[Bacterial microbiota in exacerbation of chronic purulent otitis media in children]. / Bakterial'naya mikrobiota pri obostrenii khronicheskogo gnoinogo srednego otita u detei.

OBJECTIVE: To study current spectrum of bacterial pathogens that cause exacerbation of chronic suppurative otitis media (CSOM) in children, who live in Moscow region, and to investigate sensitivity of isolated strains to various antibacterial drugs. MATERIAL AND METHODS: The results of microbiome's bacterial cultivation of purulent discharge from tympanic cavities collected from 269 children with CSOM aged from 1.5 to 18 years for the period from 2017 to 2021 yr. were analyzed. The majority of examined subjects (70.6% from 190 children) had CSOM with cholesteatoma. RESULTS: Monoculture was received in 62.5% of examined patients, bacterial associations - in 25.7%, bacterial-fungal associations - in 2.6%, and there was no growth in 9.2% of subjects. Staphylococcus aureus, which was found in 36.1% of children, dominated among agents. Pseudomonas aeruginosa was the second most frequently diagnosed agent, revealed in 12.3% of patients. Candida spp. (7.1%) was prevalent in bacterial-fungal associations. The article presents the results of isolated strains' sensitivity to antibacterial drugs. The high resistance to oxacillin, cefoxitin and antipseudomonal drugs was found among strains collected from children with CSOM and cholesteatoma. CONCLUSION: S. aureus (36.1%) and P. aeruginosa (12.3%) remain the most common causative agents for exacerbation of chronic suppurative otitis media in children. Pathogenic fungi are not isolated separately, and Candida spp. (6.7%) dominates in bacterial-fungal associations. It is generally recognized and confirmed by our research, that topical fluoruquinolones (ciprofloxacin) are the most effective drugs for exacerbation of chronic suppurative otitis media treatment. Systemic antibiotics, of which fluoruquinolones (ciprofloxacin) are the most effective, are recommended in severe exacerbation, severe and destructive forms of chronic suppurative otitis media.

[Features of bacterial microbiota in acute purulent otitis media in children]. / Osobennosti bakterial'noi mikrobioty pri ostrom gnoinom srednem otite u detei.

PURPOSE OF THE STUDY: The purpose is to study the spectrum of bacterial pathogens that cause acute purulent otitis media (APOM) in children of the Moscow region in modern conditions and assess their sensitivity to the main groups of antibiotics. MATERIAL AND METHODS: The study included 1.864 children who underwent examination and received treatment in the otorhinolaryngological department of Morozovskaya Pediatric Municipal Clinical Hospital in the period from 01 July 2018 to 31 June 2020 with a diagnosis of APOM. RESULTS: The study showed that the leading bacterial pathogens of APOM are Streptococcus pneumoniae (28.0%), Staphylococcus aureus (27.2%), Streptococcus pyogenes (22.2%), Haemophilus influenzae (7.8%), and Pseudomonas aeruginosa (6.5%). Attention is drawn to the increase in the level of resistance of S. pneumoniae to oxacillin (11.64%). CONCLUSIONS: The data obtained indicate the feasibility and prospects of vaccination against pneumococcal infection as one of the ways to curb the spread of resistance of S. pneumoniae to antibacterial drugs.

[Transcanal endoscopic middle ear surgery in children with chronic suppurative otitis media]. / Transkanal'nye endoskopicheskie operatsii na srednem ukhe u detei s khronicheskim gnoinym srednim otitom.

Otomicroscopic surgery remains the gold standard in the surgical treatment of patients with CHS. Endoscopic ear surgery is gaining more and more importance as an adjunct to microsurgery. Recently, thanks to the resolution of the endoscopic technique, endoscopic surgery can be used as an independent method. This article presents the results of endoscopic tympanoplasty, endoscopic removal of the tympanic cholesteatoma, performed on the basis of the otorhinolaryngology department of the Morozov Children's City Clinical Hospital. Research has shown that transcanal endoscopic surgery is an effective alternative to traditional otomicroscopic surgery. Advantage in minimal impact and improved visualization of all quadrants of the tympanic membrane, the anterior tympanomeatal angle of the NSP, and structures of the middle ear.

[Modern causes of tracheostomy in children]. / Sovremennye prichiny trakheostomii u detei.

The purpose of work is to analyze the causes of tracheostomy in children hospitalized in a large multidisciplinary pediatric hospital. MATERIAL AND METHODS: Retrospective analysis of case of children treated in a multidisciplinary urgent hospital - GBUZ «Morozovskaya CCCH of MDH¼, which in the period from 01.01.16 to 31.12.18 was made operation «tracheostomy¼ was conducted. RESULTS: Tracheostomy was performed in 138 (0.064%) among 216 469 hospitalized children. Age at the time of tracheostomy ranged from 2 weeks to 17.5 years (on average 67.9±59.84 months, Me=47.5 months), and 36.2% of children had tracheostomy was done on the 1st year of life. 126 (91.3%) patients required prolonged tracheal intubation prior to tracheostomy placement; the duration of intubation ranged from 1 to 95 days (on average 19.9±13.42 days, Me=14 days). The main reasons of tracheostomy were the need for long-term mechanical ventilation/respiratory support; the need for constant sanitation of the lower respiratory tract with bulbar/pseudobulbar disorders; upper respiratory paths obstruction. The diseases that led to this condition can be grouped into 4 categories: CNS pathology - 76 (55.1%) patients; brain / spinal cord tumors - 36 (26.1%); neurodystrophy and stenosis of the upper respiratory tract of various etiology - 13 (9.4% each) patients. 68.1% of patients were found incurable and required palliative care. Mortality among patients with a known catamnesis was 39.1%, mainly due to progression of the underlying disease; the lethality associated with tracheal cannulation was 1.4%. CONCLUSION: Currently, pediatric tracheostomy is moving into the category of predominantly planned surgical interventions. More than 2/3 of children requiring tracheostomy are patients in need of palliative care with severe pathology of the central nervous system; in which the main indications for surgery are the need for respiration support and regular tracheobronchial care..

[Two cases of bilateral lymphangiomatous palatine tonsil polyps in children]. / Nabliudenie dvukh sluchaev dvustoronnikh limfangiomatoznykh polipov nebnykh mindalin u detei.

Lymphangiomatous polyps of palatine tonsils are a rare condition, which is diagnosed with patomorphological study. About cases in total are reported in the literature, mostly with one-sided lesions. We managed to find only two reports of lymphangiomatous polyps of palatine tonsils in the available literature. The patients were children in both cases. We report our two cases of children with lymphangiomatous polyps of palatine tonsils.

[The algorithm of the treatment and diagnostic strategy for the treatment the children presenting with acute mastoiditis]. / Algoritm lechebno-diagnosticheskoi taktiki lecheniia detei s ostrym mastoiditom.

This article was designed to report the results of the analysis of the cases of chronic otitis media complicated by mastoiditis in the children admitted to the Morozovskaya City Children's Clinical Hospital for the examination and treatment during the period from 2009 till 2017. The objective of the present study was to evaluate the clinical significance and the optimal time schedule of computed tomography (CT) of the temporal bones in the patients with suspicion of mastoiditis for the determination of the indications for their surgical treatment. All the patients were divided into three groups differing in the severity of clinical manifestations of the disease. A special algorithm of the treatment and diagnostic strategy was developed for the management of the patients included in each group that made possible the structured approach to the choice and performance of the treatment and diagnostic procedures.

[The role of the endoscopic assistance in the surgical treatment of the children presenting with chronic suppurative otitis media and cholesteatoma]. / Éndoskopicheskaia assistentsiia v khirurgicheskom lechenii detei s khronicheskim gnoinym srednim otitom s kholesteatomoi.

The present study was designed to elucidate the possibilities for the application of angled endoscopes in the sanation of those compartments of the middle ear which are difficult to access for visual control with the use of a microscope, such as the retrotympanic structures (e.g. tympanic and facial retraction pockets), anterior epitympanum, etc. To this effect, we have undertaken the analysis of the results of surgical interventions on the children presenting with chronic suppurative otitis media and concomitant cholesteatoma. A total of 59 primary operations and 35 secondary ones were performed to treat recurrent cholesteatoma. In 41 cases, the surgical intervention was carried out without the endoscopic assistance whereas in the remaining 53 ones the microscopic observation of the difficult-to-access compartments of the middle ear were supplemented by the application of an angled endoscope. Whenever residual portions of cholesteatoma were identified, they were removed under the endoscopic control. The algorithm for the endoscopic assistance during such operations has been proposed, its advantages and limitations are considered. It is concluded that the combination of microscopic and endoscopic techniques for the examination of and operation on the middle ear creates the conditions for the more reliable (in comparison with the traditional otomicroscopic methods) removal of the residual cholesteatoma tissues and thereby allows to reduces the risk of development of residual cholesteatoma from 25% to 13.5%. The results of the present study have demonstrated the necessity of development of a universal approach to the identification of the clinically significant manifestations of chronic suppurative otitis media and cholesteatoma.

[The role of gastroesophageal reflux disease in the development of chronic exudative otitis media in the children during the first year of life]. / Rol' gastroézofageal'noi refliuksnoi bolezni v formirovanii khronicheskogo ékssudativnogo srednego otita u detei pervogo goda zhizni.

The objective of the present study was the determination of the incidence of gastroesophageal reflux disease and the evaluation of its possible influence on the development and duration of chronic exudative otitis media in the children during the first year of life. A total of 141 infants at the age of 3 months presenting with exudative otitis media refractory to the conservative treatment throughout the first 1-1.5 months of life were available for the examination. The effectiveness of the anti-reflux therapy was estimated based on the middle ear condition (the presence or absence of exudate) within 3 and 6 months after the initiation of the treatment. The signs of aspiration of gastric chimus and gastroesophageal reflux disease were documented in 92% of the cases. The anti-reflux treatment during 3 months resulted in the disappearance of the manifestations of exudative otitis media in 43% of the patients. The further prolongation of such therapy up to 6 months allowed to normalize the state of the middle ear in 69% of the children although the remaining 40% failed to respond. It is concluded that the treatment of the children presenting with exudative otitis media during first year of life should be performed taking into consideration the possible involvement of gastroesophageal reflux disease in pathogenesis of this pathological condition.

[The observation of two cases of isolated parapharyngeal abscess in a single child]. / Nabliudenie dvukh izolirovannykh parafaringeal'nykh abstsessov u odnogo rebenka.

This article reports a rare observation of the simultaneous appearance of two isolated parapharyngeal abscesses in a 3 year-old child.

[Rosai-Dorfman disease: the review of the literature and the clinical observation of the extranodal form of the disease with the involvement of mucous membranes of the nose and paranasal sinuses]. / Bolezn' Rozai-Dorfmana: obzor literatury i klinicheskoe nabliudenie ékstranodal'noi formy zabolevaniia s porazheniem slizistoi obolochki nosa i okolonosovykh pazukh.

Rosai-Dorfman disease originally known as sinus histiocytosis with massive lymphadenopathy is a rare non-neoplastic condition of unexplored etiology characterized by a benign clinical picture. The present article summarizes the results of the literature publications and clinical observations of the extranodal form of Rosai-Dorfman disease manivfested as the lesions of mucous membranes of the nose and paranasal sinuses.

[The specific features of the past medical history and etiology of pharyngeal abscess in the children]. / Osobennosti anamneza i étiologii abstsessov glotki u detei.

The present study was undertaken for the purpose of elucidating the specific features of the past medical history and the etiological factors responsible for the development of tonsillogenic pharyngeal abscesses in the children. We performed the retrospective analysis of the medical histories of 291 children presenting with this condition who had been admitted for the treatment to the ENT Department of the Morozovskzya City Children's Clinical Hospital during the period from January till December 2015. The study has demonstrated the following most common shortcomings of the outpatient treatment of the patients suffering from chronic tonsillitis at the stage preceding formation of paratonsillar abscess: inadequate antibacterial therapy of acute chronic tonsillitis or its exacerbation and limited indications for tonsillectomy at the level of the outpatient treatment. The leading role in the etiology of tonsillogenic pharyngeal abscesses in the children is played by beta-hemolytic Streptococcus of group A. It is concluded that the medical history suggesting past paratonsillar abscess is the absolute indication for the subsequent tonsillectomy in the children of any age.

[Acute otitis media in a 5 year-old child complicated by mastoiditis and abscess of the temporomandibular joint]. / Ostryi srednii gnoinyi otit u rebenka 5 let, oslozhnivshiisia mastoiditom i abstsessom visochno-nizhnecheliustnogo sustava.

This article was designed to report a case of otogenic abscess of the temporomandibular joint in a 5 year-old child. The specific feature of this observation is a rare complication of acute otitis media (otogenic abscess of the temporomandibular joint). Of crucial importance for the establishment of the correct diagnosis was the timely evaluation of the state of the temporomandibular bones by means of CT examination.

[The influence of an isotonic solution containing benzalkonium chloride and a hypertonic seawater solution on the function of ciliary epithelium from the nasal cavity in vitro].

The objective of the present study was to evaluate the influence of an isotonic saline solution containing benzalconium chloride and of a hypertonic seawater solution on the function of ciliary epithelium in the nasal cavity in vitro. To this effect, we investigated the cytological material obtained from 35 children presenting with adenoid tissue hypertrophy. The tissue samples were taken from the nasal cavity by the standard method. A cellular biopsy obtained from each patient was distributed between three tubes that contained isotonic saline solution supplemented by benzalconium chloride (0.1 mg/ml), a hypertonic seawater solution, and a standard physiological saline solution. It was shown that the number of the viable cells in both isotonic solutions was statistically comparable and significantly higher than in the hypertonic solution (p<0.05). The ciliary beat frequency of the cells embedded in the two isotonic solutions was not significantly different but considerably exceeded that in the hypertonic seawater solution (p<0.05). Thus, the present study has demonstrated the absence of the ciliotoxic influence of isotonic saline solution containing benzalconium chloride at a concentration of 0.1 mg/ml and the strong ciliotoxic effect of the hypertonic seawater solution. This finding gives reason to recommend isotonic solutions for the regular application whereas hypertonic solutions can be prescribed only during infectious and/or inflammatory ENT diseases.

[Balloon dilatation of the cartilaginous portion of the Eustachian tube in the children presenting with relapsing exudative otitis media].

The objective of the present study was to evaluate the effectiveness and the safety of balloon dilatation of the cartilaginous portion of the Eustachian tube in the children presenting with relapsing exudative otitis media. A total of 15 children (22 ears) at the age from 3 to 16 years suffering from relapsing exudative otitis media over 18 months in duration were available for the examination. Neither conservative nor surgical treatment produced any stable beneficial effect in these patients. Acoustic impedancometry yielded type B tympanograms. All the children were treated with the use of balloon dilatation of the cartilaginous portion of the Eustachian tube under endotracheal anesthesia. The follow-up examination carried out within 6--8 weeks after the treatment revealed the complete recovery of the function of the middle ear (type A tympanograms) in 11 (73.3%) children. Partial restoration of this function (as evidenced by type C tympanogram) was documented in 4 children. These patients underwent the second course of conservative therapy that resulted in the complete restoration of the function of the middle ear. It is concluded that balloon dilatation of the cartilaginous portion of the Eustachian tube in the children presenting with relapsing exudative otitis media provides the efficient and safe approach to the management of this condition. Being a minimally invasive method, it has good prospects for the practical application and is worth further investigation.

[Congenital parotid gland fistula in the children: diagnostics and surgical treatment].

The objective of the present study was to improve diagnostics and surgical treatment of congenital parotid gland fistulae. It involved 86 children presenting with this defect at the age varying from 4 months to 17 years who were admitted to the Department of Otorhinolaryngology of the Morozovskaya City Children's Clinical Hospital during the period from 2010 till 2014. It was shown that parotid fistula suppuration is an absolute indication for the surgical treatment of such children regardless of their age. The proposed diaphanoscopic technique was shown to produce good results and can be recommended for both diagnostics an intraoperative visualization of the fistulous passage.

[Apical petrositis, osteomyelitis of the base of the skull bones and of the first cervical vertebra in a 5 year-old children following chicken pox].

This publication was designed to describe a rare case of development of apicalpetrositis in a child presenting with acute otitis mediafollowing chicken pox experienced in the preceding period. We carried out the study with the use of computed tomography (CT) that demonstrated destruction of the temporal bone, bones of the base of the skull and of the first cervical vertebra. The treatment strategy chosen for the management of this condition that included antibiotic therapy and expectant observation proved justified and can be recommended as an algorithm of choice taking into consideration the difficulty of surgical approach to the apex of the petrous pyramid. However, this approach is associated with the high risk of disability arising from the potential injury to the craniocerebral nerves.

[Local anesthesia in the children undergoing the fibroendoscopic study of the nasal cavity, nasopharynx, and larynx: are topical anesthetics needed?].

This prospective randomized study with double blind control was designed to evaluate the effectiveness of various anesthetic techniques employed prior to fibroendoscopy of the nose, nasopharynx, and larynx of the children. The study included 160 children at the age varying from 3 to 14 (mean 7.4±2.96) years randomly allocated to four statistically comparable groups matched for age and sex. The following preparations were used to treat the children prior to fibroendoscopy: physiological solution (group 1), a 0.05% xylometazoline solution (group 2), a 10% lidocaine solution (group 3), and a mixture of 0.05% xylometazoline and 10% lidocaine solutions (group 4). The evaluation of the tolerance to the pretreatment of the nasal cavity with lidocaine and lidocaine plus xylometazoline (groups 3 and 4) showed that it was significantly (p<0.05) worse than in groups 1 and 2. The subjective tolerance to fibroendoscopy as reported by the patients was on the average similar in the children of all four groups (p>0.05). The doctors found the tolerance of fibroendoscopy to be the worst following pretreatment with the physiological solution (group 1) and the best after pretreatment with a mixture of lidocaine and xylometazoline (group 4) (p=0.03). The children comprising groups 2 and 3 were not significantly different in terms of the tolerance to fibroendoscopy (p>0.05). It is concluded that the pretreatment of the nasal cavity of the children with a 10% lidocaine solution before fibroendoscopy has no advantage over the pretreatment with a 0.05% xylometazoline solution; at the same time, insuflation of lidocaine as an anesthetic induces more pronounced negative emotions compared with the application of 0.05% xylometazoline.