Introduction. Modern diagnostics of laryngeal diseases is based on the use of video endoscopic technologies. The authors of the article, having almost thirty years of experience with various methods of video endoscopy, proposed a classification of video endoscopic methods of laryngeal examination.
   Objective. To develop an algorithm for the application of various video endoscopic methods of laryngeal examination in voice professionals with functional and organic dysphonia.
   Materials and methods. From 2020 to 2022, 2308 patients aged 18 to 80 years (43.2 ± 11.5) were examined in the phoniatric department of the St. Petersburg Research Institute of ENT. There were 1424 women (61,7 %), 884 men (38,3 %) people. Functional dysphonia was detected in 705 (30,5 %) people, acute and chronic laryngitis in 668 (28,9 %), tumor-like formations in 436 (18,9 %), the remaining nosological forms were diagnosed in 499 (21,7). All the patients turned out to be representatives of voice-speaking professions and complained of dysphonia.For videolaryngoscopy, videolaryngostroboscopy, autofluorescence endoscopy, NBI–endoscopy, equipment from various manufacturers was used.
   Results. An algorithm for the application of video endoscopic research methods in persons of voice-speech professions with dysphonia has been developed. Overview videolaryngoscopy and videostroboscopy were mandatory research methods for all patients with complaints of voice function. The use of these two methods proved to be sufficient for the diagnosis of functional dysphonia, paresis and paralysis, congenital malformations of the larynx, scar stenosis. In-depth diagnostics and differential diagnostics of tumor-like formations, various forms of chronic laryngitis, benign and malignant formations, in addition to videolaryngoscopy and videostroboscopy, included autofluorescence endoscopy or NBI endoscopy, which revealed the earliest stages of the pathological process.
   Conclusions. Only the complex application of various methods of video endoscopy of the larynx provided timely diagnosis and early treatment of dysphonia, maximum restoration of voice function, and, consequently, the preservation of professional longevity by persons of voice-speech professions.

   Introduction. The integration of special acoustic means into the safety system makes it relevant to conduct biomedical research to evaluate the impact of their effects on the hearing organs.
   Objective. To study the characteristics of a special sound signal and its effect on the hearing organ of an experimental biological model.
   Materials and methods. The study was conducted on 6 males (12 ears) guinea pigs (Cavia porcellus) weighing 200–250 grams at the age of 4 weeks. A set of special audio equipment was used to generate an acoustic signal. The study was conducted in a room with an area of about 47 m². The time of a single exposure to experimental animals was 3 minutes at a sound level of 127–128 dBA. Before exposure and at different times after exposure (after 24 and 72 hours), the otoscopic picture was evaluated, a Preyer’s reflex and distortion-product otoacoustic emissions (DPOAEs) was carried out.
   Results. The special sound signal was characterized by distinct frequency components and can be attributed to tonal noises. After acoustic exposure to a special sound signal, a normal otoscopic picture was observed in experimental animals. Restoration of the Preyer’s reflex occurred 24 hours after exposure. The restoration of the DPOAEs to background values at frequencies from 1.5 to 3.3 kHz occurred 24 hours after acoustic exposure, at a frequency of 4.2 kHz there was a significant tendency to recovery.
   Conclusions. With a short-term (within three minutes) single exposure to a special sound signal with a sound level of 127 to 128 dBA on biological models (guinea pigs), no pathology of the hearing organ was detected. Given the greater resistance of humans to acoustic effects, compared to guinea pigs, this can equally be extended to humans.

   For a long time for otolaryngologists, the issues of identifying and treating such a formidable disease as chronic suppurative otitis media (CSOM) have been topical. This disease still haunts many specialists, as it leads to acquired hearing loss in people of working age. Only in the last ten years, the number of children of younger age groups with already manifested acquired hearing loss has increased. Along with the correct and timely diagnosis, it is very important to cure this disease once and for all, since exacerbations often disrupt not only the performance, but also the quality of life of the patient. The gold standard for the treatment of patients with CHSO is surgical – tympanoplasty. In the process of studying the pathological process in chronic suppurative otitis media and methods of its more effective surgical treatment, the results of tympanoplasty were analyzed. An illustrative clinical example has been chosen, with the help of which it is possible to trace all the stages of surgical intervention in chronic suppurative otitis media. An otoscopic examination was carried out at several stages of observation of this patient, as well as the determination of auditory function. The presented clinical case shows step by step the effectiveness of the scheme of surgical treatment and postoperative management. Thus, these steps are applicable to any myringoplasty with tympanic membrane defects of any size. It is tympanoplasty and control in the postoperative period that makes it possible to completely close the defect of the tympanic membrane and prevent chronic otitis media from recurring.

   The treatment of acute respiratory viral infection remains an urgent public health problem. There are currently a limited number of drugs used for the treatment and prevention of this pathology with proven efficacy and safety. According to current views in the field of immunology, the most important role in immune protection against both viruses and bacteria is played by molecules and receptors that form the so-called “immune synapse”, understood as a contact of cells involved in the detection of an antigen and triggering the subsequent chain of reactions to destroy it. A complex antiviral drug that has the ability to modulate rather than block the activity of its target molecules is a product containing technologically treated antibodies to interferon gamma, CD4 and domains of the main histocompatibility complex. The combined action of its components helps to reduce the infection load on the body, reduce the severity of symptoms of SARS during the first days, reduce the duration of the infectious disease. The pharmacological effect of the drug is achieved by acting on the key molecules and receptors involved in the recognition of pathogens of both viral and bacterial origin by the immune system. In addition, the product has a direct effect on IFN-γ, which results in stopping the multiplication of viruses and protecting healthy cells from infection. The use of the antibody-based drug reduces the risk of complications and helps to increase the body’s resistance to the main pathogens of viral and bacterial infections of the respiratory tract. According to the results of clinical trials, this drug has shown high efficacy and safety in the treatment of acute respiratory viral infections (ARI) in adults. The use of antibody-based medicine in paediatric acute respiratory infections and COVID-19 treatment in an outpatient setting is currently being investigated in multicentre, double-blind, placebo-controlled randomised trials.

   Introduction. Acute infectious rhinitis refers to the frequent causes of discharge therapy with nasal decongestants.
   The aim to analyze the clinical features of unloading therapy of acute infectious rhinitis with 0.1 % xylometazoline according to the materials of the research centers of Novosibirsk and Yekaterinburg.
   Materials and methods. In the research centers of Novosibirsk and Yekaterinburg, patients with acute infectious rhinitis were observed. Intranasal therapy in the study groups (group 1) and in the comparison groups (group 2) was carried out with 0.1 % xylometazoline spray for 7 days. Group 2 additionally received silver preparation intranasally. The need for decongestant and the state of mucociliary transport (MCT) were evaluated.
   Results and discussion. Initially, patients with normal MCT rate at 1 visit in Novosibirsk accounted for 20.8 % in group 1 and 34.78 % in group 2; in Yekaterinburg – 29.17 % of patients in group 1 and 25% of patients in group 2. In the study groups, 54.2 % of patients in Novosibirsk and 100 % in Yekaterinburg used decongestant on day 5; in the comparison groups – 41.7% in Novosibirsk; 83.3% of patients in Yekaterinburg. On day 5, the volumetric air flow velocity was determined to be more than 900 cm³/s in all patients. Decongestant was used for more than 7 days by 40.35 % of patients in the first groups and 12.45 % of patients in the second groups. Inhibition of MCT on the 14 th day of follow-up, detected in two research centers, amounted to 5.26 % of patients.

   Conclusions. On the 5th day of unloading therapy, nasal breathing is objectively free. Intranasal antiseptic therapy reduces the probability of using decongestant for more than 7 days by 27.9 %. Inhibition of MCT when using 0.1 % xylometazoline should be attributed to frequent reactions.

   Otitis externa (NO) is manifested by inflammatory changes in the auricle, external auditory canal and epidermal layer of the eardrum. The disease is characterized by a wide prevalence and a continuing increase in morbidity, a persistent, resistant to adequate therapy course and frequent recurrence of the pathological process. For the development of NO, the presence of an etiotropic agent and a violation of the integrity of the epidermal layer of the skin of an endogenous and exogenous nature are necessary. According to the area of distribution and the type of pathological process, limited and diffuse NO are considered. Most often, bacteria act as the causative agents of NO, with diffuse forms Pseudomonas aeruginosa is the leader. The appointment of systemic antibiotics for uncomplicated forms of NO is impractical, it is optimal to use topical combined drugs that have adequate activity against the main pathogens of NO. The advantages of topical therapy in such patients are the rapid accumulation of required active substance concentration in the area of inflammation and almost complete lack of systemic action, minimal risk of development and spread of resistant strains of microorganisms. It is required to use antimicrobial agents that have been shown to be active against the main pathogens of otitis externa. The reduction of inflammation and pain is also an important component of the management of patients with OE. A good option for topical therapy of patients with inflammatory changes in the external ear is a drug with antimicrobial and local anesthetic action containing antibacterial components: aminoglycoside neomycin sulfate and cyclic polypeptide polymyxin B sulfate, and local anesthetic lidocaine hydrochloride. Such agents have a balanced antimicrobial and local anesthetic action, high safety and can be recommended for use in patients with diffuse otitis externa.

   Introduction. Acute rhinosinusitis accounts for 40 % to 60 % of the morbidity in the structure of ENT pathology. COVID-19 pathogen, similarly to other respiratory viruses, can cause acute rhinosinusitis, which is the most relevant at the present time due to the ongoing pandemic. Viral etiology accounts for 90–98 % of all cases of acute rhinosinusitis. Accordingly, the choice of treatment tactics with antibacterial drugs in a number of cases is unreasonable and leads to the growth of antibiotic resistance. Local antiseptics containing sodium hypochlorite with a high safety profile that do not cause pathogen resistance are used to increase the effectiveness of therapy for acute rhinosinusitis.
   Objective. To evaluate the effectiveness of nasal spray containing sodium hypochlorite on the duration of the course of exacerbation and severity of acute rhinosinusitis during the epidemiological season.
   Materials and methods. The study involved 50 patients who were divided into 3 groups: 10 patients (group 1) with acute viral rhinosinusitis (therapy: sodium hypochlorite + decongestants); 20 patients (group 2) with acute bacterial rhinosinusitis (therapy: sodium hypochlorite + systemic antibacterial therapy); 20 patients (group 3) with acute bacterial rhinosinusitis (therapy: nasal lavage with isotonic sea salt solution + systemic antibacterial therapy).
   Results and discussion. Pathogen eradication – the absence of the original pathogen at the locus of the inflammatory process during dynamic microbiological examination – was found in 14 (35 %) clinical cases: in Group 2 (sodium hypochlorite) – 10 (25 %) and in Group 3 (nasal irrigation with isotonic sea water solution) – 4 (10 %).
   Conclusions. The results of microbiological studies showed effective antimicrobial properties of sodium hypochlorite when applied to the inflamed mucous membranes, expressed in a statistically significant reduction of bacterial semination of the nasal cavity epithelium.

   Phytotherapy is based on the use of herbal medicines. Treatment with phytopreparations is characterized by efficiency, low risk of adverse events and the ability to enhance the effect of complex therapy. Herbal preparations are subject to standard requirements for quality control, safety and effectiveness. Inflammatory diseases of the respiratory tract are characterized by numerous symptoms that significantly reduce the quality of life of the patient. Along with pathogenetic therapy, symptomatic treatment is used. For the treatment of respiratory diseases, phytopreparations with antipyretic, immunomodulatory, anti-inflammatory, antitussive, mucolytic, bronchodilator and other clinically proven effects are used. The most common symptom of inflammatory diseases of the respiratory tract is cough. Many medicinal plants have antitussive effects. Ivy leaf extract has pronounced antitussive and mucolytic properties. The therapeutic effects of ivy are primarily due to the presence of saponins in its composition. Numerous randomized controlled trials have proven the efficacy and safety of H. Helix-based drugs in the treatment of cough in adults. A meta-analysis conducted by Barnes LA et al revealed that monopreparations and combined phytopreparations, including H. Helix, reduce the frequency and intensity of cough caused by viral respiratory infection. In a study involving 5,162 children, efficacy in the treatment of productive cough in children was proven. Currently, there are several medicines based on ivy leaves in liquid and solid forms on the pharmaceutical market of Russia. It leading position in sales of mucolytic agents of plant origin in Russia, due to its high efficiency and low frequency of adverse events.

   The State Report on the state of sanitary and epidemiological well-being of the population in the Russian Federation speaks of the continued growth of respiratory infections, reaching more than 33 million cases and amounting to more than 606 billion rubles of direct economic damage in 2021. Of particular importance is the new coronavirus infection SARS-CoV-2, and manifestations of its various new genovariants, for example, variant B.1.1.529 called omicron, causes various inflammatory nosologies on the part of the mucous membranes of the ENT organs (acute rhinosinusitis, acute tonsillopharyngitis, acute otitis media). The viral agent, damaging the epithelium of the upper respiratory tract, creates favorable conditions for the activation of the microbial flora. Identification of a respiratory agent is most often carried out only in severe cases of the disease, so the basic diagnosis is based on clinical symptoms. The relevance of studying the rational use of antibacterial drugs in the treatment of community-acquired respiratory infections in practical otorhinolaryngology is associated not only with the frequency of occurrence, but with a high risk of complications. As a rule, antibacterial drugs are actively used in the complex therapy of acute bacterial etiology of the upper respiratory tract. Due to the high variability and increasing antibiotic resistance, antimicrobial agents are not always rationally used for outpatients. In this context, as noted in the clinical guidelines, one of the topical issues is the rational dosed use of antibacterial drugs in accordance with the pharmacokinetics, pharmacodynamics and efficacy of prescribing a cephalosporin antibiotic in the form of dispersible tablets in the treatment of patients with acute inflammatory diseases of the upper respiratory tract and ear, as an example, clinical cases.

   Patients with infectious- inflammatory diseases of the pharynx make up a significant percentage on the intake of otorhinolaryngologists and therapists. Most pharyngeal diseases have pronounced clinical signs, have a significant impact on the performance and quality of life of patients, and have a fairly high risk of a complicated course. It is important for such patients to therapeutically provide relief of pain syndrome and stop inflammatory changes. Pharyngeal diseases and their consequences place a pronounced economic burden on the health system and society as a whole. Timely and correctly selected treatment contributes to a favorable resolution of the pathological process, against the background of preserving the protective functions of the pharyngeal mucosa and is economically feasible. Herbal preparations are effective drugs for this purpose. Phytopreparations have long been actively used in clinical practice due to their effectiveness, safety and accessibility. According to the literature, the administration of herbal preparations as monotherapy in patients with acute infectious and inflammatory pharyngeal diseases was found to be a highly effective way of treatment. The active ingredients, chamomile, marshmallow and horsetail contribute to the improvement of the body’s nonspecific defences due to enhancement of phagocytic activity of macrophages and granulocytes. Polysaccharides, essential oils and bioflavonoids of chamomile, marshmallow and yarrow have an anti-inflammatory effect and reduce oedema of the respiratory tract mucous membrane. In addition to antimicrobial and anti-inflammatory effects, herbal preparations have an immunomodulatory effect, which is particularly important because infectious inflammation, trauma, chronic stress entail a secondary immunodeficiency condition. Unnecessary prescriptions of antibacterial drugs, deterioration of the ecological situation contribute to the development of this condition. The immunomodulating effect of phytopreparations is promising not only in the treatment of upper respiratory tract pathology, but also in the secondary prophylaxis and the prevention of chronization of inflammation processes.

   Introduction. The relevance of the treatment of chronic tonsillitis is due to both the high prevalence and severity of the course of the disease with the variable development of tonsillogenic complications, both local and general. Important aspects are not always effective results of conservative methods of treatment, including the use of antibacterial drugs and, as a result, a decrease in the quality of life of patients.
   Objective. Based on the dynamics of blood leukocyte indices and local signs of chronic tonsillitis, to determine the effectiveness of a course of treatment using an effective antimicrobial agent of plant origin in patients of various age groups.

   Materials and methods. A prospective study was conducted in 494 patients aged 8 to 58 years who were treated on an outpatient basis for more than two years. Depending on the form of the disease and ongoing therapy, patients were randomly divided into 4 subgroups.
   Results and discussion. Evaluation of the effectiveness of treatment in groups of patients was carried out according to the indices in the leukocyte formula. A decrease in the average values of the indices was verified in most patients, which manifested itself in the activation of the phagocytic process with an antimicrobial herbal preparation and made it possible to reduce the manifestations of local and systemic clinical symptoms of chronic tonsillitis.
   Conclusion. Based on an objective assessment of the manifestations of local symptoms of chronic tonsillitis and an analysis of the dynamics of leukocyte blood indices, the effectiveness of a course of treatment with the inclusion of an antimicrobial agent of plant origin in patients of various age groups was shown.

   The developing resistance of microorganisms to the effects of antibacterial drugs creates difficulties in the treatment of purulent diseases. This is especially reasonable in the pandemic of a new coronavirus infection (COVID-19). The aggressive effect of new strains of the virus on the mucous membrane of the nasal cavity and nasopharynx contributes to the occurrence of complications such as acute purulent otitis media and exacerbation of chronic purulent otitis, both during coronavirusinfection and in the postcovid period. Even before the start of the pandemic, antibiotic resistance was already one of the big problems in most countries of the world, this was due to the frequent unjustified appointment of systemic antibacterial agents for viral infection, as well as uncontrolled self-medication of the population with all available drugs. Due to the fear of people getting sick with COVID-19 and disagreements among doctors in treatment tactics, the use of systemic antibiotics and hormonal drugs increased already in the first months of the pandemic. In the future, the unjustifiability of this tactic was proved, but many doctors continued to prescribe several systemic antibacterial drugs to patients with uncomplicated viral infection. Under the current conditions, when there is evidence of bacterial infection, it is rational to use local antibacterial drugs, which allows you to quickly reach high concentrations in the focus of inflammation and avoid side effects of systemic antibiotics. Among the existing means in the complex therapy of perforated otitis, a special place belongs to the preparations of the group of quinoxaline derivatives, which include hydroxymethylquinoxalindioxide (Dioxidine). The advantage of the drug is its effectiveness against resistant microorganisms, as well as stimulation of marginal tissue regeneration. This property is especially important in the treatment of perforated otitis media.

   Sore throat is one of the most common symptoms with which patients seek an appointment with an otorhinolaryngologist, and also serve as the main subjective symptom of infectious and inflammatory diseases of the pharynx. Pain in the throat, making it difficult to swallow, colloquial speech can drastically reduce the quality of life of patients, almost completely turning them off from active personal, work and social life. At the same time, the increase in the intensity of pain in the throat serves as a diagnostic criterion for the growth of the local inflammatory process, leading to its complications (peritonsillitis, paratonsillar abscess, etc.). Given that the main etiopathogenetic factors of the infectious and inflammatory pathology of the throat are viral, bacterial infection and inflammation, antibacterial and anti-inflammatory therapy are the main points of application in the complex treatment of these diseases. The economic and practical inconveniences of the need to purchase a large number of drugs justify the relevance and practical significance of the use of drug release forms, including a combination of etiopathogenetically targeted substances. This article discusses the effectiveness and feasibility of using a combination of NSAIDs and an antiseptic in one preparation. The studied materials allow us to state that the use of both individual components of the drug and its combined composition in the treatment of infectious and inflammatory diseases of the throat is justified, which manifests itself in a fairly quick and complete relief of the symptoms of the disease without complications and side effects of the drug. A comparative evaluation of the effectiveness of mono and complex therapy indicates a significant advantage of complex treatment, which includes two active ingredients of NSAIDs and an antiseptic.

   Rhinosinusitis – an inflammatory process in the nasal cavity and paranasal sinuses is a global problem of practical medicine, which remains relevant for many years. The most common cause of acute rhinosinusitis is a viral infection, only in 0.2–5 % of patients the disease is further complicated by the formation of a bacterial focus of inflammation. Treatment of patients with
ARS involves the use of etiotropic, pathogenetic and symptomatic therapy. National clinical guidelines consider the use of systemic and topical etiotropic drugs, intranasal glucocorticosteroids, topical decongestants, irrigation- elimination procedures, mucoactive therapy, standardized herbal medicine, drainage of the paranasal sinuses, antihistamines (with concomitant allergies) and some other activities. Local administration of drugs in patients with rhinosinusitis provides targeted delivery of the active substance to the pathological focus and the creation of its required concentration, the virtual absence of systemic action due to low absorption, as well as a favorable softening, moisturizing, enveloping effect of auxiliary components. One of these drugs is the combined nasal spray containing tuaminoheptane sulfate and acetylcysteine. The effectiveness and safety of the use of this combination has been demonstrated by the results of a fairly large amount of research. The mild and sufficiently long vasoconstrictive effect of tuaminoheptane sulfate, the direct mucolytic, antioxidant and anti-inflammatory effects of acetylcysteine and the high safety of this combination determine its therapeutic value in children from 6 years of age and adult patients with rhinitis and rhinosinusitis.

Erratum   

Introduction. Features of the course of chronic tonsillitis may vary depending on the age of the patient, his comorbid status and the severity of the disease. One of the characteristic manifestations of the disease are local signs of chronic tonsillitis and manifestations of a systemic inflammatory response. The article considers the issue of increasing the effectiveness of treatment of patients with chronic tonsillitis at the stage of clinical examination by using bioregulatory therapy drugs in complex conservative treatment.
   Aim. Evaluation of the effectiveness of bioregulatory therapy (Traumeel ® S) in the dynamic monitoring of patients with chronic tonsillitis.
   Materials and methods. A randomized controlled trial was conducted in patients with newly established and confirmed diagnosis of chronic tonsillitis, decompensated form. The severity of subjective and objective symptoms was assessed using a visual analogue scale, as well as pharyngoscopy data, supplemented by the results of ultrasound examination of the palatine tonsils.

   Results. In the group of patients who took bioregulatory therapy, positive dynamics was observed already on the 2 nd day and related to the reduction of bad breath and sore throat. Comparative analysis in the groups made it possible to note a more significant and faster dynamics in relation to changes in the palatine arches, elasticity of the palatine tonsils and the phenomena of retromaxillary regional lymphadenitis. The monitoring of the condition of the treated patients over the course of 6 months made it possible to identify more rare recurrences of chronic tonsillitis among patients in the complex treatment of which the bioregulatory medicine was used, the frequency of which was 2.8 times lower compared to the control group.
   Discussion. The conducted study showed that the use of bioregulatory therapy has a positive effect on the symptoms of the inflammatory process. This is confirmed by an improvement in the general condition of patients in dynamics, a decrease in pain according to visual analogue scale, and an objective assessment of changes in the structure of the palatine tonsils using ultrasonography.
   Conclusions. Вioregulatory therapy as of a complex application (oral and parenteral forms) increases the effectiveness of treatment in patients of the dispensary group with a newly diagnosed chronic tonsillitis, decompensated form. Drug can significantly reduce the duration of therapy and reduce the number of relapses after complete recovery within 6 months.

   Introduction. Allergic rhinitis (AR) is immunoglobulin E (IgE) mediated disease. Which, after exposure to allergens, manifests itself with various symptoms such as sneezing, runny nose, nasal itching, and nasal congestion, which seriously affects the quality of life of patients. In some patients, AR poses a risk of developing serious mental disorders. Currently, various medicines are used for treatment.
   Objective. Consideration of the effectiveness of AR therapy with antileukotriene drugs, depending on the mental state of the patient.
   Materials and methods. The study involved 200 people diagnosed with AR. The patients were divided into 2 groups: group 1 (100 people) with basic therapy with intranasal glucocorticosteroids (inGCS – mometasone furoate) and group 2 (100 people) – inhalers in combination with an antileukotriene drug (montelukast). All were screened for the presence of a depressive disorder. The tactics of case management and prescription of drugs were defined by the level of depression. Patients with AR have mental health problems that correlate with AR symptoms.

   Results. Patients of the 1st group, who did not achieve complete relief of AR symptoms, when assessing their mental state using the PHQ-2 and PHQ-9 questionnaires, showed a mild depression (23 people). The symptoms of AR were stopped, when an anti-leukotriene drug was added to the therapy.
   Conclusions. With the ineffectiveness of the basic therapy of inGCS and a negative assessment of the patient’s mental state, the use of an antileukotriene drug is justified to improve the level of depressive mood and complete relief of symptoms of AR.

   Allergic rhinitis (AR) is one of the most common diseases in the world, which is based on immunoglobulin E (IgE) – mediated inflammation that develops after contact with various allergens. About 40 % of people suffer from various allergic diseases, every 3 rd inhabitant of the Earth has symptoms of allergic rhinitis and every 10 th has bronchial asthma. The early phase of allergen binding to IgE antibodies occurs within a few minutes after contact, the late phase develops after 4–6 hours. In addition to the airborne pathway of penetration, contact with the allergen is possible through the skin and mucous membranes, gastrointestinal tract, with parenteral administration of drugs. Taking into account the etiotropic factor, there are year-round allergic rhinitis (CAR) and seasonal (SAR). By the nature of the course, intermittent and persistent allergic rhinitis are distinguished. The most basic symptoms of allergic rhinitis include: sneezing, rhinorrhea, nasal congestion, itching, decreased sense of smell. Treatment includes antihistamines, intranasal steroids, leukotriene receptor antagonists and immunotherapy. To date, antihistamines of the second generation are recommended and widely used for the treatment of patients with allergic rhinitis, the main representative of which is levocetirizine (levocetirizine dihydrochloride).

   The purpose of the work is an analytical review of the results of clinical trials of levocetirizine for allergic rhinitis.

   The article discusses in detail the prevalence, etiology and pathogenesis, classification of the disease, treatment regimens for patients with allergic rhinitis, and provides two own clinical observations. Based on the data of a number of studies, the advantages of using antihistamines of the second generation in allergic rhinitis have been demonstrated, expanding not only the possibilities of treating patients, but also preventing the transition of the disease into a chronic process.

   Structural features of the extarnal ear form a number of factors that affect the course of inflammatory and scar processes. A strong difference in the structure of the external ear requires an individual approach, taking into account their structure. To maintain normal functioning, the external ear has specialized defense mechanisms, such as the presence of ceruminous glands, a weak acidic environment with bactericidal properties, a special epidermal migration mechanism aimed at self-cleaning the lumen of the auditory canal. But in addition to protective factors, the structure of the external ear has features that contribute to the development of a long-term inflammatory process. The data of studies describing the features of the narrowing of the of the cavity external auditory canal, both due to age-related changes in the auricle and due to the bending of the walls of its bone section. The shape of the external auditory canal affects not only the visualization of ear structures, but also the course of the inflammatory process. In the case of the development of scar and adhesive changes in the external auditory canal, this leads to a significant hearing loss. The main principles of the methods developed by the authors for the elimination of scar changes in the external auditory canal, depending on the localization in its departments, are described. In addition to the direct elimination of cicatricial changes, it is mandatory to eliminate the places of maximum narrowing of the external auditory canal with the expansion of its cavity, the formation of a skin lining, taking into account the complexity of epithelialization and the need to restore protective mechanisms. An important role in maintaining the effectiveness of treatment is played by the correct choice of tamponade and stenting for a long time. To correct the inflammatory process and prevent excessive formation of connective tissue, injections of ultra-long-acting glucocorticosteroids are used, carried out directly at the site of scar formation. Such an integrated approach to the correction of scars in the external auditory canal, taking into account the peculiarities of its structure, allows achieving high treatment results (up to 80 %), preventing the recurrence of the adhesive process and prolonged inflammation.

   Currently, one of the most pressing concerns of labor psychology and healthcare is emotional burnout in healthcare professionals. During the COVID- 19 pandemic this condition has become very significant due to it takes a lot of physical, phychoemotional and ethical commitment of medical personnel. Emotional burnout is a syndrome that derives from chronic stress and leads to the depletion of personal, emotional, and energy resources of a person in the professional life. It is an dynamic sequential process and relevant to stress stages (the alarm stage, the resistance stage and the exhaustion stage). There are many various factors inducing the burnout syndrome: social, political, economic, bureaucratic, etc. In the process of studying this phenomenon, different models of emotional burnout were proposed. The most famous model is the three-part model of burnout by С. Maslach, which includes emotional exhaustion, depersonalization and a decrease in personal achievements. In Russia V. V. Boyko has been studying the burout phenomenon. There are three main stages of emotional burnout (alarm, resistance and exhaustion), which have a close connection to stress stages; each stage has a specific combination of symptoms. According to a number of authors, burnout syndrome is closely related to empathy, therefore, it is necessary to study the relationship between the level of empathy and the degree of emotional burnout in healthcare professionals for planning further psychological support for the prevention of this syndrome.

   Introduction. In recent years, the world has seen an increase in the number of patients with difficulty in nasal breathing due to nasal obstruction, one of the causes of which are functional disorders of the nasal mucosa in various forms of rhinitis. Frequent use of intranasal decongestants among the population further contributes to the lack of effectiveness of conservative treatment and the need for surgical correction to restore free nasal breathing. This article discusses the possibility of using a homeopathic preparation containing calendula, witch hazel, aesculus, menthol and zinc oxide in patients with nasal obstruction in vasomotor and chronic subatrophic rhinitis to stop the clinical manifestations of the disease and improve the quality of life of patients.
   Аim. Тo evaluate the effectiveness of a drug containing calendula, witch hazel, aesculus, menthol and zinc oxide in patients with vasomotor and chronic subatrophic rhinitis in the complex treatment of nasal obstruction.
   Мaterials and methods. The study involved 48 adult patients of both sexes, aged 20 to 50 years, diagnosed with vasomotor (idiopathic) rhinitis in 24 and chronic subatrophic rhinitis in 24 patients. The studied preparation containing calendula, witch hazel, esculus, menthol and zinc oxide was smeared on the mucous membrane of the nasal cavity by laying gauze turundas for 5 minutes, 3 times a day, while the course of treatment was 10 days. The efficacy and safety of the drug was assessed by the dynamics of the severity of subjective symptoms, objective clinical data during control examinations by an otorhinolaryngologist in points, as well as by the presence of side effects in the treatment of the disease.
   Results. Results of the study showed a pronounced positive trend in the form of relief of subjective complaints and the main clinical manifestations of the disease, accompanied by an improvement in the quality of life in patients in both groups examined during treatment. Side effects were not observed in patients in both study groups.
   Conclusions. Based on the results of the study, conclusions were drawn about the efficacy and safety of using a complex homeopathic preparation containing calendula, witch hazel, esculus, menthol and zinc oxide in an adult group of patients with nasal obstruction, which makes it possible to recommend it for widespread use for the complex treatment of nasal syndrome. obstruction in vasomotor and chronic subatrophic rhinitis, as well as other forms of rhinitis accompanied by nasal obstruction syndrome.

   Cochlear implantation is a high-tech method of rehabilitation of persons with complete deafness. However, cochlear implantation in patients may be accompanied by a number of difficulties due to the peculiarities of the structure of the cochlea, the relative position of anatomical structures relative to it and the nature of the acquired pathology of the inner ear. The reaction of the facial nerve during stimulation of one of the electrodes of the cochlear implant system is a common complication that can lead to a deterioration in the patient’s quality of life due to significant discomfort and restrictions on the use of the cochlear implant system. The debut of twitching of facial muscles in patients after cochlear implantation can occur both at the stage of connecting the speech processor and at the stages of further rehabilitation, which according to world literature can reach an interval of 10 years from the moment of surgery. Anatomical features of the cochlea, its interposition with the facial nerve, changes in the bone labyrinth, further progression of remodeling or ossification of the cochlea play a significant role in the development of symptoms of facial nerve stimulation in patients with sensorineural hearing loss of the IV degree, including at the stage of subsequent settings of the speech processor. The frequency of occurrence of this complication in various literature sources varies from 1 to 14.9 %. The purpose of this work is to review the world literature on the etiology of facial nerve stimulation in users of cochlear implants, highlighting the main theories of the origin of non-auditory sensations in this category of patients, since the data conducted in various studies are variable, and with a certain etiology reaches 38 %.