Introduction. It is believed that with age, the voice becomes less resistant to voice loads. Among different speech professions, it is the profession of a teacher that most often leads to voice disorders. The main reason contributing to the development of dysphonia in the teachers is the increased voice load.

Оbjective. Study age-related changes in voice endurance and to assess the effect on this characteristic of voice loads, taking into account the characteristics of the teaching profession.

Materials and methods. The basis of the analysis was 170 people. Of these, 125 volunteers of non-speech professions of different ages from 21 to 83 years old without organic laryngeal pathology (group I) were divided into three age subgroups: young age (40), average age (43), elderly and senile age (42). Group II consisted of 45 females of various kinds of pedagogical activities (kindergarten teachers, school teachers, university teachers). All participants were evaluated for voice endurance by using the specialized program The LingWaves and the voice strain test (VST).

Results. It has been found that with age, the endurance of the voice decreases significantly, and to a greater extent in females than in males. Despite long, daily voice loads, the voice of female teachers had greater endurance than that of women in nonspeech professions. At the same time, the volume of voice load and work experience did not significantly affect the voice endurance, in contrast to the nature of pedagogical activity.

Conclusions. Among teachers of different professions, it was the kindergarten teachers who demonstrated the worst indicators of VST, which is most likely due to the peculiarities of their work with young children.

The article highlights the problem of using phytotherapy in the treatment of the most topical inflammatory diseases of the ENT organs, namely acute and chronic rhinosinusitis. Phytotherapy of ENT diseases has always attracted both doctors and patients. However, from the standpoint of evidence-based medicine there were a lot of questions about most herbal remedies due to the small number of reliable, well-controlled studies. This article presents the data of evidence-based studies on phytotherapy of acute and chronic rhinosinusitis. They allow us to speak about secretolytic, secretomotor, anti-inflammatory, anti-edema, moderate antibacterial and antiviral effects of phytopreparations. A common pharmacological property of plants included in phytopreparations is the ability to block the phase of exudation and reduce the permeability of the vascular wall. Phytotherapy is a good alternative method of treatment of patients with chronic rhinosinusitis (CRS). Data on the complex therapy of rhinosinusitis are given. Nevertheless, the safety and efficacy of phytotherapy for the treatment of patients with CRS are currently uncertain. The clinical guidelines of the Russian Ministry of Health 2021 on the treatment of acute rhinosinusitis (ARS) note the following: any patient with ARS can be prescribed herbal remedies with proven anti-inflammatory and mucolytic effects in the absence of contraindications to accelerate resolution of the disease symptoms. The results of works devoted to the use of preparations of plant origin for the treatment of patients with acute and chronic sinusitis allow to estimate them as rather effective in the complex treatment of this group of patients. However, further controlled studies are required to obtain additional data on the effectiveness of phytotherapy.

Introduction. Since 2020, the pandemic caused by the SARS-CoV-2 virus poses a serious threat to health systems in many countries around the world. Finding inexpensive and affordable, effective and safe medications that can promote rapid recovery and reduce the risk of a severe course of COVID-19 is an important challenge for the health care system of any country. It has long been known that 7% hypertonic sodium chloride solution has nonspecific antiviral, antibacterial and antifungal properties. A 2020 study shows the effectiveness of hypertonic NaCl solutions in blocking SARS-CoV-2 replication in Vero cells. These data suggest that hypertonic solutions can be used as a prophylactic and alternative comprehensive treatment for patients with COVID-19.

Aim. We study the efficacy and safety of hypertonic solution with hyaluronic acid in patients undergoing outpatient treatment with mild to moderate COVID-19.

Materials and methods. We conducted an open prospective study of the use of hyaluronic acid (HA) solution 7% (Ingasalin® forte 7%) in outpatients with confirmed SARS-CoV-2 infection who had 1 or more risk factors for a severe course of the disease. Patients were divided into 2 groups of 30 patients each. The main group received, in addition to standard therapy (according to the interim guidelines in effect at the time of treatment, version 14 dated 12/27/21), inhalation of 7% HG with HA in the morning and evening for 10 days; patients in the control group received standard therapy according to the interim guidelines.

Results and discussion. Patients of the study group who received hyaluronic acid solution 7%  had statistically significant decrease of dyspnea and normalization of saturation values already on the 5th day of therapy compared to patients of the control group. One patient in the study group was hospitalized, and 4 patients in the control group were hospitalized. There were no side effects associated with the administration of hyaluronic acid solution 7%. Also, there was no development of cough or its intensification against the background of inhalation in patients of the main group.

Conclusion. It is reasonable to use hyaluronic acid solution 7% in outpatients with mild to moderate COVID-19 and with one or more risk factors of severe disease course as part of complex therapy.

Тhe article discusses the issue of the features of the course and treatment of ARI in children at the present stage. It is emphasized that the irrational use of antibiotic therapy leads to increasing antibiotic resistance, to the development of side effects. In order to improve the effectiveness of therapy, the use of traditional medicine, in particular phytotherapy, is proposed. Phytotherapy is a scientifically based treatment with medicinal plants or their parts used in native fresh or dried form, as well as in the form of galenic preparations. This treatment is especially advisable in sensitive patients, in patients with comorbid and polymorbid conditions, in the presence of resistance to the drugs shown to the patient, to prevent the development of side effects, at the stage of rehabilitation, as well as for the prevention of various diseases. In order to treat ARI and its complications, the use of the phytotherapeutic drug Umkalor in treatment protocols is justified.

Acute inflammatory diseases of the upper respiratory tract (URTI) accompanied by cough are one of the most common groups of diseases in the world. It includes acute respiratory viral infections, often manifested by rhinosinusitis, tonsillopharyngitis and laryngitis. According to statistics, about 90% of all infectious diseases are acute respiratory infections, with cough accompanying acute respiratory infections in 83% of cases. Cough largely determines the severity of the disease, and its duration over 4 weeks indicates a high probability of process chronicity. Cough with difficult to detach sputum dramatically reduces the patient’s quality of life, bringing discomfort in everyday activities. In addition to the cough, the problem of viral diseases lies in the rather difficult diagnosis at the outpatient stage, due to which excessive prescription of antibiotics occurs. In order to avoid the occurrence of complications, chronicization of the disease and reduce the level of inappropriate prescriptions of antibacterial drugs, it is necessary to apply therapy, aimed both at the etiology, the links of pathogenesis, and the symptoms in order to alleviate the condition of the patient and his speedy recovery. The processes leading to the development of cough in URTI are described in the article; principles of differential diagnostics and peculiarities of therapy of URTI are reviewed. The article presents data on the use of a natural remedy, ivy leaf extract, which helps to get rid of cough in a shorter period of time, thereby improving the well-being of the patient, and is notable for its good tolerability and rare occurrence of side effects, which may surpass synthetic alternatives.

One of the most frequent otorhinolaryngological pathologies is inflammatory diseases of the nose and paranasal sinuses. In Russia, according to the Ministry of Health and Social Development, 15% of adults and 5% of children suffer from chronic rhinosinusitis. According to analysis of medical records, indicators of ENT diseases do not decrease, and long-established treatment regimens prove to be ineffective, despite the large number of different medications. One of the hypotheses existing at the present stage attributes this tendency to the underestimation of the complexity of regulatory systems in the era of reductionism, when the organism is unable to fully adapt to the influence of the environment. In this connection, the concept of bioregulatory systems medicine (BrSM), developed by an international group of scientific experts and clinicians of different specialties, whose underlying principles are the perception of the human being as a complex and integrated system, acquires particular significance. The development of any process is carried out through multilevel interaction between the various systems of the body, the so-called intra-network interactions. According to the views accepted in BrSM, multipurpose therapy is justified to influence different links of pathogenesis. Thus, the bioregulatory approach is multitargeted, i.e., it involves the use of multicomponent drugs affecting the body as a single system. The purpose of this study is to consider treatment regimens for inflammatory diseases of the nose and paranasal sinuses from the perspective of bioregulatory systems medicine. It is concluded that bioregulatory nasal spray therapy is safe and well tolerated, has anti-inflammatory, antiviral, moisturizing effects, and stimulates mucosal regeneration, is combined with other medicines, and is an excellent alternative to traditional methods of treatment, has no side effects and limitations typical of them.

Introduction. With an increase in the level of acquired antibiotic resistance of pathogens, treatment becomes more complicated and slows down, especially in infections associated with biofilms. There is a growing need for the development and use of new antibacterial drugs with specific antimicrobial activity.

Aim. To study the antimicrobial action and the dynamics of the formation of resistance to benzydamine hydrochloride from a various infection agents. 

Materials and methods. To obtain biofilms, microorganisms were cultivated in flat-bottomed culture plates. Planktonic cells were obtained by suspending and reseeding single colonies of the daily culture into flat-bottomed culture plates. To determine the antimicrobial activity of the studied preparations, two-fold dilutions were prepared and added to the wells of the plate with a bacterial culture. The dynamics of the formation of resistance to benzydamine hydrochloride was studied by passaging the cultures in a liquid nutrient medium with increasing concentrations of the antiseptic by a twofold step. After 2–3 days of incubation from a test tube with the maximum concentration of the drug, in which bacterial growth was observed, the bacteria were transferred to new ones with higher concentrations of the drug.

Results. It was shown that benzydamine hydrochloride showed a high level of activity against bacteria M. catarrhalis and yeast-like fungi C. albicans. A slightly lower activity of the drug was noted for bacteria of the species S. aureus and E. coli, however, within the limits of the therapeutic concentration of the drug in finished dosage forms. Benzydamine hydrochloride had a significantly higher level of antibacterial activity against pre-formed biofilms compared to drugs such as chlorhexidine and hexetidine. An analysis of the dynamics of the formation of resistance to the drug benzydamine hydrochloride in microorganisms of various species showed that the possibility of developing resistance to benzydamine hydrochloride is extremely small. The process of adaptation was observed only in E. coli. The studied strains of the species S. aureus, C. albicans, and M. catarrhalis did not acquire resistance to the test drug.

Conclusion. Benzydamine hydrochloride can be effectively used against a wide range of pathogens of ENT infections, as it has been shown to have a significantly higher level of antibacterial activity against pre-formed biofilms, various types of bacteria and yeast-like fungi and an extremely low level of resistance compared to other antiseptic drugs.

Introduction. The prevalence of chronic rhinosinusitis, an increase in the resistance of pathogenic microorganisms, growing numbers of patients with allergic reactions to antibiotics necessitates the use of topical antibacterial therapy or the nasal cavity and paranasal sinuses, which are accessible for local remedies.

Aim. Efficacy and tolerability of topical antibacterial drug hydroxymethylquinoxalindioxide in the treatment of chronic rhinosinusitis exacerbation has been investigated in our study.

Materials and methods. An open non-invasive observational study of efficacy and tolerability of irrigation therapy with hydroxymethylquinoxalindioxide in 50 adult patients with exacerbation of chronic rhinosinusitis has been conducted at the Department of Otorhinolaryngology, Pavlov State Medical University (Saint Petersburg). The patients were randomized into 2 groups. In the first group, patients were treated with 40 ml of 0.25% hydroxymethylquinoxalindioxide solution nasal irrigation b.i.d. for 7 days, in the second – the same amount of normal saline was used. Duration and severity of symptoms, dynamics of nasal endoscopic picture, and the results of bacteriological study were evaluated before and after the treatment. Safety was assessed according to the data of complete blood cell count, mucociliary transport time and the incidence of adverse events.

Results and discussion. In the hydroxymethylquinoxalindioxide group, there was a statistically significant improvement in the mucociliary transport time by the end of treatment from 19.1 ± 5.08 minutes to 15.2 ± 1.2 minutes (p = 0.002) compared to the normal saline group. According to the results of bacteriological study, eradication of the pathogen in the hydroxymethylquinoxalindioxide group was achieved in 85% (n = 21), comparing to only 17% (n = 4) of cases in the control group.

Conclusion. Irrigation therapy with 0.25% hydroxymethylquinoxaline dioxide is more effective than saline flush solution. The drug can be recommended for irrigation therapy in adults with chronic rhinosinusitis exacerbation.

In the pandemic new coronavirus infection (COVID-19), different clinical symptoms are observed depending on its dominant strain. The Omicron strain affects the nasal mucosa, causing the possibility of complications such as tubootitis and acute otitis media. Untimely or incomplete treatment of otitis media can contribute to the development of chronic forms of the course. Inflammatory process in the middle ear always proceeds with impaired hearing function due to the development of adhesions in the tympanic cavity. In patients with a reduced immune status, weakened course of the coronavirus infection itself, recovery comes later with a long recovery of hearing acuity, so it is very important to start treatment at the first manifestations of pain in the ear. In addition, the danger of otitis media against the background of SARS-CoV-2, if not treated in time, is the development of serious complications – mastoiditis, meningeal syndrome. Local analgesic therapy in the form of analgesic ear drops is recommended to reduce inflammation of the eardrum tissues. The combination of phenazone and lidocaine allows you to quickly stop the pain, block the development of phases of inflammation in the middle ear. Using a combination of phenazone and lidocaine reduces the time of onset of the analgesic effect, while increasing the intensity and duration of action, which is very important, especially in children. These components are not resorbed and have no systemic effect on the patient’s body. The combination of phenazone and lidocaine can be used in the treatment of children of all age groups, adults, pregnant women and nursing mothers.

Sore throat is an acutely common health problem both in Russia and around the world as a whole. This is one of the most common reasons adults and children seek primary specialized care. The overuse and misuse of antibiotics, especially for viral infections of the respiratory tract, such as acute and exacerbation of chronic tonsillopharyngitis, greatly increases the risk of developing and spreading antibiotic resistance. Up to 80% of cases of sore throat have a viral etiology of the disease, and even when the infection is bacterial, except for pyogenic streptococcus, the vast majority of cases do not require systemic antibiotic therapy. However, antibiotics are still often and unreasonably prescribed to treat sore throats. In addition, topical antibiotics for sore throats are widely available over the counter over the counter. The clinical guidelines for the treatment of acute tonsillopharyngitis indicate that systemic antibiotic therapy is indicated for patients with sore throat of streptococcal etiology. Considering the growing antibiotic resistance in the world, much attention is paid to over-the-counter treatment of sore throat, which does not contain antibiotics in its composition, namely, the appointment of local anti-inflammatory drugs that can prevent the further development of the infectious process in the throat. The combined local and systemic effects, achieved through local delivery of flurbiprofen to the inflamed tissues in throat, have led to the development of flurbiprofen 8.75 mg in different types of dosage forms (including lozenges and sprays) to treat a sore throat.

Introduction. The relevance of the search for effective methods of treatment of various forms of laryngitis is associated with a high frequency of occurrence, which has a certain seasonality. Optimization of treatment tactics is dictated by the variability of etiopathogenetic mechanisms, with a certain similarity of clinical symptoms, and the reactivity of the mucous membrane to inflammation. The methods of treatment described in the literature are diverse and lead to the search for therapeutic adjustments.

Objective. To increase the effectiveness of the treatment of various forms of acute laryngitis using the multicomponent drug Homeovox^® in complex therapy.

Materials and methods. A randomized simple controlled clinical trial involved 132 patients with acute laryngitis of various etiologies. Efficacy in terms of recovery time and safety were evaluated in two parallel groups: group 1, patients with acute laryngitis on the background of acute respiratory viral infection and group 2, patients with acute laryngitis on the background of a new strain “omicron”, COVID-19. In the course of treatment, both groups were divided into 2 subgroups: 1^st – patients who received standard conservative therapy and the 2^nd – persons who, in addition to complex therapy, received the drug – Homeovox^®. Treatment results were assessed using the VAS scale, quality of life was assessed using the SNOT-22 questionnaire, cognitive functions were evaluated using standard psychological tests.

Results and discussion. The use of the multicomponent preparation Homeovox^®, which has multidirectional mechanisms of action in the complex therapy of patients with various forms of acute laryngitis, improved clinical symptoms, quality of life and recovery time. Good portability, high efficiency and safety were noted.

Conclusions. The use of the preparation Homeovox^® in the treatment of various forms of acute laryngitis has demonstrated its ability to quickly stop the symptoms of the disease and significantly improve the quality of life of patients.

Antibiotic resistance is a serious health problem. The use of new dosage forms of antibiotics should comply with the strategy of rational use of antimicrobials, which includes a set of measures for hospitals and outpatient network aimed at preserving the effectiveness of existing antibiotics. The principles of the strategy for the use of antimicrobial/antibacterial drugs: the exclusion of unjustified prescribing of antibiotics, the priority of prescribing drugs based on the identification of the bacterial agent and its sensitivity to the antibiotic in comparison with empirical prescribing, taking into account data on regional antibiotic resistance, the application of the principle of minimum sufficiency in relation to the choice of the drug – its dose, the choice of route of administration, safety and duration of treatment. The article uses the example of healthcare systems in different countries to assess the effectiveness of the strategy of rational use of antimicrobials. The problem of unjustified use of antibiotics in the treatment of COVID-19 is discussed. New innovative forms of antibiotics are dispersible tablets. Amoxicillin EXPRESS and Amoxicillin + Clavulanic Acid EXPRESS are antibiotics with improved pharmacokinetic properties in the form of dispersible tablets that have proven their safety and effectiveness against many gram-positive and gram-negative microorganisms. The analysis of the effectiveness of therapy of diseases caused by beta-hemolytic streptococcus group A, with the use of two forms: Amoxicillin and Amoxicillin + Clavulanic acid. A clinical case of the use of Amoxicillin + Clavulanic acid EXPRESS in the form of dispersible tablets is presented, which confirms the effectiveness of this drug in the treatment of acute streptococcal tonsillitis.

Allergic rhinitis occupies a special place among diseases of the upper respiratory tract. Every year the urgency of the problem increases due to the annual increase in the incidence among all age groups of the population. Allergic diseases are often associated with other respiratory diseases or cause them, which requires early diagnosis and selection of competent therapy. Allergic reactions can range from seasonal allergens, such as tree or weed pollen, to year-round irritants, such as dust and pet dander. Currently, the pathogenesis of allergic rhinitis is being actively studied. There is still debate about the most accurate classification of allergic rhinitis, reflecting all its aspects, such as the time of onset and duration of symptoms, their impact on patients’ lives. This is necessary to find the best methods of treatment with maximum efficiency. The main clinical manifestations of allergic rhinitis are nasal itching, sneezing, swelling of the nasal mucosa and rhinorrhea. Often, to relieve symptoms, patients are forced to take many drugs for a long time, which has a significant impact on their quality of life. All over the world, new ways are being developed to optimize the treatment of this group of patients, among which combinations of several drugs used to treat allergic rhinitis, which meet all safety and efficacy requirements. The most commonly used and most effective combinations of drugs are combinations of intranasal glucocorticosteroids with topical histamine H1 receptor antagonists, as well as leukotriene receptor blockers with oral antihistamines.

Introduction. Modern algorithms for the diagnosis and treatment of allergic rhinitis (AR) recommend a stepwise approach for managing symptoms of the disease. A part of patients with AR have symptoms that indicate to the past COVID-19 followed by significant impairment of the olfactory function. The article places special emphasis on the intranasal glucocorticosteroid option of treatment to manage nasal and general symptoms in persistent AR.

The aim of the study is to evaluate the efficacy of mometasone furoate in patients with a confirmed diagnosis of persistent AR, olfactory disorders, and past COVID-19 infection.

Materials and methods. A total of 72 patients with persistent AR were included in the randomized controlled prospective study. All patients had a history of olfactory dysfunction with varied severity, which persisted after COVID-19 infection.

Results. Measuring the severity of nasal and general symptoms on Day 15 of treatment showed a positive outcome in both groups: the patients of the main group experienced changes, to a greater extent, in nasal congestion, rhinorrhea, olfactory disorders, the 

patients of the control group generally demonstrated a reduction in nasal congestion, rhinorrhea, itching and sneezing, and improvement of sleep. The final measuring of the severity of complaints on Day 30 of treatment showed that patients of the main group managed to cure the olfactory disorders (0.9 points on the VAS), nasal congestion (0.4 points on the VAS), rhinorrhea and itching (0.2 points on the VAS). Sleep disorders continued to disturb patients in both groups, its improvements in the main group were statistically insignificant.

Conclusions. The complaints of nasal congestion, impaired olfactory function and sleep disorders were noted to prevail in patients with persistent form of AR after COVID-19. The followed measuring of the olfactory function using the SST-12 screening test showed that all patients had anosmia. It has been confirmed that the use of mometasone furoate in the treatment of persistent AR in patients with severe olfactory dysfunction after COVID-19 would be appropriate.

Background. Leukotrienes play an important role in the pathogenesis of allergic rhinitis (AR) and eosinophilic type of chronic rhinosinusitis with nasal polyps (CRSwNP). There is a phenotype of CRSwNP in combination with AR, which has specifics of local inflammation.

The aim of our study was to investigate the efficacy of using an antileukotriene drug in the treatment of AR in combination with CRSwNP.

Materials and methods. 63 patients with AR and bilateral CRSwNP after endoscopic bilateral polypotomy were randomly divided into 2 groups. In the 1st group 32 people (age 50.28 ± 1.37 years) were prescribed a basic therapy with nasal spray of mometasone furoate at a daily dose of 400 µg in combination with montelukast 1 tab. 10 mg at night, in the 2^nd group 31 people (age 50.31 ± 1, 16 years old) received only mometasone furoate monotherapy. Endoscopic examination of the nasal cavity was performed once every 3 months. The follow-up period was 1 year.

Results. After 3 months in the 1^st group of patients there was a recurrence of polyp growth was observed in 25% of cases, in the 2^nd group in 35.5% of patients (p < 0.05). After 6 months, the number of relapses of CRSwNP decreased to 15.6% of cases in group 1 and to 22.6% in group 2 (p < 0.05). After 9 months in group 1 recurrence of NP was recorded in 12.5% of patients and nasal polyps were completely absent during endoscopic examination in 9.4% of cases, in the 2^nd group, relapse was detected in 19.35% of patients (p < 0.05). 1 year after surgery, in group 1, relapse of NP was found in 12.5% of patients with AR and in 12.5% of cases was remission of the pathological process with cancellation of basic therapy. In group 2, recurrence of NP was in 16.1% of cases, there were no reasons for withdraw treatment of intranasal glucocorticosteroids in this group.

Discussion. The clinical effectiveness of the addition of Montelukast to basic therapy has been reflected in a reduction in the growth rate of polyposic vegetation, the number of repeated operations and the stabilization of the flow of chronic inflammatory process.

Conclusions. In the case of the clinical phenotype of AR with CRSwNP, the addition of a leukotriene receptor blocker montelukast to the basic therapy of intranasal glucocorticosteroids made it possible to improve drug control of both diseases and reduce the frequency of CRSwNP relapses.

Introduction. There is an abundance of various methods of surgical treatment in the world, which include: classical tonsillectomy (TE), shaver TE, unipolar and bipolar bilateral TE, laser TE, palatine tonsil coblation, etc. However, there is still a risk of recurrence of chronic tonsillitis after TE there is a need for a study in the late postoperative period.

Purpose of the study. Improving the efficiency of surgical treatment of patients with chronic tonsillitis based on the analysis of five main methods of surgical treatment of chronic tonsillitis according to clinical and laboratory criteria.

Materials and methods. Patients were divided into 5 study groups depending on the method of tonsillectomy: The first group consisted of 60 patients after classical tonsillectomy. In the second group there were 55 patients after palatine tonsil coblation. The third group included 48 patients after laser tonsillectomy. The fourth group consisted of 64 patients after tonsillectomy using the surgitron apparatus. The fifth group consisted of 58 patients after microdebrider tonsillectomy.

Results. By analysis, it was found that the best results were obtained in patients of the 1^st group, who underwent classical tonsillectomy. In this group, there are fewer cases of subjective and objective clinical symptoms (sore throat, signs of subatrophic pharyngitis, hypertrophy of the lateral folds of the pharynx, remnants of the lymphoid tissue of the palatine tonsils, as well as postoperative cicatricial changes). In a laboratory study, patients of the 1^st group had the lowest values of the indicators (ASL-O titer, CRP and DNase B levels, negative results of the Streptatest).

Introduction. One of the most relevant areas of modern medicine is research affecting the assessment of the quality of life of a person. Hearing loss can significantly limit various areas of life, thereby affecting the overall quality of life and certain particular characteristics. One of the methods of surgical treatment of otosclerosis is stapedoplasty with the installation of a titanium prosthesis.

Aim of the study. To assess the quality of life index in patients with otosclerosis and its dynamics depending on the surgical treatment performed.

Materials and methods. The study involved 39 patients who underwent piston stapedoplasty with the installation of a titanium prosthesis. Quality of life was assessed at the preoperative and postoperative stages. We used a Russified version of the SPOT-25 questionnaire (Stapesplasty Outcome Test 25) with a range of results, where 0 is the minimum impact, and 100 is the maximum.

Results. All patients successfully underwent stapedoplasty. The average score in the preoperative period was 58.8 ± 14.9, in the postoperative period – 29.4 ± 20.4. Statistical comparison revealed a statistically significant improvement in all separately assessed indicators (p < 0.001) and overall quality of life (p < 0.001).

Conclusion. The introduction into practice of a new tool for assessing the patient’s condition through such a parameter as quality of life can influence the rationale for the methods and tactics of patient treatment, which can positively affect the quality of medical care provided.

Introduction. Literature review search did not show enough information to answer the question concerning the need to remove hair in the external auditory canal as a part of preoperative preparation of the surgical field in middle ear surgery with endaural and transcanal approaches.

Aim of the study. To substantiate the removal of hair from the external auditory canal during transcanal and endaural otosurgery.

Materials and methods. A prospective randomized study included 2 groups. In the first group, tympanoplasty and stapedoplasty were performed via endaural approach with and without hair removal in the external auditory canal. The effect on the intraoperative overview and postoperative wound healing was assessed. Shunting of the tympanic cavity in the second group, with transcanal approach, have been performed under the control of a microscope and endoscope. The evaluation was done via a questionnaire, it was given to the doctor before and after hair removal separately. Postoperative inflammatory reaction was also assessed.

Results. Postoperative wound healing of the external auditory canal in the first group were considered comparable between the main and the control group, and had no complications. In the second group, inflammation was absent in all patients. Hair removal significantly improve the visibility in endaural and transcanal approach.

Conclusions. Hair removal from the external auditory canal increases the visibility of the surgical field and facilitates the work of an otosurgeon. It is especially recommended as a preoperative preparation, especially for transcanal surgical interventions on the middle ear under endoscope control.

The article is devoted to the organization of primary specialized and periodic accreditation of otorhinolaryngologists in 2022. The process of accreditation of doctors of various specialties is introduced by stages, the program is scheduled for completion to 2026. The normative-legal acts regulating the accreditation procedure are considered. The changes in the Procedures for its implementation, technical and organizational features in connection with the entry into force of the Order of the Ministry of Health of the Russian Federation No. 1081n “On approval of the Regulations on the accreditation of specialists” analyzed. Master’s degree graduates and persons with non-medical education have been added to the specialists who are subject to primary specialized accreditation. At the stages of primary specialized accreditation, the number of test tasks, practical tasks and situational tasks, as well as the time to solve them, will now be determined by the Methodological Center. In periodic accreditation, the ways of submitting documents have been revised, it will be possible to do this in person, by mail, or using the federal register of medical professionals. The requirements for training and portfolio design have also changed. The 144 hours of training established by the order can be earned both by advanced training programs without mandatory confirmation on the portal of continuing medical education, and by credits received for education on the portal of continuing medical education. Accreditation process outcomes are posted on the Federal Accreditation Center portals. Information about persons who have got the accredited specialist status are entered by the Ministry of Health of the Russian Federation into the integrated national health information system for maintaining of personalized registration of persons involved in the medical activities.

Introduction. In the medical literature, there is not enough work on the impact of obstructive sleep apnea (OSA) on the development of atherosclerosis of the brachiocephalic arteries and venous dysgemenia. For the purpose of early diagnosis of vascular complications, further study of extracranial vessels in patients with OSA is necessary.

Aim. To study the chances of changes in brachiocephalic vessels by ultrasound examination in patients with obstructive sleep apnea.

Materials and methods. A survey was carried out of 88 patients. The results of anthropompetry, polysomnography and ultrasound examination of brachiocephalic vessels were evaluated.

Results and discussion. New data were obtained on the severity of macroangiopathy, an increase in the peak systolic blood flow velocity in the internal jugular veins, and an increase in the diameters of the vertebral veins in patients with sleep apnea. It was also found that in patients with OSA, the chances of having a wide diameter of the common carotid artery (CCA) on both sides and the internal carotid artery on the left are more than 3 times higher, the probability of thickening of the intima-media complex in the area of the CCA and its bifurcation is more than on the left 3.5 times and the chances of macroangiopathy are 3 times higher in comparison with the examined patients without apnea.

Conclusion. Timely assessment of the entire spectrum of pathological changes in the brachiocephalic vessels in patients with OSA will make it possible to diagnose early signs of atherosclerotic lesions of the arteries, venous dysfunction at the extracranial level.

Endolymphatic sac tumors are rare neoplasms of the temporal bone, histologically benign, but clinically behaves as malignant tumors causing destruction of surrounding tissues. The tumor originates from the posterior surface of petrous part of temporal bone, where endolymphatic sac is situated anatomically. The tumor causes destruction of the posterior surface of the petrous part of the temporal bone, inner ear, mastoid process, etc. Endolymphatic sac tumor can be both sporadically and in patients with von Hippel – Lindau disease. Due to the rarity of this tumor, it is easy to confuse it with other tumors, such as paraganglioma, middle ear adenoma, adenocarcinoma, papillary thyroid carcinoma or papilloma of the vascular plexus. Computed tomography (CT) and magnetic resonance imaging (MRI) are of great diagnostic importance and play an important role in planning treatment tactics. The optimal method of treatment is resection of pathologically altered tissues. In some cases (incomplete resection of tumor, the patients with concomitant diseases or inoperable cases) receive courses of X-ray or radiosurgery. If a tumor is detected in the early stages, the volume of resection can be minimized while preserving hearing and vestibular function of the inner ear. Recurrence usually happens due to difficulty to identify the extension of the tumor. Diagnosis and correct preoperative planning, with embolization if it possible, will facilitate surgery and avoid subtotal tumor resection due to intraoperative bleeding. Long follow-up period is important in order to avoid recurrences. Insufficient coverage of this problem in the literature is associated with a low percentage of its occurrence in otosurgical practice, which complicates the timely diagnosis and treatment of this type of tumors of the temporal bone, worsens the prognosis.