inferior turbinate on the right is determined. There were no signs of continued or recurrent tumor growth. CONCLUSION: Neoplasms of the nasal cavity, in particular the inferior turbinate, are extremely rare pathologies. They are mainly detected when performing anterior rhinoscopy, endoscopic examination of the nasal cavity. The result of histological examination is compact osteoma. The gigantic size of the inferior turbinate osteoma in our case is probably due to the patient's failure to consult a specialist (otorhinolaryngologist) for a long time. Surgical treatment of this pathology should consist in an endoscopic endonasal approach: this approach allows the most complete and minimally traumatic removal of the tumor.