Today, acute rhinosinusitis is one of the most common infectious diseases in the world. Usually, acute rhinosinusitis develops against the background of acute respiratory viral infection caused by influenza viruses, parainfluenza, respiratory syncytial virus, adenoviruses, or rhinoviruses. At the same time, in 1–2% of cases, the course of acute respiratory viral infection is complicated by bacterial sinusitis. At the same time, in 1–2% of cases, the course of acute respiratory viral infection is complicated by bacterial sinusitis. Considering the stages of the process, it is extremely important to adequately prescribe therapy at the onset of acute respiratory viral infection before the development of symptoms of acute rhinosinusitis, since the prognosis largely depends on its effectiveness. Treatment of acute rhinosinusitis is aimed at relieving the symptoms of the disease, improving aeration of the nasal cavity and paranasal sinuses, restoring the functions of mucociliary transport, and in the case of bacterial agent attachment, at the eradication of the pathogen. Such problems are solved through complex therapy, including irrigation measures, decongestants, topical glucocorticosteroids, and antibiotics if indicated. To improve the function of mucociliary transport the standard therapy of acute rhinosinusitis is combined with herbal medicines, which have a mucoactive, secretomotor, secretolytic and anti-inflammatory effects. The article presents data on the pharmacokinetics and pharmacodynamics of the drug Sinupret, the results of experimental studies and clinical studies that prove the high effectiveness and safety of the drug in the complex treatment of acute rhinosinusitis. One of the important advantages of using the herbal drug Sinupret is an increase the effectiveness of antibiotic therapy, which allows for a faster recovery in bacterial sinusitis, and moreover in cases of acute post-viral sinusitis, Sinupret can be used as monotherapy.

The significance of the issues of allergic diseases is not in doubt. It is difficult to find a person who has not suffered at least some Allergy symptom, not everyone develops diseases, but most people face Allergy symptoms. The prevalence of various allergic diseases is increasing every year, currently reaching 30% of the population, and the world health organization predicts it will reach 50% in the next few decades. The most common nosologies are allergic rhinitis, bronchial asthma, atopic dermatitis, urticaria, but there are many other conditions of hypersensitivity. This article addresses the issues of inflammatory reactions in General and specifically allergic inflammation, discusses the main aspects of the pathogenesis of allergic rhinitis and urticaria, and questions of drug therapy for these diseases. Most people are sure that they can take anti-allergic medications for allergies, and most often they are referring to antihistamines. Unfortunately, even some medical specialists lack an understanding of the specifics of antihistamine therapy. some people still believe that there are three or four generations of antihistamines, and patients use drugs not as prescribed by doctors, but on the recommendation of friends or pharmacists. Irrational use of antihistamines leads to a decrease in effectiveness, and it is not uncommon to discredit specific drugs and groups of drugs in General. This article demonstrates the results of various European and Asian studies on the effectiveness and safety of antihistamines and bilastin in particular, as well as their own experience of using antihistamines in practice.

The treatment of patients with chronic stenosis of the larynx and trachea is a laborious long process that requires special attention to the choice of surgical tactics and conservative therapy. The effectiveness of the performed surgical treatment largely depends on the course of the postoperative wound process, which explains the need for an individual approach to patient management in order to prevent the development of bacterial complications. One of the factors contributing to the occurrence of these complications are transient microorganisms that colonize the mucous membrane of the respiratory tract, represented mainly by Streptococci, Staphylococci and Neisseria, as well as Acinetobacter, Moraxella, Corinebacterium, Escherichia, Klebsiella. In order to prevent postoperative complications, it is necessary to carry out antibacterial prophylaxis with I–II generation cephalosporins (cefazolin, cefuroxime) or inhibitor-protected aminopenicillins (amoxicillin/clavulanate, ampicillin/sulbactam) during clean surgical interventions. In cases where a bacteriological examination reveals hospital strains of microorganisms, it is necessary to carry out antibacterial therapy aimed at eradication of the bacterial pathogen. In case of “dirty” surgical interventions in patients in cases where a bacteriological examination does not reveal pathogenic strains of microorganisms, it is recommended to carry out antibacterial therapy with broad-spectrum antibiotics, within 7–10 days after the surgery. Irrigation and inhalation therapy occupies a special place in the treatment of patients with chronic stenosis of the larynx and trachea. At the final stages of the operation, irrigation of the surgical area with solutions of glucocorticosteroids and anesthetics is used, and inhalation therapy is used starting from the early postoperative period, continuing throughout the entire period of inpatient treatment, as well as at the outpatient stage. Among the inhalation drugs used topic antibiotics, glucocorticosteroids, mineral water, mucolytics, and bacteriophages are most often used.

Acute nasopharyngitis is the most common reason for visit a doctor, usually benign, self-limited disease. It is also characterized by a high frequency of complications in children and nonspecific symptoms that require special care from the doctor when examining patients. The clinical and social significance of acute nasopharyngitis is due to their high prevalence, and inadequate treatment leads to a protracted course or to a transition to a chronic one. The relevance of this problem adds to the presence of a large number of various drugs, but not many drugs have evidence-based effectiveness. In the treatment of acute nasopharyngitis local drugs are very important. The drug is a silver proteinate agent with broad antibacterial anti-inflammatory activity. The drug is used to treat infectious rhinitis. This article evaluates the use of a new form of the silver proteinatedrug, the drug is available in the pharmacy, easy to use, long shelf life. This article describes the place of silver proteinate among drugs that help to relieve the symptoms of acute nasopharyngitis and provides data on its effectiveness, safety and features of use in children. The drug can take a worthy place among topical drugs due to its high efficiency in the treatment of acute rhinitis and its possible use at any age.

The article deals with the treatment of acute inflammatory diseases of the oropharynx, which are an essential part of ENT pathology and are one of the main therapeutic and diagnostic tasks for an otorhinolaryngologist both on an outpatient basis and at the inpatient stage of medical care. It is known that most acute pharyngeal diseases have a viral etiology, do not have etiotropic treatment, and are treated mainly symptomatically. Nevertheless, many patients are irrationally prescribed systemic antibiotic therapy, which leads to an increase in global antibiotic resistance. There are known patterns of correlation between the practice of irrational prescribing of antibacterial therapy and peaks of antibiotic resistance in different countries. At the same time, local antimicrobials are often prescribed, many of which have a negative effect on the pharyngeal microbiome and contribute to bacterial superinfection. The appointment of this group of drugs is also unjustified, given the viral etiology of the pathological process. Acute infections of the upper respiratory tract, including the pharynx, often occur against the background of violation of mucosal immunity, which is the first barrier in the system of protection against respiratory infections. In the treatment of these diseases, it is important to use drugs that not only have antimicrobial properties, but also stimulate mucosal immunity and reparative processes. The solution in this situation can be the therapeutic use of various factors of local immunity that will not cause antibiotic resistance and bacterial superinfection, but will act synergistically with autologous factors of mucosal protection. This article provides an analysis of prospects of using one of such drugs in inflammatory pharynx diseases.

Introduction. Тo study the microscopic picture of the tissues of the perforated tympanic membrane after the introduction of blood plasma enriched with platelet growth factors into the perforated area of the tympanic membrane in the experiment.

Materials and methods. 36 rats (72 tympanic membranes) were examined. The animals were divided into 2 groups, the main and the control. The tympanic membrane was perforated in rats of both groups using sterile play. Animals of the main group were injected with a single application of autoplasm of blood enriched with platelet growth factors into the area of perforation of the tympanic membrane. The animals of the control group underwent only dynamic observation. The rats were withdrawn from the experiment in batches of 6 individuals on day 5, 10, 15 after the tympanic membrane perforation, then a histological assessment of the tissue regeneration of the tympanic membranes was performed. Results. In animals of the main group on the 5^th day after perforation of the tympanic membrane, edema and disorganization of connective tissue were significantly less frequently recorded than in animals of the control group (p ≤ 0.05). Fibroblastic infiltration of tympanic membrane tissues was significantly more often observed in rats of the main group compared with rats in the control group (p ≤ 0.05). In rats of the main group on the 10^th day after perforation of the tympanic membrane, edema and disorganization of the connective tissue of the tympanic membranes were noted significantly less frequently than in rats of the control group (p ≤ 0.05). Signs of fibroblastic infiltration and neoangiogenesis at the same time in animals of the main group were revealed significantly more often, in contrast to rats in the control group (p ≤ 0.05). In animals of the main group, on the 15th day after perforation of the tympanic membrane, fibroblastic infiltration and neoangiogenesis were revealed in all cases of observation, which significantly exceeded the corresponding indicators in the control group, and leukocyte infiltration in rats of the main group, in contrast to the previous stages of the study, was noted significantly less frequently. than in rats of the control group (p ≤ 0.05).

Conclusion. Earlier and complete regeneration of damaged tissues of the tympanic membrane under conditions of its traumatic perforation was noted in rats of the main group under the influence of PCOTFR. In rats of the main group, more organized collagen fibers, the presence of basophilic leukocytes, signs of neoangiogenesis, and extensive fields of fibroblasts were visualized.

Extraesophageal manifestations of gastroesophageal reflux disease (GERD), despite the improvement of methods of diagnosis and treatment of patients with this pathology, still remain an urgent problem of medicine and cause increased attention of clinicians and researchers. In some cases, patients with GERD do not present typical complaints of heartburn, regurgitation; the disease may manifest extraesophageal manifestations, such as chronic cough, hoarseness, reflux laryngitis, and others caused by the presence of laryngopharyngeal reflux (LFR) – inflammation of the mucous membrane of the upper digestive and respiratory tracts with possible morphological changes associated with direct and indirect (reflex) exposure to gastroduodenal reflux. The occurrence of LFR is possible due to a violation of the motor function of the esophagus and insufficiency of the upper esophageal sphincter, as well as a decrease in the tone of the pharyngeal muscles. The most accessible methods of diagnosis of LFR are registration of complaints according to the questionnaire “index of reflux symptoms”, assessment of the clinical and functional state of the larynx using a visually analog “scale of reflux signs”. A positive response to the empirical use of proton pump inhibitors in combination with procinetics and determination of pepsin content in saliva can also be alternative diagnostic methods. To date, 24-hour pH-impedance monitoring is a method that allows the most accurate diagnosis of all types of reflux, regardless of the pH value, to verify high reflux in combination with its physical properties, as well as to estimate the time of chemical and volumetric esophageal clearance. In addition to performing esophagogastroduodenoscopy, the use of this method is indicated in patients with suspected extraesophageal manifestations of GERD. The article presents clinical examples of patients with extraesophageal manifestations of GERD, describes the possibilities of 24-hour pH-impedance monitoring of the esophagus in the diagnosis of LFR and reflux-associated diseases of the larynx.

Introduction. Chronic rhinosinusitis with nasal polyps (CRSwNP) is based on a chronic inflammatory hyperplastic process in the mucosa membrane of the nasal cavity and paranasal sinuses (SNPs). According to the consensus on the biological treatment of CRSwNP with or without asthma, which is one of the latest consensus documents of the European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA), which was published in December 2019, the need for surgical treatment or systemic administration of corticosteroids due to the active nasal polyps growth are conditional signs for the decompensation of clinical control. Currently, the basic treatment for patients with CRSwNP is the long-term use of intranasal corticosteroids (INCS), which leads to an improvement in the quality of life, while minimizing the risk of exacerbations and complications.

Research purpose. To evaluate the effectiveness of the basic therapy of intranasal glucocorticosteroid mometasone furoate for different phenotypes of CRSwNP.

Methods. All patients with recurrent CRSwNP were divided into 3 equal phenotypic groups of 40 people each: group 1 – CRSwNP without asthma and respiratory allergies, group 2 – CRSwNP + atopy, group 3 – CRSwNP + non-allergic asthma. The observation period was 3 years.

Results. Using the algorithm of stepwise therapy of CRSwNP, dynamic monitoring of these patients by an ENT and an allergistimmunologist, basic therapy with corticosteroids with constant treatment correction once every 3 months, it was possible to stabilize the inflammatory process throughout the respiratory tract and reduce the need for surgical treatment.

Conclusion. With CRSwNP, long-term use of Mometasone furoate INCS is the main drug of basic therapy to minimize the recurrence of nasal polyp growth and is accompanied by clinical efficacy and the absence of adverse side effects.

Nowadays the problem of treating of acute respiratory viral infections, primarily manifested with the clinical picture of acute rhinitis, remains an important problem due to the high prevalence and variety of etiological factors of this disease. Pathogenesis of rhinitis, regardless of the etiology, includes the swelling of the nasal mucosa, the increase in nasal secretion, which blocks nasal breathing and significantly reduces the quality of life. In uncomplicated forms of acute infectious rhinitis, symptomatic treatment is traditionally used, including the elimination therapy and drugs for reducing the nasal mucosa swelling. Topical decongestants have a sympathomimetic effect, affect α1- and α2-adrenergic receptors and help to eliminate swelling of the nasal mucosa and improve nasal breathing, and as a result, restore the patency and aerodynamics of the airways, recover the drainage function of the paranasal sinuses and auditory tube. To date, the pharmaceutical market offers many intranasal decongestants that differ in the duration of exposure, frequency of use, the occurrence of side effects or adverse events. The article shows the pharmacological and pharmacokinetic characteristics of the drug xylometazoline, highlights the results of Russian and foreign studies that demonstrate the efficacy and good tolerability of xylometazoline with a short-term topical course of treatment. The conclusion is made about a good profile of the efficacy and safety of the drug and confirmed that in compliance with the recommendations for the frequency and duration of application, xylometazoline could be recommended for use in a complex symptomatic treatment of acute rhinitis in adults and children.

Introduction. Petrous temporal bone (PTB) cholesteatoma is an epidermal cyst, which is the result of uncontrolled growth of keratinizing squamous epithelium in the petrous part of the temporal bone. Cholesteatoma is classified into congenital, acquired, and iatrogenic.

Objective. To discuss the classification of infralabyrinthine petrous bone cholesteatoma (PBC), add modified classificationand to propose adequate differential surgical management.

Methods. The setting was a National Medical Scientific Center of Otorhinolaryngology FMBA (Russia). The data of 14 patients who underwent surgery for different variations of infralabyrinthine PBC from 2017 till 2020 were analyzed and included into the study (with respect to localization type of the approach used, complications, recurrences and outcome). The follow-up period ranged from 6 to 34 months with a median of 18 months.

Results. Based on preoperative CT scans and intraoperative findings a Scale of Cholesteatoma extension CLIF(APO) and Modified classification of infralabyrinthine cholesteatoma (in relation to mastoid segment of the facial nerve) are proposed. The scale includes the main anatomical structures of the temporal bone and the adjacent parts of the occipital and sphenoid bones, which may be involved in the cholesteatoma process: cochlea, vestibule and semicircular canals, internal auditory canal, jugular foramen, bony chanal of the internal carotid artery, petrous apex, occipital condyle. Based on the modified classification and scale we present an algorithm for decision making and surgical approach choosing.

Conclusion. The implementation of the Scale of Cholesteatoma Extension in Otology and Radiology practice will allow to preoperatively diagnose the extension of PBC, unify the data of the localization of cholesteatoma; allows standardization in reporting and continuity at all stages of treatment. The modified classification proposed by us in this article facilitate the algorithm for selecting the type of surgical approach and determine whether to perform less aggressive combined microscopic approaches with endoscopic control.

Acute otitis media (OSA) is one of the most common diseases in children and adults and the most common cause of antibiotic therapy, often unreasonable. 20–70% of respiratory infections in adults and children is complicated by the development of CCA. Despite the fact that only 10% of CCA has a viral etiology, the vast majority of CCA are also viral-bacterial co-infection. The article presents the main pathogenetic mechanisms of the development of CCA, such as viral and virus-induced. The term “heat-generating” microorganisms is introduced. A review of the most common pathogens of CCA viral and bacterial. An otomicroscopic picture is described based on the generally accepted domestic classification of CCA. The main tympanometric curves and their types during CCA are presented. Much attention is paid to the modern principles of pathogenetic and symptomatic therapy. In particular, local anti-inflammatory and analgesic therapy using ear drops containing lidocaine. Some progress in the prevention of acute otitis media is discussed, which has led to a decrease in the frequency of visits to doctors about otitis media and the appointment of antibiotics. This is due to the widespread use of vaccines, as well as the introduction of “wait-and-see” tactics in mild and moderate cases of CCA without initial antibiotic treatment. Success in reducing the incidence of CCA will depend mainly on preventing the colonization of the nasopharynx by otopathogens, as well as reducing the incidence of viral infections. According to international and domestic recommendations, the basis for the prevention of acute otitis media is vaccination against pneumococcus, hemophilus bacillus and influenza virus.

Rhinitis is inflammation of the mucous membrane inside the nose. The clinical symptoms of this disease include nasal congestion, sneezing, itching of the nose and roof of mouth, rhinorrhea, and mucus draining down the back of the throat. Both allergic and non-allergic factors can play a role in the development of rhinitis. The most commonly used classification of rhinitis includes allergic rhinitis, non-allergic rhinitis, infectious rhinitis, and its specific forms. Allergic rhinitis is classified into the intermittent or persistent types, and may also be classified as mild, moderate and severe according to the severity of symptoms. Treatment of allergic rhinitis includes elimination of contact with allergen, allergen-specific immunotherapy and pharmacotherapy, which is selected depending on the severity of the symptoms. Infectious rhinitis develops in acute viral infection, and rhinitis symptoms are present in acute and chronic rhinosinusitis. Non-allergic rhinitis comprises conditions ranging from vasomotor rhinitis and gustatory rhinitis to non-allergic rhinitis with eosinophilia syndrome. Mixed rhinitis has components of allergic and non-allergic rhinitis. In addition, there are CPAP rhinitis, occupational rhinitis, medication rhinitis, rhinitis in systemic administration of drugs, rhinitis of pregnant women, atrophic rhinitis, rhinitis in systemic diseases. The type of rhinitis is diagnosed based on the patient’s complaints, anamnesis and clinical picture, some cases require laboratory tests and CT scan of the paranasal sinuses to differentiate the diagnosis. Approaches to the treatment of rhinitis depend on its type and include elimination of allergens or provoking factors, administration of saline solutions, intranasal glucocorticosteroids, systemic antihistamines, intranasal cromones, decongestants, antibacterial drugs may be prescribed to treat infectious rhinitis. Rhinitis should be differentiated from structural abnormalities, including congenital features, acquired conditions, neoplasms, gastroesophageal reflux, nasal liquorrhea.

Increase in the number of acute and chronic diseases is a global trend. On the one hand, the emergence of new types of viruses, their active mutation, an increase in antibiotic-resistant bacterial strains, a high frequency of immunodeficiency and allergic diseases contribute to this. On the other hand is inadequate treatment of inflammatory diseases of the upper respiratory tract, widespread use of systemic antibiotics without indications. The use of bioregulatory medicines with proven efficacy in the complex treatment can reduce the drug load on the body, reduce the bacterial complications and side effects. Traumeel®S joins the physiological course of inflammation and activates pro-resolving mediators, contributes to its faster completion and tissue repair. The efficacy and safety of Traumeel®S has been confirmed in many randomized clinical trials. The drug has proven its value in almost any inflammatory pathology of the upper respiratory tract and ear. The drug Lymphomyosot®, a multicomponent agent with lymphatic drainage action, has proven itself perfectly in the complex therapy of chronic tonsillitis. In November 2019, the Council of Experts of the National Medical Association of Otorhinolaryngologists on the problems of pathology of the lympharyngeal ring was held. It is recommended to use the multicomponent bioregulatory preparation Traumeel®S to correct the inflammatory process, which has shown in studies a modulating effect on inflammatory mediators without suppressing COX-2 (prostaglandins). With exacerbation of chronic tonsillitis and lymphadenitis of nonspecific etiology, it is possible to use the multicomponent preparation Lymphomyosot®, which helps to improve the drainage and detoxification function of the lymphatic system.

Chronic tonsillitis is one of the most common pathologies of the lymphoepithelial pharyngeal ring. The main pathogen in chronic tonsillitis and its complications is group a β-hemolytic Streptococcus A (BGSA). This pathogen is detected in 30–60% of patients. At the present stage, the role of latent viral infections (Epstein – Barr virus (EBV), cytomegalovirus (CMV)) in the formation of chronic tonsillitis in children has been proven. Treatment of frequently ill children with pathology of the pharyngeal lymphoid ring remains an urgent and widely discussed issue. Depending on the etiology and clinical form of chronic tonsillitis (simple, toxicallergic form (TAF I or II), the choice is between conservative methods and radical surgical treatment. Surgical treatment of chronic tonsillitis in children is recommended only if there are absolute indications. To standard methods of conservative treatment, such as sanation of lacunae of the tonsils with antiseptic solutions, the appointment of physiotherapy, funds for the correction of systemic and local immunity are actively used. In Pediatrics, the safe and optimal complex of effects of the herbal medicinal product Tonsilgon N is widely used. Based on the analysis of clinical observations of frequently ill children with chronic tonsillitis, the effectiveness of the herbal medicine Tonsilgon H (in monotherapy mode) was revealed. As a result, the expediency of using the drug Tonsilgon H in the treatment of compensated forms of chronic tonsillitis in frequently and long-term ill children was established. There was a significant decrease in the frequency of acute respiratory infections and, consequently, the risk of transition to a decompensated form of chronic tonsillitis.

The clinical picture of allergic rhinitis includes sneezing, nasal discharge, impaired nasal breathing, and itching of the nose and roof of mouth. Depending on the duration of symptoms, allergic rhinitis is divided into intermittent and persistent forms, and depending on the severity of symptoms, it can be mild, moderate, and severe. Treatment for allergic rhinitis includes elimination of allergic contacts, allergen-specific immunotherapy, and pharmacotherapy. The choice of a treatment regimen is determined by the severity of symptoms, age of a patient and presence of concomitant diseases. The work is aimed to review the most common pharmaceuticals to treat allergic rhinitis. Saline solutions are used as monotherapy when symptoms are mild, or before use of other topical drugs to clean mucous membranes before their application. Intranasal glucocorticosteroids can be used as monotherapy, if symptoms have different levels of severity, and supplemented with other drugs, in case they are not efficient. Intranasal glucocorticosteroids do not have a systemic effect due to minimal bioavailability. The patients with moderate/severe allergic rhinitis are recommended to use them jointly with second generation antihstamines, intranasal cromones, intranasal antihistamines and leukotriene receptor antagonists. The significant side effect of antihistamines, especially of the first generation, are sedative effects on the central nervous system. The side effects of leukotriene receptor antagonists are neuropsychological disorders. Intranasal cromones have a high safety profile, which makes them popular in paediatric practice. However, the dosage regimen up to 3–4 times a day reduces patient adherence to treatment. Decongestants are not indicated as monotherapy for allergic rhinitis but can be used in combination with other drugs in short courses, taking into account the possible side effects.

Introduction. Viral infection is the main cause of damage to the ciliated epithelium of the nasal cavity mucosa, which in turn leads to disruption of mucociliary transport, increased viscosity and mucus hypersecretion in the sinuses and deceleration of its evacuation. Smokers suffer from chronic obstructive pulmonary diseases, in particular obstructive bronchitis. Their cough symptom complex sharply increases in acute respiratory viral infection (ARVI), especially when the mucociliary airway system is affected. The etiotropic treatment of this combined pathology is a therapy capable of affecting the entire mucociliary system of the upper and lower respiratory tract, including a drug based on ivy leaf extract, with the active ingredient of the saponin group.

Aim of the study. To determine the effectiveness of phytopreparation in preventing exacerbation of chronic bronchitis of smokers in patients with acute viral rhinosinusitis.

Materials and methods. Complex examination of 20 active smokers suffering from acute viral rhinosinusitis (AVR), including computed tomography of the lungs, was conducted. The randomized study included the use of phytopreparations in the complex therapy of acute rhinosinusitis in patients with obstructive bronchitis.

Results and discussion. Use of medicines based on ivy extract in the complex treatment of acute rhinosinusitis in smokers allowed to achieve reduction of AVR symptom complex complicated by exacerbation of chronic bronchitis by the 5th day of the disease. Dynamics of cough complaints reduction in comparison groups reflects the beneficial effect of ivy extract in smokers with ARVI, complicated by AVR, and in the absolute majority of cases allows avoiding bacterial complications.

Conclusion. The conducted study proved the effectiveness of Gedelix in the complex treatment of viral acute rhinosinusitis in smokers. In the absolute majority of cases (80% of the total number of patients in the group) it was possible to avoid long-term exacerbation of chronic bronchitis and bacterial complications.

Significant role of getting the required amount of air into the human body belongs to the breathing by the nose. The nasal cavity prepares the air for reciprocity with the lower respiratory tract owing to the complex structure of the mucous membrane. When nasal obstruction occurs, breathing is carried out mainly through the mouth, and there is a violation of the basic functions of the nose, as well as the ingress of unadapted aggressive air to the sensitive alveolar structures of the lungs. This leads first to functional, and then to morphological and structural changes. In addition, difficult nasal breathing leads to impaired aeration of the paranasal cavities, middle ear cavity and hypoxia of all organs of the body. Even short episodes of nasal obstruction affect the quality of life, and prolonged untreated or incorrectly treated acute viral rhinosinusitis can spill over into lingering bacterial diseases of the ENT organs. Decongestants are used to eliminate nasal congestion. Decongestants include a wide range of substances that are used topically or systemically, in the form of monotherapy or in combination with other substances. The most popular drugs in this group are topical decongestants, since they have the most pronounced effect. The main nasal decongestants can be divided into two groups: sympathomimetic amines: primary aliphatic; phenolic and non-phenolic compounds, as well as imidazoline derivatives. Among the modern vasoconstrictor drugs oxymetazoline. Using it strictly according to the instructions within 3–5 days guarantees the absence of the development of local and systemic complications.

A literature review on the infralabyrinthine petrous bone cholesteatoma (PBC) was presented in this article. Attention is paid to etiology and clinical symptoms of the disease, classifications. All modern classifications divide cholesteatoma with localization under the labyrinth into two big groups: infralabyrinthine and infralabyrinthine apical. This is not enough to determine the algorithm of surgical tactic of these patients. The most used approaches to the infrlabyrinyhine area and lateral skull base were analyzed (infralabyrinthine and infracochlear, subtotal petrosectomy, transotic approach, group of transcochlear approaches, infratemporal and translabyrinthine approaches). Possible variants of the surgery ending are described (tympanoplasty or “cul-de-sac” closure). Comparison of the results of different authors, starting from 1990, in which the infralabyrinthine cholesteatoma was distinguished as a separate class was carried out. 16 publications were analyzed based on the type of used classification, the total number of cases with infralabyrinthine cholesteatoma, the type of surgical approach, the complications and recurrence rate. The total number of patients was 141, 84 with infralabyrinthine (59,6%), 57 (40,4%) with infralabyrinthine apical PBC. The most common type of surgery were subtotal petrosectomy, transcochlear approach in different variations and transotic approach. The recurrence rate ranged from 0 to 29%. This paper identifies unresolved issues, the necessity of new classification and algorithm of surgical management based on it.

Introduction. According to different authors, 4 to 40% of the child and adult population suffer from chronic tonsillitis (СT), with many authors noting an increase in the number of cases and no tendency to decrease the frequency of this pathology.

Objective. To optimize diagnostics and treatment tactic of taking patients with chronic tonsillitis (CT) using our own clinical and laboratory data and morphological data as well as literature data.

Materials and methods. Аt the first stage of work, 166 patients were examined. They were divided into 4 categories (experimental groups) depending on clinical CT classification according to B.S. Preobrazhensky and V.T. Palchun. We also formed a group of patients who did not have CT symptoms. All patients underwent tonsillectomy or tonsillotomy. All tissue samples of palatine tonsils we got were investigated using immunohistochemical markers and default histological colorings. At the second stage, the dynamics of complaints, clinical symptoms and laboratory parameters were assessed in 247 patients diagnosed with CT Toxic-Allergic Form I (CT TAF I) before conservative treatment and 3 months after conservative treatment. Patients were divided into 3 groups depending on the conservative treatment regimen: a course of flushing the lacunae of the tonsils; antibiotic therapy with a retard form of clarithromycin; complex treatment combining the first two options.

Results. Тhe chronic inflammatory process in the palatine tonsils changes their cytoarchitectonics. At the same time, there is a direct correlation between the presence and severity of changes with the clinical classification of chemotherapy according to B.S. Preobrazhensky and V.T. Palchun.

Conclusion. With CT TAF II, the palatine tonsil not only loses its importance as an organ of the immune system, but also becomes a hotbed of infection in the body, which can cause severe complications. Only tonsillectomy can effectively protect the patient from these complications. At the stage of CT TAF I, the formation of metatansillar complications occurs. Patients with this form of CT require special attention, and correctly conducted conservative therapy can protect patients from local and general complications of CT. A variant of such conservative therapy that gives a lasting effect is complex therapy with washing the lacunae of the palatine tonsils with an antiseptic solution and simultaneous antibiotic therapy with 14-membered macrolides that can accumulate in the lymphadenoid tissue.