[Optimization of the puncture treatment method for acute bacterial maxillary sinusitis]. / Optimizatsiya metoda punktsionnogo lecheniya ostrogo bakterial'nogo verkhnechelyustnogo sinusita.

OBJECTIVE: Optimization of the method of puncture treatment of acute bacterial maxillary sinusitis (ABMS) through the development of original devices for drainage of the maxillary sinus (MS). MATERIAL AND METHODS: Registration and comparative analysis of the results of puncture methods of treatment of 120 patients with ABMS using developed new original devices for drainage of MS with one channels and with two channels in comparison with the Kulikovsky's needle (KN) was carried out. Based on the results of the analysis, the effectiveness of the original devices was assessed. During the clinical study, patients were divided into two groups: in group I, patients underwent of the MS puncture using KN, in group II, using original devices. Groups I and II, depending on the absence or presence of a block of the natural anastomosis MS, was divided into subgroups A and B, respectively. After puncture of the MS, the pain syndrome was assessed by patients using Visual Analogue Scale (VAS) and by doctors - using Touch Visual Pain (TVP) scale. RESULTS: Our study showed that when puncturing the upper jaw with an original needle with one channels and with two channels, compared with the use of KN, there is a decrease in pain (the average VAS score was 1.5±0.3 and 1.7±0.3 points, respectively; the average TVP scale score was 0.9±0.2 and 1.8±0.3 points, respectively, the difference is significant, p≤0.05). Patients of subgroup IB were manipulated with two KN, patients of subgroup IIB manipulated using the original device with two channels without an additional needle (the average VAS score was 3.0±0.4 and 1.3±0.3 points, respectively; the average TVP scale score was 2.7±0.4 and 1.0±0.2 points, respectively, the difference is significant, p≤0.05). The doctors also assessed the devices used for puncture of the upper jaw. As a result of the study, the high efficiency and safety of using new original devices was established.

[Epidemiology and modern methods of treatment of non-traumatic nosebleeds]. / Epidemiologiya i sovremennye metody lecheniya netravmaticheskikh nosovykh krovotechenii.

Data on the detection incidence of nosebleeds (NBs) of non-traumatic origin in the population show considerable variability in statistical indicators, and NBs treatment and consequences depend on the localization of hemorrhage source, the volume of blood loss, patient's general condition, the presence and nature of comorbid pathology and a number of other factors. There are some differences in the choice of NBs treatment options, evaluation of their clinical and economic efficiency, which indicates the need to analyze and systematize the results of such studies. OBJECTIVE: To analyze data on prevalence and current treatment approaches of non-traumatic nosebleeds. MATERIAL AND METHODS: The search for publications (articles and related abstracts) on the subject of the study, presented in the PubMed database, has been conducted. The choice of material was made according to the following key words: non-traumatic nosebleeds, causes, incidence, methods of stopping nosebleeds. RESULTS: The literature data show a significant prevalence of NBs in the population, their potential hazard to the life of patient and the importance of clinical and demographic characteristics of persons for determining treatment tactics in each case. In practical terms, primary and secondary NBs should be distinguished. In case of primary NB, the use of coagulation and nasal packing is recommended after determining the place of bleeding. In secondary NB it is necessary to establish its cause in order to assess risk factors and apply appropriate topical or systemic drug therapy. The so-called difficult (difficult-to-treat) NBs deserve special attention. As a rule, these cases involve bleeding from the posterior parts of nose. The analysis of publications shows a high (90%) efficacy of surgical interventions, used as first-line treatment. Effectiveness of embolization in such cases was 75% and of anterior/posterior nasal packing was 62%. CONCLUSION: The literature data show a significant prevalence of nosebleeds in the population and their potential hazard to the life of patient. The existing differences in the assessments of treatment options for this pathology, their clinical and economic efficiency are the basis for further research, in particular, to clarify the causes of nosebleeds' occurrence and recurrence, the impact of treatment methods on quality of patients' life.

[Damage to the inner ear with syphilitic infection]. / Porazhenie vnutrennego ukha pri sifiliticheskoi infektsii.

The epidemiology of neurosyphilis is presented in article. The pathogenetic mechanisms of involvement in the syphilitic process are described already in the early stages of the disease of the central and peripheral nervous system and, in particular, of the auditory and vestibular analyzers. Described classical clinical forms of neurosyphilis. Statistical data on the incidence of syphilis in Russia from the 20-30s of the last century to the present are given. Presented analysis of the development of the incidence rate in Russia of syphilis and neurosyphilis, the main methods for the diagnosis of neurosyphilis. The changes in the structure of neurosyphilis disease that have occurred over the past 20 years, which are characterized by nonspecificity, course wear and inversion of typical clinical symptoms, as a result of pathomorphism, are described. The article describes the mechanism for the development of the pathological process in the inner ear with syphilitic infection. Described changes in the capillary wall of the vascular streak, leading to impaired hematolabyrinth barrier function and the development of the labyrinth hydrops. Literature data on the electron microscopic study of the vascular strip of the rabbit webbed snail infected with syphilis are presented. The article also collected literature data on indicators obtained by audiological and vestibulological studies of the inner ear in cases of early and late neurosyphilis. The article focuses on the possible only manifestation of neurosyphilis in the form of cochleovestibular symptoms.

[Presbyacusis]. / Presbiakuzis - aktual'naia problema stareiushchego naseleniia.

In the world, the spread of hearing loss due to age is an important socio-medical problem. Age-related hearing loss is the result of the biological process of aging of the tissue elements of the auditory analyzer. Changes in hearing develops by a complex of factors associated with both genetic, environmental and social aspects. Presbycusis is one of the causes of human cognitive disorders. Recent studies on hearing impairment prove a correlation with cognitive processes that increase the risk of dementia in the elderly. Timely rehabilitation of hearing with the use of hearing aids allows you to delay the processes of inhibition of cognitive function, and allows older people to prolong active longevity. Patients require consistent auditory and cognitive training for better socialization.

[Angioedema of the upper airways during a routine surgery]. / Angionevroticheskii otek verkhnikh dykhatel'nykh putei, razvivshiisia u bol'noi vo vremia planovoi operatsii.

The article describes a rare clinical case of the development of angioedema of the larynx and pharynx in a patient during a surgery under endotracheal anesthesia. The authors of the article indicate that in the practice of clinic is 1 case for 32011 people, which is 0.003% of all hospitalized in the hospital for the elective surgical treatment of diseases of the upper respiratory tract. After removal of the tonsils and cyst of the nasopharynx, the surgeon noted a pronounced edema of the uvula, the mucous membrane of the soft palate, the lateral walls of the laryngopharynx and larynx. The patient was not taken out of the anesthesia. The mechanical ventilation was continued and the patient was transferred to the intensive care unit and intensive care unit where antiedematous and symptomatic therapy was conducted. On the 3rd day of treatment, the upper respiratory tract edema reduced, the patient was extubated. The authors present an algorithm for the examination and treatment of patients with angioedema.

[Immunological disorders in patients with purulent-inflammatory pathology of ENT organs in conditions of comorbidity with diabetes mellitus]. / Immunologicheskie narusheniia u patsientov s gnoino-vospalitel'noi patologiei LOR-organov v usloviiakh komorbidnosti s sakharnym diabetom.

The article discusses the problems of the comorbid course of purulent-inflammatory diseases of the ENT organs and diabetes mellitus. The authors consider the main immunological factors of systemic and tissue immunity, which make it possible to detect immunodeficiency in conditions of purulent inflammation - immunoglobulins A, M, G, phagocytosis parameters, lysozyme, lactoferrin, general bactericidal activity, antibody affinity, determined in blood serum and saliva. In the course of the work, results were obtained that characterize a decrease in the systemic and tissue immune reactivity, which correlate with the degree of compensation of diabetes mellitus, which is a predictor of the occurrence and development of focal suppurative inflammation in the ENT organs. The authors conclude that rational antihyperglycemic therapy is necessary to maintain a satisfactory level of glycemia.

[Possibility of application Mexidol for the treatment of patients suffering from sensorineural hearing loss and cerebrovascular insufficiency]. / Perspektivy primeneniia preparata Meksidol dlia lecheniia bol'nykh, stradaiushchikh neirosensornoi tugoukhost'iu i tserebrovaskuliarnoi nedostatochnost'iu.

Sensorineural hearing loss can develop as a consequence of vascular pathology. The etiology and pathogenesis of chronic sensorineural hearing loss allow us to consider promising the use of neuroprotective drugs in the treatment regimen that can activate the function of the neural structures of the auditory pathway. Ethylmethylhydroxypyridine succinate, having complex pharmacological capabilities and a wide range of effects realized at the neural and vascular levels can be used in the treatment of hearing impairment and speech intelligibility.

[The peculiar features of epidemiology and clinical course of syphilis encountered in the otorhinolaryngological practice under the present-day conditions]. / Osobennosti épidemiologii i klinicheskogo techeniia sifilisa v otorinolaringologicheskoi praktike v sovremennykh usloviiakh.

The article was designed to report the available information about the main characteristics of epidemiology and pathomorphism of syphilis. It describes the process of development and clinical symptoms of syphilis, both classical and undergoing modification, under the present-day conditions, with special reference to the distinctive features and peculiarities of ENT organ lesions with the underlying syphilitic etiology.

[The pedagogical activities at the Department of Otorhinolaryngology of the Faculty of General Medicine]. / Pedagogicheskaia deiatel'nost' kafedry otorinolaringologii lechebnogo fakul'teta Rossiiskogo natsional'nogo issledovatel'skogo meditsinskogo universiteta im. N.I. Pirogova.

This article was designed to substantiate the main principles of the academic process as practiced at the Department of Otorhinolaryngology of the N.I. Pirogov Russian National Research Medical University under the current conditions of the ongoing modernization of the system of higher medical education. The authors emphasize the necessity of the combination of theoretical and practical training with special reference to the specific features of the curricular and extracurricular activities. The importance of the formation of the properly functioning teaching staff is underscored. To enhance the efficiency of the educational process, the wide application of the computer-assisted technologies is recommended that can be simultaneously used to improve the methods for diagnostics and treatment of various pathological conditions. The activities based at the specialized students' scientific circle may prove very helpful to facilitate the acquisition of the necessary theoretical knowledge and practical skills by the medical students and thereby to promote the formation of professional otorhinolaryngologists.

[The experience with the supervision and treatment of the patients presenting with external otitis].

This clinical study was designed to estimate the efficacy and tolerability of the locally applied Pimafucort preparation for the treatment of diffuse otitis of bacterial and mycotic origin. The results of dynamic bacteriological investigation in conjunction with clinical observations give reason to recommend the local therapy as the sole treatment of uncomplicated forms of diffuse external otitis.

[Microbial view and optimal antibiotic therapy in acute purulent ENT diseases]. / Mikrobnyi peizazh i puti ratsional'noi antibiotikoterapii pri ostrykh gnoinykh zabolevaniiakh LOR-organov.

The aim of the study was elaboration of optimal antibiotic treatment in acute pyoinflammatory ENT pathology basing on the results of updated microbial tests and basic rules of microflora suppression by antibiotics. A total of 200 patients were examined. Of them, acute purulent sinusitis was diagnosed in 15, acute purulent otitis media in 25, paratonsillar abscess in 12 cases. Their microflora was studied for antibiotic sensitivity, the ability to form beta-lactamase was evaluated, microbiological examination of the content from purulent foci was made. It was found that the majority of acute purulent ENT diseases were caused by streptococci, gram-negative microorganisms (H. influenzae, M. catarrhalis, Klebsiella spp. et al), staphylococci and obligate anaerobes most of which produce beta-lactamase (up to 79%). From 88 to 100% pathogens were sensitive to amoxicillin/clavulanate, 18-59% -- to cephasoline, lincomycin or ampicillin. The treatment with antibiotics of different groups was assessed by dynamics of clinical symptoms and results of repeated microbiological analyses. The optimal antibiotic to start therapy of patients with acute purulent ENT diseases was amoxicillin/clavulanate in a new form -- 1000 mg (twice a day for 7 days).

[Bacterial contamination of the maxilla after radical surgical treatment]. / Bakterial'naia obsemenennost' verkhnecheliustnoi pazukhi posle radikal'nogo khirurgicheskogo lecheniia.

Qualitative and quantitative examinations of the microflora in a postoperative cavity of 62 patients early after radical surgery on the maxilla with opening of the ethmoidal labyrinth have found that in spite of a noticeable antibacterial effect of the operation pyoinflammatory process in the wound is possible. Treatment basing on bacteriological findings is recommended.

[Transcranial duplex scanning in estimation of cerebral hemodynamics in patients with secondary cochleovestibular neuritis]. / Transkranial'noe dupleksnoe skanirovanie v otsenke tserebra'noi gemodinamiki u bol'nykh s vtorichnym kokhleovestibuliarnym nevritom.

The authors present pilot experience with transcranial duplex scanning (TCDS) of the cerebral vessels in 17 patients with secondary cochleovestibular neuritis combined with chronic leptomeningitis (primarily of the posterior cranial fossa). This method has determined extra- and intracranial hemodynamics, characterized arterial and venous blood flow qualitatively and quantitatively, outlined possible genetically determined factors in development of dyscirculatory disorders. Finally, hemodynamic defects of two types were revealed in 12 patients. Type 1 (3 patients) was characterized by asymmetric circulation in the territory of the middle, anterior and posterior cerebral arteries, by the absence of venous congestion. Type 2 (9 patients) was characterized by impaired venous outflow manifesting as higher speed of the blood flow and its phase response along the intracranial veins and sinuses. In 7 patients these defects combined with asymmetric circulation along brain stem arteries. These patients were diagnosed to have perilymphatic labyrinthine hydrops.

[On postop strategies in surgically treated forms of ethmoid sinusitis]. / Problema posleoperatsionnoi taktiki pri khirurgicheskikh formakh gaimoroétmoidita.

146 patients were subjected to radical operations on the maxillary sinus with opening of the ethmoidal labyrinth cells. The superior effect of postoperative insertion of the latex tampon over gauze turunda was seen. Effective were also analgetics-antipiretics (paracetamol) and tactivin as medical correctors of early postoperative symptoms.

[Use of rovamycin and amox-clav in patients with infectious-inflammatory pathology of the ORL organs]. / Primenenie rovamitsina i amoksiklava u patsientov s infektsionno-vospalitel'noi patologiei LOR-organov.

Clinical and microbiological findings led the authors to the conclusion that antibacterial drugs rovamycin and amox-clav are active against ENT infection and inflammation. The trial included 69 and 42 patients given rovamycin and amox-clav, respectively.

[The potentials for using paracetamol in otorhinolaryngology]. / Vozmozhnosti primeneniia paratsetamola v otorinolaringologii.

The authors recommend to use paracetamol in otorhinolaryngological practice for anesthesia and lowering of body temperature. The drug effects are specified for 51 patients treated for acute otitis media. Follow-up data are outlined on conventional treatment of acute otitis media.