Objective. This study was conducted to increase effectiveness of anti-relapse therapy of chronic rhinosinusitis with polyps to create a stable long-term remission in the long-term postoperative period.

Patients and research methods. 60 patients with total spread of polyposis process in the nasal cavity and paranasal sinuses were examined. All patients underwent endoscopic polysinusotomy and 3 weeks after surgery, basic anti-relapse therapy of PRS in the form Of nasonex intranasal spray of 400 mcg/day for 6 months in combination with irrigation with isotonic salt solutions was prescribed. At the same time, 30 patients 1.5 months after polysinusotomy were additionally given a short course of systemic corticosteroid therapy with Methylprednisolone, starting at 20 mg/day in combination with Omeprazole at 20 mg /day for 14 days. Subjective assessment of the patients ‘condition was carried out by questionnaire, for objective diagnosis acoustic rhinometry and CT of the paranasal sinuses were used.

Results. Simultaneous administration of a short course of corticosteroid therapy in combination with prolonged intranasal use of Nasonex spray in patients with nasal polyps in the postoperative period contributed to the most rapid subjective improvement of nasal breathing. The combined scheme in 27 (90%) subjects showed a statistically significant improvement in intra-nasal aerodynamics (p<0.05) 2 months after polysinusotomy according to the results of acoustic rhinometry, the average MPPS1 was 0.67 ± 0,04 cm2 before and after the decongestant test. In 13 patients (44,3%) who received only intranasal corticosteroids reactive edema from the nasal mucosa were more pronounced, which contributed to the formation of zones of pathological narrowing of the nasal flow and a decrease in МППС1 to 0.43 ± 0,04см2 to test with decongestant. 2 years after surgical treatment in patients undergoing a combined course of corticosteroid therapy in relation to patients receiving only monotherapy with intranasal corticosteroids, there was no recurrence of polyposis in 86.7% of cases (26 patients), against 66.7% (20 patients), receiving only intranasal corticosteroids. 

The article deals with modern concepts of etiology, pathogenesis, diagnostics and treatment of inflammatory diseases of the outer ear. The problem of otitis externa flow in patients with diabetes is covered. The role of various microorganisms is discussed: Staphylococcus aureus, bacteria of Enterobacteriaceae family, fungi of Aspergillus, Candida, Penicillium, Mucor genera in the development of diffuse inflammation, variants of using local topical medications in the treatment of acute and chronic inflammatory diseases of the outer ear, as well as local therapy of otitis externa in combination with acute otitis media are considered. As the most effective and safe means the authors suggest using the local combined drug Candibiotic, which contains antibacterial, fungicidal, corticosteroid and analgesic components that affect the main pathogenesis factors of the disease.

Aim of the study – analysis of modern ideas about the pathogenesis of rhinitis medicamentosa. The authors consider the factors causing changes in inflammatory nature and leading to rhinitis medicamentosa. The comparative estimation of modern means of pharmacotherapy was made. On the basis of literature and clinical research data, it is concluded that Otrivin has a much more gentle effect and contributes less to the development of rhinitis medicamentosa.

Acute respiratory viral infections (ARVI) are one of the most common reasons patients seek ambulatory care. ARVIs can be caused by more than 200 strains of viruses, among which rhinoviruses remain a leading cause. The article discusses the epidemiological characteristics of ARVI and the economic damage caused by high incidence to the community. The clinical presentation of ARVI is nearly always accompanied by a combination of symptoms such as nasal discharge, nasal congestion, sore throat and cough combined with muscle pain, weakness, fatigue, headache and decreased appetite. Diagnosis of acute respiratory viral infections must be differentiated from influenza, allergic rhinitis, streptococcal tonsillitis, sinusitis and otitis media. Practicing hand hygiene is an effective way to prevent infections. The article discusses possibilities and effectiveness of concomitant adjuvant therapy, including the use of decongestants, topical glucocorticosteroids, nasal irrigation solutions, non-steroidal anti-inflammatory drugs, paracetamol and antitussive drugs. Antibacterial therapy does not have a positive effect on the course of ARVI. A clinical case describing the management of a patient with ARVI is provided.

Both allergic rhinitis (AR) and polypous rhinosinusitis (PRS) are a serious problem in context of their impact on quality of life, the risk of complications, overlay of bronchial asthma (BA) and medical control of these diseases. In most cases, T2 type eosinophilic inflammation lies beneath their pathogenesis, but the mutual influence of simultaneously existing chronic processes on each other appears under-investigated. Objective of the study: Compare the clinical and immunological characteristics of patients with polypous rhinosinusitis and concomitant allergic rhinitis and without respiratory allergy. All patients with PRS were divided into 2 phenotypic groups: Group 1 – PRS without bronchial asthma and respiratory allergy (54 people), Group 2 - PRS + allergic rhinitis, but without bronchial asthma (46 people). IL-1β-, IL-4-, IL-5-, IL-6-, IL-13-, IFN-γ-, TGF-β1-, TGF-β2-, TGF β-3 cytokines in nasal polyp tissue were determined using the Bio-Plex multiplex analysis system. Results: In patients with PRS combined with AR, the eosinophilic type of inflammation in the polyp tissue was determined in 100% of cases, it was accompanied by an increased level of IL-6, TGF-β1, TGF-β2, TGF-β3 and a reduced level of IL-5, IL-13 compared to PRS without comorbid pathology. Conclusions. Given the same clinical course of polypous rhinosinusitis, the identification of the difference in the cytokine profile in the nasal polyp tissue gives evidence of a different mechanism of the inflammatory response for different phenotypes of PRS. The polypous rhinosinusitis combined with allergic rhinitis is characterized by 100% eosinophilic type of inflammation, high levels of TGF-β family protein cytokines, pro-inflammatory cytokine IL-6 and a lower level of T2-cytokines IL-5 and IL-13 compared with the PRS group without comorbid pathology. The simultaneous treatment of PRS and allergic rhinitis using the joint efforts of otorhinolaryngologists and allergists will allow to achieve medical monitoring of both diseases and prevent their progression and development of complications.

The article discusses typical tasks of quantitative comparison and analysis of the effectiveness of diagnostic medical technologies. Indicators of clinical informativeness of diagnostic methods, quantitative methods for their calculation and interpretation, their importance for making diagnostic decisions are discussed. Using one of the diagnostic methods as an example, algorithms for comparing the test diagnostic test with the gold standard test according to clinical information indicators are described: sensitivity, specificity, positive and negative predictive value of test results, accuracy, likelihood ratio of positive and negative test results. The problems of constructing ROC curves by the example of diagnostic indicators of nasal obstruction: airflow and pressure, as well as the calculation and presentation of AUC (in one figure), finding diagnostic threshold points for two tests (changes in flow and resistance), and testing the statistical hypothesis about the equality of AUC of these two tests, creating a nomogram for calculating the post-test probability of illness. It is shown how, using the presented technique, it is possible to efficiently calculate all the standard operational characteristics of diagnostic medical technologies and additional useful indicators. All calculations were performed in the statistical program R. The text of the article presents program codes of the R language with explanations.

Aim of the study - the analysis of the current understanding of local changes in the mucous membrane of PNS in AS, as well as methods of pharmacotherapy of the disease. The authors consider the main mechanisms of pathogenesis of both acute and chronic sinusitis. One of the reasons underlying the development of infectious inflammation is described in detail: disturbance of drainage function of paranasal sinuses, aeration, mucociliary transport. Analytical evaluation of modern means of rational pharmacotherapy was made. It is concluded that the use of mucolytic drugs improves treatment results.

Background: Bilastine is a new non-sedating H1 antihistamine approved for the symptomatic treatment of allergic rhinoconjunctivitis (ARC) and urticaria in adults and children over 12 years of age. In this paper, bilastine was compared with desloratadine in the treatment of various forms of allergic rhino-conjunctivitis classified according to the ARIA recommendations.

Materials and Methods: This was an international, multi-centre, open-label, prospective randomized, parallel-group, phase III study which enrolled a total of 226 patients with ARC. The diagnosis of the allergic rhino-conjunctivitis was established on the basis of nasal and non-nasal symptoms and confirmed by the skin prick test. Patients were randomized to one of the two treatment groups: bilastine 20 mg daily or desloratadine 5 mg daily.

Results: The results for the primary and secondary endpoints showed a comparable reduction in TSS, NSS, and NNSS from the baseline to the end of the treatment between the treatment groups, with slightly better effects for bilastine. Additional tests carried out in the subgroup of patients with moderate / severe persistent (MSP) ARC demonstrated comparable results for the bilastine and desloratadine groups regarding the mean change in TSS from the baseline until the 28th day, except for the sneezing score, for which bilastine showed the higher response (-1.60 ± 0.60 vs. -1.39 ± 0.63), and a statistically significant difference between the treatment groups regarding AUC for TSS ( -26.07 [95% CI: -48.6, -3.53] p = 0.024), NNSS (-10.51 [95% CI:-19.42, -1.59] p = 0.021), the sneezing score (-4.79 [95% CI:-9.06, -0.51] p = 0.028) and the ocular redness score (-5.50 [95% CI: -8.91, -2.08] p = 0.02).

Conclusion: In general, bilastine and desloratadine showed a comparable efficacy profile in the treatment of ARC; however, the results obtained in the subgroup of patients with moderate / severe persistent symptoms indicate that bilastine has a stronger therapeutic effect 

The article is devoted to the problem of chronic tonsillitis. The aim of the study was to assess changes in the morphofunctional state of the palatine tonsils in chronic inflammation. The study presents comparative data of immunohistochemical examination of the tonsils in normal and chronic tonsillar pathology. The authors used the clinical classification of chronic tonsillitis developed by B.S. Preobrazhensky and V.T. Pal’chun. Histological changes in the palatine tonsils of patients with toxic-allergic form 2 chronic tonsillitis were described in accordance with this classification. The control group represented palatine tonsils tissue taken from patients without chronic tonsillitis. The examination was carried out using markers of apoptosis, antiapoptosis, cell proliferation, as well as various types of lymphocytes. The authors describe a tonsil tissue handling technique, morphological and functional state in each study group, compared the studied parameters in two groups, reflected the dynamics of changes in the palatine tonsils with chronic tonsillitis. Increased apoptotic and anti-apoptotic activity combined with decreased cell proliferation, increased number of T-helpers and B-lymphocytes gives evidence of significantly decreased functional activity of the palatine tonsils in chronic inflammation. These changes are correlated with the clinical picture to develop the most optimal management of the disease.

The choice of an optimal tactic for chronic rhinosinusitis treatment is a very topical issue in otorhinolaryngology. Several pieces of existing literature report a positive impact of a herbal-based remedy Sinupret for patients in the post-rhinosurgical period. 

Objectives of the study: The investigation of the effect of Sinupret on patients with chronic maxillary sinusitis in the early postoperative period.

Materials and methods: 15 patients with chronic rhinosinusitis were examined. The age of patients ranged from 20 to 57 years. The examination of patients was carried out right before the surgery and three months after it. The examination also included general otorhinolaryngological examination, assessment of the overall severity of the disease on the VAS scale, endoscopy of the nasal mucosa, assessment of nasal breathing function based on the analysis of the main indicators of anterior active rhinomanometry and computed tomography of the paranasal sinuses. Two days before their surgery, each patient was prescribed to take two tablets of Sinupret 3 times a day up to 14 days.

Results: By day 10 of the post-surgery period, all patients reported noteworthy improvement in nasal breathing, a significant decrease in nasal discharge and no discomfort in the projection of the paranasal sinuses. There was a substantial decrease in the severity of oedema, exudation and formation of crusts, fibrin in all examined patients with rhinoscopy. According to the anterior active rhinomanometry, a statistically significant increase in the total nasal flow and a decrease in nasal resistance to physiological values were established 3 months after surgery.

Conclusion: This article presents the results of Sinupret usage in the combined therapy before and after surgical treatment of patients with chronic rhinosinusitis and abnormal development of nasal structures. The results of that 14-day treatment evidenced an acceleration of epithelialization and restoration of drainage; as well as an improvement of ventilation function of the nasal cavity and paranasal sinuses. In addition to that, the chosen treatment contributed to the reduction of the rehabilitation period and the absence of relapses of chronic maxillary sinusitis was observed. 

The problem of allergic rhinosinusopathies is one of the most pressing in modern rhinology. It has drawn the attention of clinicians for several decades. Allergic rhinitis is a common disease, the onset of which often come in early childhood. In later life, this disease significantly reduces the quality of life. The widespread prevalence of allergic rhinitis among children and able-bodied adults, growing incidence rates of the disease represent a significant medical and social problem. Allergic rhinitis should be treated by otorhinolaryngologists and allergists-immunologists. Given the pathogenetic mechanisms of the disease, it is necessary to act upon the local symptoms and total body. Extension of disease remissions, teaching patients the principles of elimination therapy and how to maintain a healthy microclimate at home, relapse prevention are the main directions in the treatment of allergic rhinitis. The primary task of otorhinolaryngologists and allergists-immunologists is to restore unlabored nasal breathing in such patients. Symptomatic therapy includes administration of vasoconstrictor drugs, anticholinergics, cromons, local and systemic antihistamines, leukotriene receptor blockers, topical and systemic glucocorticosteroids (GCS), sorbents, pre- and probiotics. Despite the fact that the symptomatic therapy methods cannot provide a long-lasting effect after cancellation, local symptomatic treatment of allergic rhinitis using topical corticosteroids is generally accepted and widely used in the otorhinolaryngology practice. Flixonase is one of the topical corticosteroids that are often prescribed for allergic rhinitis. The aim of our paper was to evaluate the effectiveness of the treatment regimen of allergic rhinitis using Flixonase as a local GCS. 24 people with perennial allergic rhinitis aged from 19 to 38 years were under our observation. The following therapy was prescribed to the patients: decongestants, rinsing the nasal cavity with saline (saltwater) solutions, corticosteroids (Flixonase), mild sedatives. Flixonase showed its efficacy in our study.

The pathological inflammatory process in the Eustachian tube, as well as the catarrhal stage of acute otitis media, are the most common conditions in the practice of a pediatric otolaryngologist. The article presents literature data on acute pathology of the middle ear, epidemiology, etiology and standard conservative therapy. The fact of the influence of persistence of herpes virus infection on the development of hyperplastic processes in the lymphoid ring of the pharynx in children is described. It was noted that there are few data on the conduct of etiotropic and pathogenetic therapy in patients with acute middle ear pathology infected with pathogens of latent infections in the literature. The article presents a clinical case of successful treatment of the patient with acute otitis media and timely identified markers of an active infection process. Also the determination of clear indications and the timing of the specific conservative treatment of acute otitis media in children, based on an analysis of the etiological aspects of the development of this disease, the duration and somatic condition of the patient allowed to reduce the percentage of complications and relapses in the development of acute otitis media. When selecting adequate therapy for acute otitis media in children, it is necessary to consider the etiology of the disease in each individual patient. In the presence of acute lymphoproliferative syndrome in combination with middle ear inflammation, it is necessary to verify the causative factor with a laboratory examination (diagnosis by polymerase chain reaction and enzyme-linked immunosorbent assay with antibody detection) for herpes virus infection (Epstein-Barr virus, cytomegalavirus, herpes simplex virus 6 type), with further selection of specific therapy and observation of an otolaryngologist and infectious disease specialist.

The article states the principles for antibiotic therapy for chronic tonsillitis (CT) and acute tonsillopharyngitis (ATP). The greatest attention is paid to the non-angina CT, when the patients, as a general rule, are deprived of antibiotic therapy. At the same time, the article provides data of St. Petersburg Research Institute of ENT, whereby at least 40% of patients with CT have streptococcal etiology of the disease caused by group A beta-hemolytic streptococci (GABHS) that is confirmed by not only bacteriological, but also immunological research methods (increase in antistreptolysin-O). In addition, the number of diseases caused by groups C and G beta-hemolytic streptococci has increased in recent years. These groups of streptococci contribute to the development of complications like those caused by GABHS, and therefore the doctor’s attitude towards them should be more critical and in some respects - the same as to GABHS. As you know, streptococcal infection is one of the most dangerous due to the development of internal organs and systems complications. This proposition justifies the need for systemic antibacterial therapy in patients with CT, when they are diagnosed with streptococcal infection, regardless of the presence of angina. In vitro studies showed that GABHS has good sensitivity to penicillin preparations. However, it is not always possible to achieve treatment targets in practice. Given that the duration of antibiotic therapy for streptococcal infection should be at least 10 days, it is difficult to achieve full medication adherence. In this regard, prolonged-release penicillins, such as Bicillin-5, gain ground. The article substantiates the use of this drug in CT, discusses a clinical case, which shows the medical history of a girl with coexistent affection with GABHS of the pharynx and vagina. Only 4-month administration of Bicillin-5 allowed to cure the patient, having achieved GABH eradication.

Acute traumatic perforation of the tympanic membrane occupies a significant place in the structure of the pathology of the middle ear, since «persistent» perforation of the tympanic membrane is the main cause of chronic inflammation in the middle ear, leading to hearing loss and reducing the quality of life of patients. «Persistent» perforation of the tympanic membrane, according to various authors, is formed in 84-392 cases per 10,000 population, so restoring the integrity of the damaged tympanic membrane is one of the main tasks of reconstructive otosurgery. Most authors are of the opinion that it is advisable to close the traumatic eardrum defect early. To date, many ways to close it have been developed. In modern otorhinolaryngology there is extensive experience in using various methods of myringoplasty using various materials for traumatic perforation of the tympanic membrane. However, such a wide variety of plastic techniques and the variety of materials used for this indicates an unresolved problem of closing the perforation of the tympanic membrane. To date, many works have been published that confirm the effectiveness of the use of blood plasma enriched with platelet growth factors in plastic surgery, cosmetology, traumatology, and dentistry. The result of exposure to blood plasma enriched with growth factors is the expression of proteins that regulate chemotaxis, adhesion, cell proliferation, angiogenesis, cell differentiation and the synthesis of extracellular matrix components. Blood plasma enriched with growth factors is autologous (biocompatible), safe from the point of view of the transfer of infectious pathogens. Thus, it can be assumed that the use of plasma enriched with growth factors during surgery during closure of acute perforation of the tympanic membrane will lead to accelerated tissue regeneration and, consequently, a reduction in the length of the postoperative period, and improved treatment outcomes. The use of this method is possible even in a day hospital.

Periodontitis as a manifestation of the systemic diseases was placed in separated part in the contemporary periodontal diseases classification. It has its own specific traits caused by features of the common pathology. The way as ß-thalassemia major is impacting to periodontium could be recognized as the indirect acting out of the side of dental and occlusal anomalies or direct acting of ß-thalassemia major to the periodontium. The range of the influence on periodontium depends on the degree of intensity of the systemic diseases.

Actuality. The growth of inflammatory diseases of ENT organs and associated purulent-septic intracranial complications is an urgent problem of modern otorhinolaryngology. Severe complications associated with sepsis and inflammatory lesions of the membranes and brain matter are life-threatening conditions for otorhinolaryngological patients.

Objective. To study the epidemiological situation of inflammatory diseases of the ENT organs and associated purulent-septic intracranial complications in the Kabardino-Balkarian Republic.

Materials and methods. Data of official statistics, electronic databases, statistical reports of the Ministry of Health of the KabardinoBalkan Republic, data of outpatient’s medical records and hospital medical records of multidisciplinary medical and preventive institutions, data on the prevalence of diseases of ENT organs in the Kabardino-Balkarian Republic from 2011 to 2018 among adults and children.

Results and conclusions. The results obtained reflect a significant increase in inflammatory diseases of the ENT organs in the Kabardino-Balkarian Republic from 2011 to 2018. both in the number of reported cases and in the primary incidence. Despite the decrease in the number of inpatient ENT beds in the Republic in 2013, the number of patients treated increased. The reduction of ENT beds entailed an increase in hospital mortality, which is represented exclusively by ENT-associated intracranial complications. Today, the Republic has a rather high level of ENT-associated intracranial complications associated with low prevention and diagnosis of inflammatory ENT diseases, which dictates the importance of using a multidisciplinary approach (ENT doctor, neurologist, ophthalmologist, resuscitator, therapist, neurosurgeon), the need for review management tactics, development of algorithms for the diagnosis and optimal treatment of patients with ENT-associated HFD.