Introduction. One of the characteristic manifestations of COVID-19 is a disorder of smell, which, according to the literature, occurs in 61.2% - 85.6% of patients with COVID-19. The article discusses the problems of post-viral dysosmia in COVID-19 convalescents. Purpose of the study. Evaluation of olfactory disorders in patients after coronavirus infection and the possibility of obtaining additional benefits from prescribing bioregulatory medicine drugs.

Materials and methods. The assessment of the severity of olfactory disorders in patients, taking into account the age according to self-assessment data using a visual analogue scale, as well as an objective assessment of odor identification using the Sniffin ‘Sticks Screening 12 Test. The possibility of increasing the efficiency of recovery of olfactory disorders by prescribing complex preparations of bioregulatory therapy (main group) was studied.

Results. The percentage of persons who fully restored the olfactory function in the main group was 56.5%, while in the patients of the control group only in 6.6%. Faster (on the 7^th day) dynamics of identification testing using SST-12 in patients taking complex preparations of bioregulation therapy was noted. On the 3rd day of therapy, there was a significant decrease in anxiety in patients treated with bioregulatory drugs.

Discussion. The conducted study objectively confirmed that the olfactory disorder is present in the vast majority of patients with ARS. The appointment of bioregulatory therapy contributes to the early restoration of the olfactory function.

Conclusions. Based on the results of this study, it can be concluded that it is advisable to use bioregulatory drugs.

Introduction. Importance of the search effective methods of treating chronic adenoiditis in children is associated with a high incidence and risk of developing complications. Treatment of chronic adenoiditis are described in the literature, but the advantages of any of them are inconclusive, which leads to the search for additional more progressive methods.

Objective. To increase the effectiveness of the treatment of chronic adenoiditis using complex therapy of non-drug methods in combination with the herbal preparation Tonsilgon N.

Materials and methods. Biochemical changes in lymphoid tissue were studied on biopsy material in 111 children with chronic adenoiditis, grade 3 adenoid hypertrophy, directed to planned surgical treatment. In the preoperative period, patients were divided into 4 groups: Group 1-control group, patients who received conventional methods of treatment; 2-study group, patients who additionally used low-frequency ultrasound irrigation of the nasal cavity and nasopharynx with photochromotherapy; The third group, patients who received the herbal preparation tonsilgon N (drops) as preoperative therapy; The fourth group study underwent low-frequency ultrasound irrigation of the nasal cavity and nasopharynx in combination with photochromotherapy and took the drug Tonsilgon N in an age-related dosage.

Results and discussion. When comparing the results of biochemical studies, an increase in the products of lipid peroxidation was noted in patients of the first group, which was regarded as a factor in the protracted course of the disease. The use of targeted phytoniring drugs in combination with low-frequency ultrasonic cavitation and photochromotherapy in complex therapy significantly modulates the processes of lipid peroxidation and can potentiate the antioxidant protection of cells.

Conclusion. Objective data were obtained for the first time on biochemical changes in lymphoid tissue for various methods of therapy indicate the prospects of using non-drug methods in combination with a herbal preparation in the complex therapy of chronic adenoiditis.

Gastroesophageal reflux disease (GERD) is a disease of the gastrointestinal tract caused by the discharge of stomach contents into the esophagus. In GERD, both esophageal and extraesophageal manifestations are widespread, but, unfortunately, the latter are less well known. About one third of GERD patients have extraesophageal symptoms, which can occur even in the absence of the usual esophageal symptoms of GERD, which makes diagnosis difficult. The most common of these is laryngitis. In addition to reflux laryngitis, laryngopharyngeal reflux (LFR) can cause the development of contact granulomas, laryngeal stenosis, functional dysphonia, vocal fold nodules, Reinecke's edema, and laryngeal neoplasms. These symptoms disappear after taking antireflux therapy, but there is still no consensus on its duration.

Aim. To evaluate the results of treatment of laryngeal manifestations of LFR with omeprasole 20 mg 30 minutes before meals in the morning.

Methods. The study involved 531 patients with complaints of hoarseness, of which women 337 - 63.5%, men 194 - 36.5%. We prescribed omeprasole 20 mg 30 minutes before meals in the morning for 6 weeks. Patients were questioned using the Reflux Symptom Index (RSI) questionnaire and indirect laryngoscopy with an assessment of laryngeal changes according to the Reflux Signs Scale (RSS).

Results. There was a statistically significant decrease in hoarseness 1 week after treatment, which continues to decrease 6 weeks after the initiation of treatment when evaluating the data on the RSI questionnaire. There was no statistically significant difference in the laryngoscopic picture before the start of treatment and after 1 week of treatment according to RSS; a statistically significant decrease in the quantitative assessment of RSS was revealed 6 weeks after the initiation of treatment.

Conclusions. Omeprasole at a dose of 20 mg in 30 minutes reduces the symptoms of LFR already after 1 week, the decrease in the severity of symptoms continues by 6 weeks of its use. Improvement of the laryngoscopic picture with the appointment of omeprazole 20 mg 30 minutes before meals occurs by the 6th week of its use. A positive correlation was found between the severity of LFR symptoms, including hoarseness, and the severity of changes in the laryngoscopic picture.

Introduction. The article is devoted to the special role of the primary care physician - therapist, geriatrician, general practitioner, in assisting the elderly and senile in taking appropriate and timely measures in identifying people with chronic sensorineural hearing loss (SNL), consulting them at the stage of primary health care.

Aim of the study. Understand the intended role of general practitioners and therapist in identifying and counseling patients with hearing loss in primary health care.

Materials and methods. A survey of general practitioners and therapist was conducted in the form of 88 statements, collected in six concepts, in response to the question “What should be the role of a general practitioner in the treatment of chronic sensorineural hearing loss in persons of an older age group?” in the format of a Google-questionnaire.

Results. The results showed a sufficient awareness of general practitioners and therapist about the predisposition of their elderly patients to hearing loss and the significance of the associated consequences on the quality of life. As a result of the data obtained, the highest percentage of statements was noted in Concept 1 “Determine - Diagnose - Discuss” and varied on individual issues from 27.8% to 55.6%, the lowest - in Concept 5 “Educate - Strategise - Encourage” and ranged from 16.7% to 44.4%.

Discussion. Strengthening collaboration between therapists and otorhinolaryngologists, otorhinolaryngologists, and audiologists is the most effective strategy for reducing individuals with untreated SNL. The importance of the role of the primary care physician in multidisciplinary care and its coordination is especially emphasized in the concept of “Know - Refer - Coordinate”.

Conclusions. The authors conclude that the priority concept of modern health care, which makes it possible to significantly improve the quality of life of patients in the older age group and reduce the psychosocial consequences of hearing loss.

The overuse and inappropriate use of systemic antibiotics is the most serious cause of problems associated with the increasing resistance of bacterial pathogens. What served as the basis for WHO to call the XXI century “The era of antibiotic resistance”. The wide spread of resistant strains of microorganisms, the growth of severe and complicated forms of diseases leads to an increase in the frequency of unfavorable treatment outcomes. In the Russian Federation, an increase in the incidence of acute rhinosinusitis from 4.6 to 12.7 cases per 1000 population has been noted in the last decade. The incidence of acute rhinosinusitis in Europe is recorded in 6.4 ± 3.6 of all cases of visits to primary care physicians. Up to 38% of outpatients in the ENT profile suffer from various forms of otitis media, including up to 30% of acute otitis media. The most important way to overcome the global problem of antibiotic resistance, along with the delayed use of systemic antibacterial drugs initiated by the world medical community, is to switch to the active use of topical drugs with antimicrobial activity. The article provides an overview of the data of domestic and foreign literature on the properties of a topical antibacterial drug with the active ingredient hydroxymethylquinoxaline dioxide. The results of experimental work and clinical studies, proving the high efficacy and safety of the drug in the complex treatment of bacterial infections of the upper respiratory tract, have been analyzed.

Patients with complaints of coughing make up a significant percentage of doctors in various specialties. Cough is not an independent disease, in most clinical cases it is a symptom of a respiratory disease. In acute respiratory pathology, the cough is usually short-lived and stops after the eradication of the infectious agent and the relief of inflammatory changes. It is important therapeutically to provide a reduction in the duration and relief of cough, as well as the prevention of complications. An effective symptomatic agent in the treatment of coughs of various origins, including inflammatory diseases of the respiratory tract, are herbal preparations. The fairly widespread use of phytopreparations in clinical practice is due to their high safety, physiological action, availability and effectiveness. The pharmacological action of these drugs in respiratory infections is manifested by antiinflammatory, cytoprotective, antiviral and antioxidant effects, multifactorial improvement of mucociliary cleansing processes. One of these phytopreparations is a monocomponent syrup with expectorant, mucolytic and antispasmodic. The therapeutic effect of drug is explained by the presence in the composition of triterpene glycosides (saponins) from the leaves of Hedera helix . The effectiveness and safety of drug is proved by a sufficient volume of clinical studies and observations. Literature data show that Hedera helix leaf preparations significantly reduce the severity of acute respiratory infections of the upper respiratory tract.

Virtually none of the patients had severe side effects. Allergic reactions were recorded in less than 0.5% of cases, with no mention of a severe allergic reaction of the anaphylaxis type. Thus, the drug of plant origin in the form of drops can be successfully used in patients with symptoms of acute respiratory diseases.

Introduction. Antihistamines are the most commonly prescribed class of medications for the treatment of allergic rhinitis (AR). However, they are also widely used in the treatment of inflammatory diseases of the ENT organs. One such drug is levocytirizine, (R) an enantiomer of cetirizine, which is a selective antagonist of peripheral histamine H1-receptors. This article analyzes the properties of levocytirizine in terms of safety and efficacy in allergic rhinitis.

Aim of the study is to assess the efficacy of levocetirizine in patients with seasonal allergic rhinitis (SAR) and perennial allergic rhinitis (PAR) versus placebo, and safety for patients with allergic rhinitis.

Materials and methods. In this, double-blind, placebo-controlled study, 52 patients with year-round allergic rhinitis and 28 patients with seasonal allergic rhinitis were randomized to receive levocetirizine 5 mg/day once or placebo. Mean overall measures of five symptoms (nasal congestion, nasal itching, itchy eyes, rhinorrhea, and sneezing) were compared between treatment groups at 1, 2, and 4 weeks. All individual symptom scores were also examined.

Results. Levocetirizine showed a significant improvement in the condition of patients with CAR and SAR over the entire treatment period compared to placebo. Assessment of individual symptoms showed statistically significant differences in favor of levocetirizine. Conclusion. Levocetirizine is an effective, safe, and well-tolerated drug for the treatment of allergic rhinitis.

Introduction. Adenotomy is a common surgical procedure in childhood. In children with recurrent infections of the respiratory tract, hypertrophy of the pharyngeal tonsil, a sign of lymphoproliferative syndrome of a secondary immunodeficiency state, is characterized by reduced adaptive abilities of mucosal immunity with impaired biocenosis in chronic inflammation. Pharyngeal tonsil surgery is considered stressful in frequently ill children and therefore requires preoperative preparation. In this context, it is relevant to study the nature of changes in the factors of mucosal immunity in terms of cell destruction in the nasal secretion in the complex treatment of children with hypertrophy of the pharyngeal tonsil and chronic adenoiditis, as prevention of complications in the postoperative period of adenotomy.

Aim. To increase the effectiveness of the treatment of chronic adenoiditis in children with recurrent infections of the respiratory tract using the combined effect of low-frequency ultrasonic cavitation with monochromatic unpolarized light and bacterial lysates.

Materials and methods. In order to test the hypothesis about the possibility of canceling adenotomy in 77 children aged 3-6 years with hypertrophy of the pharyngeal tonsil, accompanied by chronic inflammation. The effectiveness of the complex treatment was assessed by the functional and metabolic status of nonspecific resistance factors in the nasal lavage.

Results and discussion. The combined effect of low-frequency ultrasonic cavitation with photochromotherapy and bacterial lysates leads to the normalization of pathophysiological changes on the surface of the mucous membrane, leading to a balance of the qualitative and quantitative composition of the functional-metabolic status of NG, which makes it possible to postpone adenotomy. The best clinical result is observed when bacterial lysates are used in complex therapy in combination with physiotherapy in children with chronic adenoiditis and, to a certain extent, substantiate the advisability of a combined effect as a non-invasive and effective method.

Conclusions. Topical bacteriolysate in a complex treatment regimen for children with recurrent infections of the respiratory tract against a background of chronic inflammation eliminates bacterial antigens and enhances the intrinsic defenses of the mucous membrane of the pharyngeal tonsil.

Otitis media with effusion is difficult to diagnose, since the course of the disease is mostly asymptomatic, while the initial stage of the disease is very similar to Eustachiitis or the pre-perforative stage of acute otitis media. At this stage, dysfunction of the auditory tube and negative pressure in the tympanic cavity creates the conditions for the production of transudate, which clinically, in addition to hearing loss, is accompanied by soreness, a feeling of congestion, pressure, fluid transfusion in the ear. When conducting local medical procedures, they are primarily guided by the condition of the mucous membrane of the eustachian tube, nasopharynx and nasal cavity, but changes in the eardrum are no less important. Thus, the use of topical analgesics with an anti-inflammatory effect becomes no less relevant in the treatment.

A literature review was carried out with an analysis of scientific research data on the use of a topical combination drug that has a local anesthetic and anti-inflammatory effect in the treatment of diseases of the external and middle ear.

Analysis of the literature showed that the use of lidocaine-phenazone-containing drops promotes rapid regression of the inflammation in the external auditory canal and the tympanic membrane, as well as relieving of pain. It can be used both in children (including newborns) and in adults who are suffering from otitis media but with intact tympanic membrane, including otitis media with effusion.

Combined topical drugs containing lidocaine-phenazone demonstrate efficacy and safety in the treatment of catarrhal and otitis media with effusion in all age groups.

Influenza remains one of the most common respiratory viral diseases with a high risk of complications. In the context of the COVID-19 pandemic, there is a possibility of simultaneous circulation of two viruses, which makes it necessary to conduct a differential diagnosis. Influenza and COVID-19 have common pathways of transmission of the pathogen and similar symptoms, so the optimal differential diagnosis is the use of test systems for both viruses. Against the background of influenza and COVID-19, complications from various organs and systems can develop. The article describes in detail the complications of influenza from the cardiovascular system. After infection with the flu virus, there is a 6-to 10-fold increase in the risk of acute myocardial infarction and a 3 - to 8-fold increase in the risk of stroke. COVID-19 is associated with arterial hypertension, diabetes mellitus, cardiac arrhythmias, myocarditis, high risk of acute myocardial infarction, and heart failure. The article presents the data of our own research, indicating that the transferred COVID-19 disease increases the risk of acute coronary syndrome, regardless of the presence of risk factors for cardiovascular events. Prevention of the development of influenza complications is the early administration of etiotropic antiviral therapy. Numerous studies confirm the effectiveness of the neuraminidase inhibitor oseltamivir in the treatment of influenza. The use of oseltamivir reduces the severity of clinical manifestations, reduces the duration of the disease, reduces the risk of complications and death. The most effective measure to prevent influenza and COVID-19 is specific immunization. In some cases, chemoprophylaxis can be used. The article discusses studies on the effectiveness of influenza chemoprophylaxis with the use of neuraminidase inhibitors.

Performing not only respiratory, but also protective, olfactory, aesthetic and a number of other functions, the nose is an important part of the upper respiratory tract. The mucous membrane of the nasal cavity is the first protective barrier of the body that protects against the effects of adverse environmental factors, carrying out warming, purification and neutralization of the inhaled air. This mission is provided by the activity of the multilayered columnar ciliated epithelium, consisting of three main types of cells: ciliate, goblet and basal. The main protective mechanism in the nasal cavity is mucociliary clearance, carried out by means of nasal mucus and beating of cilia unidirectional towards the nasopharynx with a frequency of up to 1000 per minute. Violation of the integrity and disruption of the physiological functions of the mucous membrane of the nasal cavity leads to the development of pathological processes, which in turn can lead to a failure in the work of other organs and systems of the body. To date, about 16-18% of all diseases of the ENT organs are chronic forms of rhinitis. According to the ICAR classification, which is based on the pathophysiological mechanisms of the development of rhinitis, allergic and non-allergic forms are distinguished. Common to various forms is the effect of certain factors on the mucous membrane of the nasal cavity and, as a consequence, a violation of the mechanisms of its work.

One of the forms of chronic rhinitis, caused by thinning of the mucous membrane and severe disorders of mucociliary transport, is atrophic rhinitis. The main symptoms of the disease are dryness, the formation of crusts in the nasal cavity, periodic bleeding. The approach to the treatment of acute and chronic processes against the background of atrophic changes in the nasal cavity should be comprehensive and aimed at restoring the physiological functions of the mucous membrane and the mechanisms of mucociliary transport.

The lymphoepithelial pharyngeal ring is located in the entrance gate and is constantly exposed to infectious agents. Currently, chronic pathology of the lymphoepithelial pharyngeal ring remains one of the most common problems in the practice of a pediatric doctor. Hypertrophy of the pharyngeal tonsil, chronic adenoiditis, which occurs in 35.3% of children under the age of 7 years, and chronic tonsillitis, which occurs in 15-63% of cases, are among the most common diseases of childhood. Taking into account the wide range of infectious microbiota that contributes to the development of chronic pathology of the lymphoepithelial pharyngeal ring, the issue of differential diagnosis of the etiology of the disease and the selection of adequate treatment regimens remains relevant. In most cases, at the present stage, the approach to the treatment of patients with chronic inflammation of the lymphoid ring of the pharynx in children is reduced to replacing the surgical method with a conservative one with the appointment of immunocorrective and immunomodulatory drugs. The lack of a positive effect of the ongoing conservative treatment, clinical and laboratory signs of persistent streptococcal infection say us about the need for surgical treatment. At the same time, a group of frequently ill children requires special attention with the development of new regimens of the immunocorrecting and immunomodulating drugs usage.

Introduction. The high incidence of community-acquired pneumonia and the high complication rates in the cases of severe pneumonia actualize the search for new pharmacotherapy tools to improve the effectiveness of standard patient management regimens. A high level of severe inflammatory response underlies the high risk for developing septic complications of pneumonia, along with impaired immune responses.

The aim is to evaluate the efficacy of azoximer bromide introduction in the combination therapy regimen for hospitalized patients with moderate to severe community-acquired pneumonia.

Materials and methods. A prospective, open label, parallel group, randomized study comparing the efficacy of azoximer bromide introduction in the combination therapy of hospitalized patients with moderate to severe community-acquired pneumonia was conducted at the premises of Federal Scientific and Clinical Center for Reanimatology and Rehabilitation. 30 patients were included in the study group and 37 patients in the comparator group. The baseline characteristics were comparable in both groups. Results. The azoximer bromide introduction in the combination therapy of patients with community-acquired pneumonia led to a statistically significant reduction in the duration of hospital stay (Me (LQ; HQ): 9 (8; 10) days for the study group and 13 (10; 14) days for the comparator group, (p = 0.000078), duration of ICU stay (Me (LQ; HQ) 2 days (1.5; 2.5) and 5 days (5.0; 6.0), respectively, (p = 0.00001), the duration of febrile fever 5 (± 0.6) days versus 10 (± 1.2) days (p = 0.0000), the incidence of acute respiratory failure (13.33% in group 1 versus 37.84% in group 2, p = 0.024) and septic shock (10% in group 1 versus 32.43% in group 2, p = 0.0285).

Conclusions. The azoximer bromide introduction in the standard therapy regimen for patients with community-acquired pneumonia allowed to reduce the duration of hospital stay, the duration of ICU stay, the length of febrile fever, the incidence of septic shock and respiratory failure. The possible mechanisms of action may include a reduction of the severe inflammatory reactions and an optimization of the patient's immune response to the infectious process.

Allergic rhinitis (AR) is one of the most common allergic diseases, especially in economically developed countries, including Russia. The main goal of AR therapy is the control achievement over the disease symptoms, the minimizing of the future exacerbations risks and side effects. Antihistamines and glucocorticosteroids are the main classes of medicines used in all allergic diseases, including AR. According to the Federal Clinical Guidelines for Allergic rhinitis the use of the intranasal corticosteroids in combination with antihistamines is recommended on the second stage of therapy and higher. Both classes of medicines have a complementary effect on the allergic inflammation pathogenesis main stages. The intranasal corticosteroids and antihistamines using allows the delivery of the medicines to the allergic inflammation area directly. Modern intranasal corticosteroids have a high affinity that provides the high efficacy in the low concentrations using and the insignificant systemic bioavailability. The review presents the key characteristics of the olopatadine and mometasone furoate nasal spray in a fixed combination, which registered in the Russian Federation recently. This combination is recommend for use in adults and children over 12 y.o. with allergic rhinitis. The pharmacological characteristics of the nasal spray components including the action mechanism described. The main clinical studies results presented, that confirmed the high efficacy and safety of olopatadine/mometasone furoate combination in AR patients. The olopatadine and mometasone furoate fixed combination ensures the rapid onset and the long-lasting effect with minimal adverse events risks that increases compliance and leads to the control achievement over the AR symptoms.

The article provides data on the effectiveness of the use of the drug in the treatment of acute, chronic and recurrent diseases of the respiratory tract and ENT organs. The drug is an extract of Pelargonium sidoides. From the standpoint of modern pharmacology, it is known that the use of natural products based on plant materials ensures safety and the absence of pronounced side effects. The main active ingredients of pelargonium are phenolic compounds: coumarins, flavonoids and phenolic acids. The article details the biochemical and pharmacological properties of each of the above groups of compounds. It has been shown that the presence of several classes of phenolic compounds simultaneously contributes to the potentiation of the pharmacological effects of each group separately. Therefore, drug has a pronounced polytropic effect: antiviral, antibacterial, immunomodulatory, mucolytic, anti-inflammatory, antioxidant, cytoprotective. The article presents the results of numerous domestic and foreign randomized, placebo-controlled studies demonstrating its high efficacy and safety in the treatment of ENT diseases, upper respiratory tract infections and bronchitis, not only in adults, but also in children over 1 year old. On the basis of the analyzed and presented material, the authors concluded that the use of a natural-based drug in the treatment of acute respiratory infection is effective and safe, both as monotherapy and in combination with other medicinal substances. He is able to quickly eliminate not only the symptoms of inflammation, but also to support the body with any ailments of this type.

The search for rational treatment of diseases of the nasal cavity and paranasal sinuses is due to the high incidence among the world's population. Despite the absolutely clear recommendations that would seem to greatly facilitate the choice and scope of therapy, it is extremely important to have a differentiated approach to each patient, depending on age, concomitant pathology, the nature of the course of the disease, the severity of clinical, primarily pain symptoms, and the presence of rhinogenic complications. Differential diagnosis of viral and bacterial acute rhinosinusitis (ARS) allows to avoid unreasonable prescription of antibiotics in the former case and choose therapy in such a way as to help relieve clinical symptoms, timely cure the disease and prevent complications. A systematic review of the literature was conducted with the analysis of scientific research data on the evaluation of the effectiveness of protargol or silver proteinate in the local treatment of upper respiratory tract diseases. A review of studies shows that silver proteinate has astringent, antiseptic and anti-inflammatory effects. The spectrum of antimicrobial action of silver is much wider than many antibiotics and sulfonamides. At the same time, pathogenic microflora is more sensitive to silver ions than non-pathogenic microflora. The analysis of the works also demonstrates the absence of adverse reactions when using this drug. The obtained data allow us to recommend preparations based on silver proteinate as a complex therapy for acute and chronic diseases of the nasal cavity and nasopharynx. The vasoconstrictive effect of protargol allows it to be used as an alternative to decongestants in order to avoid the development of drug-induced rhinitis and tachyphylaxis. Sialor® is a new, convenient, affordable, longer-shelf-life form of silver proteinate.

Introduction. The relevance of the study is due to the complexity of the differential diagnosis of Kosten's syndrome and meningioma in the area of the cerebellar bridge angle of the brain, as well as the severe suffering of patients

The purpose of our study: development of an algorithm for the approach to the differential diagnosis of meningioma of the cerebellar angle and Kosten's syndrome.

Materials and methods. To accomplish the set tasks, we examined 22 patients who complained of headache, hearing impairment, sensation of tinnitus, pain and crepitus in the temporomandibular joint during movements of the lower jaw, paresthesia of the oral and nasal mucosa. All patients were assigned studies: cone-beam computed tomography (CBCT) and magnetic resonance imaging (MRI) of the TMJ according to indications.

Results. Since complaints can lead patients to see doctors of various specialties, it is necessary to be able to differentiate between Costen's syndrome and a tumor of the cerebral pons-cerebral angle. In Costen's syndrome, the pain most often has an aching character, in contrast to the volumetric formations of the brain, in which the pain is burning, spreading along the branches of the facial or trigeminal nerve. One of the main methods of excluding a brain tumor is magnetic resonance imaging.

Conclusions. The most significant modern method for diagnosing Costen's syndrome and meningioma of the cerebellopontine angle is magnetic resonance imaging (MRI) of the TMJ and the brain. Differential signs of Costen's syndrome are distal displacement of the head of the lower jaw, diagnosed by CBCT and MRI, as well as displacement of the articular disc (determined by MRI). A meningioma of the cerebellopontine angle is indicated by the burning nature of pain in half of the face, as well as confirmation of the diagnosis by magnetic resonance imaging of the brain.

Introduction. According to the literature, oxidative stress is described as one of the main factors in the pathogenesis of chronic suppurative otitis media, supporting the inflammatory process at the local level. The transition of inflammatory mediators to the systemic level is associated with the risk of developing ear purulent-destructive complications. The study of the products of lipid peroxidation in comparison with morphological changes in the structures of the temporal bone will justify the tactics of the operation.

Aim. Comparison of the levels of lipid peroxidation products at the local and systemic levels in chronic suppurative otitis media, depending on the nature of pathomorphological changes in the structures of the temporal bone.

Materials and methods. A prospective study of 130 patients with chronic suppurative otitis media at the age of 20-62 years with a verified diagnosis of chronic suppurative otitis media, admitted for surgical treatment, was carried out. To study the indicators of oxidative stress at the systemic level, the blood serum of patients was used; at the local level, the bone biomaterial obtained from patients during the surgical treatment of chronic suppurative otitis media was used. The quantitative determination of the primary, secondary and final products of peroxidation was carried out in the groups of patients with separate registration of lipoperoxides in the heptane and isopropanol phases of the lipid extract by spectrophotometry.

Results and discussion. In the observation of patients with morphological signs of purulent destruction of the temporal bone, not only a local level of inflammation activity, but also a systemic level of an unfavorable outcome was revealed in two variants: osteoproliferation or osteonecrosis of the bone tissue of the temporal bone in chronic purulent otitis media with a constant threat to the patient's life due to intracranial purulent complications.

Conclusion. The appearance in low concentrations of lipid peroxidation products in serum in patients with chronic purulent otitis media substantiates the need for a behind-the-ear approach in reconstructive-sanitizing otosurgery even with minimal clinical manifestations and CT scan data, since at the preclinical level it confirms the osteonecrotic type of bone remodeling with the risk of delayed death.

Introduction. Acute rhinosinusitis is one of the most common infectious diseases in the world. But despite their predominantly viral nature, the activation of their own microflora occurring during the disease, the addition of pathogenic and the associated risks of rhinogenic complications lead to the widespread use of antibacterial therapy for this pathology. Local antiseptics, such as framycetin sulfate in the form of nasal spray, play an important role in the multicomponent structure of rhinosinusitis therapy.

The aim of the study was to evaluate the effect of an aerosol preparation of framycetin sulfate of domestic and imported production on the activity of the atrial fibrillation of the nasal cavity as topical antibacterial therapy in acute rhinosinusitis.

Materials and methods. The study included 30 adult patients diagnosed with acute rhinosinusitis. The patients were randomized into 2 equal groups and received standard therapy for this disease, according to clinical recommendations. The differences in the groups concerned only topical antibacterial therapy. The 1st experimental group used a drug of domestic production, the 2nd group - a control group, used an imported framycetin spray.

Results. Data were obtained not only comparing the clinical picture depending on the treatment, but also information about the effect of the drug on the activity of the atrial epithelium of the nasal cavity, the distribution of the substance in the nasal cavity, and even considered the structural differences of the vials that affect the distribution of the drug during injection. Conclusion. Topical antibacterial therapy with framycetin sulphate is an effective method in complex treatment of acute rhinosinusitis. Innovative technologies for the creation of an aerosol of framicetin solution allow to achieve stable dosage of the drug during use.

Sore throat is a common complaint, which can be caused by a typical viral pharyngitis, or it can be rooted in a life-threatening disease such as epiglottitis or inflammation of the cellular spaces in the throat and neck. The doctor should take a closer look at a patient with a sore throat, immediately make a differential diagnosis and prescribe adequate treatment, including surgical intervention, if necessary.

The article discusses the most common causes of a sore throat, including various types of pharyngitis, paratonsillar abscess, parapharyngeal abscess, retropharyngeal abscess, epiglottitis.

Viral pharyngitis has a favourable prognosis, resolves without intervention and complications, but bacterial and fungal pharyngitis have a more severe course. Streptococcal pharyngitis caused by group A в-hemolytic streptococcus holds a dominant position in bacterial etiology and requires the use of antibiotic therapy. The differential diagnosis of streptococcal pharyngitis is based on the modified Centor scores in the routine clinical practice. Antibiotic therapy for streptococcal pharyngitis includes a 10-day course of unprotected penicillins. If a patient has an allergic reaction to penicillins, it is recommended to use clindamycin or clarithromycin. The surgical intervention combined with intramuscular or intravenous antibiotic therapy is recommended for the treatment of purulent processes in the cellular spaces of the neck. These diseases can have life-threatening complications, which include neurological damage, the spread of purulent process in the mediastinum with the development of mediastinitis, laryn-geal stenosis, sepsis, necrotizing fasciitis, jugular vein thrombosis and erosion of the carotid artery. The third generation cephalosporins and protected penicillins are recommended for the treatment of epiglottitis, and respiratory fluoroquinolones are used, if a patient has a history of allergic reactions to penicillins. In severe cases with symptoms of stenosis, intubation can be performed in addition to the use of antibiotics.

Acute rhinosinusitis is one of the most common diseases in the world. According to statistics, about 10 million cases are registered in Russia every year.

Acute bacterial rhinosinusitis (ABRS) in most cases develops as a result of an acute respiratory viral disease, proceeds easily and it does not require antibiotic therapy. However, it significantly reduces the patient's quality of life in cases of moderate and severe disease, and in the absence of timely treatment, can lead to intracranial complications (meningitis, encephalitis, intracranial abscesses, etc.) and orbital (reactive edema of the eyelid, phlegmon of the orbit, periorbital abscesses, etc.). To avoid complications, with exacerbation of rhinosinusitis, it is necessary to choose the right antibiotic therapy, taking into account the resistance of the microorganisms that caused the disease.

The article describes the differential diagnosticprinciples of bacterial rhinosinusitis according to the latest recommendations and research in this area, the most common antibiotic-resistant pathogens in the practice of an ENT doctor are presented, the issue of choosing the correct systemic antibiotic therapy for the treatment of patients with moderate and severe acute bacterial rhinosinusitis is considered according to modern data on the sensitivity of bacterial pathogens to antibacterial drugs prescribed in the otorhinolaryngologist's practice. The article presents data on a new universal cephalosporin of the 3rd generation (the active ingredient is cefditoren), as a second- and third-line drug, due to its high activity against most causative agents of acute bacterial rhinosinusitis, and clinical observation using the above antibacterial agent within the framework of the considered topics.

Introduction. Today the high prevalence of benign vocal fold lesions is shown (up to 55-70%). The possibilities of surgical management of this pathology are very extensive. Laser technologies are becoming more and more popular among high-tech treatment methods. However the comprehensive postoperative management of these patients is equally important.

The aim of the study was to assess the features of the postoperative period in patients undergoing the endolaryngeal surgery using a semiconductor laser with a wavelength of 445 nm.

Material and methods. On the basis of Saint-Petersburg Research Institute of Ear, Throat, Nose and Speech from February to June 2021 20 patients with benign vocal fold lesions 6 women and 14 men from 24 to 67 years old were examined and treated. All the patients underwent endolaryngeal surgery with direct microlaryngoscopy using a new semiconductor 445 nm laser in an inert gas atmosphere (intraoperative helium supply). After surgical treatment, the patients observed vocal rest, received antiinflammatory, antibacterial therapy, inhalations, as well as the drug Homeovox® according to the standard scheme.

Conclusion. Endolaryngeal surgery with the removing of benign vocal fold lesions using a semiconductor laser with a wavelength of 445 nm has been proven to be safe and effective. According to the results of video laryngostroboscopy, acoustic analysis of the voice (the questionnaire “Voice handicap index-30”) it was noted that the laryngeal functions were restored in a short time. The inclusion of Homeovox® in the complex postoperative treatment had a favorable effect on the restoration of the phonatory function.

Introduction. Laryngeal pathology occupies a leading place in the general structure of diseases of the upper respiratory tract, chronic edematous-polypous laryngitis, Reinke-Gayek edema accounts for 5.5% of all benign diseases of the vocal folds. The main method of treating Reinke-Gayek's disease is surgical treatment, which consists in removing excess mucosa, or “stripping” - tearing a strip of mucosa with forceps from the vocal fold. One of the main principles of laryngeal surgery is the maximum preservation of the structures of the vocal fold, obtaining a flexible vibration of the muscular-membranous part and the mucous membrane of the vocal fold.

Purpose. The purpose of our work is to improve the effectiveness of treatment of chronic edematous-polypous laryngitis using a CO₂ laser.

Tasks. To develop a differentiated approach to the surgical treatment of chronic edematous-polypous laryngitis using a carbon dioxide laser.

Materials and Methods. We treated 46 patients with Reinke-Gayek disease, including 35 women and 11 men. The age of the patients ranged from 40 to 67 years. Preoperative examination included endoscopic examination, laryngostroboscopy. The type was determined according to the classification of H. Yonekawa, for the choice of further surgical tactics. In type II, an incision of the mucosa, aspiration of gelatinous matter from the Reinke space, and laying of the mucosa were performed. With type III, it is made by forming M-shaped flap to close the defect.

Results. All patients in the preoperative period were surveyed with the VOICE HANDICAP INDEX(VHI-30) questionnaire, laryn-gostroboscopy, and maximum phonation time. In the postoperative period, the examination was performed twice, 1 month after the operation and 3 months after the operation. There is a significant increase in indicators, an increase in the maximum phonation time, a decrease in VHI-30 points.

Conclusion. The use of this technique allowed to significantly accelerate the recovery of the voice, reduce the time spent in the hospital, minimally damaging the structure of the mucous membrane of the vocal folds.

Introduction. The need to close liquor fistulas as early as possible is associated with a high risk of intracranial complications. Certain difficulties in closing bone defects are due to the variability of the exact localization of the fistulous canal, the choice of the surgical approach, and the reliability of the plastic material. The literature describes various methods for eliminating basal liquorrhea, however, the advantage of none of them has not been proven, which determines the relevance of the search for new methods.

Objective. Based on the analysis of long-term results, to study the efficiency of plastic closure of cerebrospinal fluid fistulas using high-intensity laser radiation.

Materials and methods. An analysis of 15 years of experience in studying the effectiveness of plastic closure of cerebrospinal fluid fistulas in 126 operated patients with basal liquorrhea was carried out. The duration of the disease ranged from 2 months to 1.5 years. The main group consisted of 94 patients who underwent plastic closure of CSF fistulas using high-intensity laser radiation with a wavelength of 0.97 pm and a power of 2.5-3.5 W. The control group consisted of 32 patients who did not receive coherent laser radiation. In addition to the generally accepted methods of postoperative management, low-frequency ultrasonic cavitation irrigation of the operated cavities was used to accelerate the reparative processes in all patients.

Results and discussion. The average follow-up period after surgery was over 13 years. When comparing the results of treatment, the main criterion for evaluating the effectiveness of the operation was the frequency of relapses. In 15 (12.3%) cases, a relapse was noted, of which 5 (3.71%) were patients in the main group and in 10 (8.32%) patients in the control group, who were closed by repeated surgery

Conclusion. The clinical features of the basal liquorrhea include the variability in the localization of the fistulous canals, certain difficulties in their detection, a wide variety of plastic closure methods, and a high percentage of relapses. A prospective uncontrolled study has shown that this method of CSF fistula plasty using improves the efficiency of surgical treatment.

Introduction. In recent years, injuries ranked fourth among the main causes of death of the population after diseases of the cardiovascular system, malignant neoplasms and infectious diseases. The clinical course of associated injuries, as a rule, is characterized by a high number of complications, much more than in isolated injuries.

Objective. Explore approaches to improving otorynolaryngological tactics from the standpoint of normalizing the functional state of the nasal mucosa, as well as increasing the effectiveness of treatment of patients with severe concomitant trauma on prolonged mechanical ventilation.

Materials and methods. In the process of studying the problem of impaired mucociliary clearance of the nasal mucosa, the functional state of the mucous membrane in patients with severe concomitant head trauma undergoing prolonged artificial lung ventilation was analyzed. We studied the state of one of the most important mechanisms of sanitation and local protection of the respiratory tract - mucociliary clearance, which provides the necessary potential for barrier, cleansing and immune functions. A study was made of the thermal effect of the nasal cavity, pH + of the mucous membrane, the study of the frequency of beating of the cilia of the ciliated epithelium and the rate of mucociliary transport

Results and discussion. The results of the study showed that the problem of post-traumatic and nosocomial sinusitis in patients with severe concomitant head trauma must be resolved as soon as possible, with the involvement of modern diagnostic and treatment methods, including the proposed method of artificial ventilation of the nose. The severity of the patient's condition, the severity of the injuries received excludes the use of advanced methods of surgical, otorhinolaryngological treatment.

Conclusion. 12:30 PMThe use of minimally invasive methods of treatment, precision technical execution, including under endovideo control, polysinusotomy made it possible not to burden the condition of the victims and exclude iatrogenic damage that could entail irreversible changes in the body and condition of the victim.

Introduction. Preoperative, in particular, antiseptic, preparation of the external auditory canal (EAC) is an important issue for the otosurgeon to take in mind, especially with endaural approach.

The aim of the study is to assess the skin microbiota of the EAC and the effectiveness of antiseptic treatment before endaural intervention.

Materials and methods. A prospective study including 19 patients who underwent ear surgery by endaural approach: 10 stapedoplasty; 9 tympanoplasty. Ear swabs culture were taken from all the patients preoperatively and after removing the tamponade. Of the 10 patients with otosclerosis, 5 underwent skin preparation with 10% povidone iodine and a swab culture.

Results. According to the microbiological examination results, Staphulacoccus Auricularis prevailed in the first smear - 52.6%. In 5 patients with otosclerosis, in comparison to the 1st swab: one case with absence of microorganisms growth, in the other 4 -decrease in the degree of contamination by half. In the 3rd swab, there was no growth in these patients and in the rest, who didn't undergo antiseptic preparation. Patients, without antiseptic preparation of the ear canal, after tympanoplasty (9 patients) in the second smear, had an increase of contamination (from 105 to 106 CFU/ml).

Conclusions. Analysis of the microbiome before and after the operation revealed the growth of predominantly (94.7%) opportunistic microorganisms. Preoperative antiseptic preparation reduces the degree of contamination of the skin, which, in our opinion, prevents complications and improves the healing process.