Acute rhinosinusitis is a widespread pathology faced by both outpatient doctors and otorhinolaryngologists in hospitals. At the same time, only understanding of the principles for diagnosing various forms of sinusitis, in particular, the criteria for bacterial sinusitis, provides the adequate treatment decisions. Antibacterial therapy plays a key role in the treatment of patients with acute bacterial sinusitis. Additionally, there is an increasing frequency of the antibiotic resistance of the main bacterial pathogens in the respiratory group of diseases. Both in Russian and foreign clinical guidelines, the so-called lines of antibacterial therapy are clearly identified. Strict adherence to the national recommendations and a thorough analysis of clinical and anamnestic data allows a rational approach to the choice of an antibacterial drug. There is an increase in the rate of uncontrolled and inadequate antibacterial therapy, particularly using of penicillins and short course of macrolides, over the last decade. Such trend is dangerous due to the increased risks for the development of the antibiotic resistance to those groups of antibiotics. Use of dispersible forms is one of the key point of the strategies to overcome the antibiotic resistance. The most important features of dispersible forms of antibiotics are prevented destruction in the stomach and maximal absorption in the upper parts of small intestine. It allows to increase the bioavailability of the drug and to minimize the impact on the intestinal microbiome, which reduces the incidence of common adverse reactions from the gastrointestinal tract. According to literature, oral administration of dispersible forms of drugs allows to reach the plasma concentrations similar to those in parenteral administration.

Acute and chronic infectious and inflammatory diseases of the upper respiratory tract occupy one of the leading places in the structure of morbidity of the population of the world and remain the most frequent cause of patients seeking medical care. The prevalence and frequency of respiratory infectious diseases make a significant contribution to the structure of the causes of temporary disability, which entails negative socio-economic consequences. Specific attention in the current epidemic season is attracted by the change in the traditional structure of pathogens associated with several strict anti-epidemic measures during the COVID-19 pandemic, as well as a decrease in the activity of other pathogens during the active circulation of SARS-CoV-2. In this aspect, the increased resistance of pathogens to etiotropic drugs and insufficiency of the arsenal of pathogenic drugs dictate the need to search for alternative approaches to the treatment of inflammatory diseases of the mouth and throat. The main purpose of non-specific preventive measures of acute and recurrent diseases of the oral cavity and pharynx is to reduce bacterial content of mucous membranes by various pathogens and to activate own protective anti-infective mechanisms. In clinical practice medicines which contain bacterial lysates are considered to be an effective part of treatment of upper respiratory tract’s inflammatory diseases. They allow achieving elimination of a pathogenic organism and also help to restore autoregulation of immune response in the whole organism, reduce the frequency of infectious diseases. Topical bacterial lysates, acting directly in the locus of inflammation, do not harm the human microbiome, have a high safety profile, combine well with other medicines and can be used for patients of different ages. Topical immunotherapy has a significant preventive effect, preventing possible complications and improving the quality of life. The use of Imudon and IRS 19 leads to positive clinical and immunological shifts and promotes the efficiency of rehabilitation and preventive measures.

Since 2019, the interest in coronavirus infection has increased worldwide due to the emergence of several pandemic outbreaks associated with this group of pathogens. In total, 3 outbreaks of pandemics were registered in the 21st century, caused by new strains of coronaviruses: MERS-CoV, SARS-CoV and SARS-CoV-2. Among them the leader in prevalence, occurrence of severe respiratory complications and mortality is SARS-CoV-2. SARS-CoV-2 is the causative agent of the coronavirus disease of 2019. COVID-19 is a disease characterized by acute respiratory viral syndrome, transmitted by airborne droplets. The clinical course of COVID-19 varies significantly from patient to patient and can range from asymptomatic to severe forms. One of the common symptoms of the manifestation of COVID-19 is a smell disorder. The pathogenesis and clinical course of coronavirus infection caused by SARS-CoV-2 were examined to identify the causes leading to olfactory disorders in the manuscript. The analysis of existing methods for the diagnosis of olfactory disorders and their treatment was also carried out. The content of the article includes current hypotheses of the pathogenesis of viral anosmia in COVID-19 and a new look at the relevance of this problem among the population around the world. The article analyzes scientific data on the problem of anosmia in coronavirus infection caused by SARS-CoV-2, investigates modern diagnostic methods, highlights the principles of treatment of patients with post-COVID anosmia and presents prospects for further research on this problem.

Introduction. Acute respiratory viral infections are the most widespread diseases, accounting for up to 90% of all infectious pathology, which supports the relevance of optimizing the treatment of acute viral rhinosinusitis.
Aim. Evaluate the dynamics of clinical symptoms of acute viral rhinosinusitis, which arose as part of an acute respiratory infection, when supplementing therapy with the drug Respero Myrtol (Pol-Boskamp GmbH and Co.KG, Germany), the active ingredient of which is myrtol standardized 120 mg in 1 capsule.
Materials and methods. The dynamics of clinical symptoms of 20 cases of acute viral rhinosinusitis in comparison groups was analyzed. Traditional treatment of patients included taking propionic acid derivatives, ascorbic acid, intranasal use of decongestants and irrigation of the nasal cavity with isotonic saline solutions. Patients who have received traditional treatment are defined as a “standard therapy group”. To assess the effectiveness of therapy using standardized myrtol, 20 cases of acute viral rhinosinusitis against the background of acute respiratory viral infections with a similar severity were analyzed, in which patients received outpatient therapy with Respero Myrtol 2 capsules 3 times a day for 7 days in addition to the above treatment (the “myrtol therapy” group). The dynamics of the disease assessed: the number of days of disability before recovery, the period of normalization of body temperature in feverish patients, the need for vasoconstrictive intranasal agents after the seventh day of therapy, the period of complete relief of pain syndrome, the period of normalization of night sleep, the number of cases of bacterial superinfection and the need for systemic antibacterial therapy.
The results. In the observed patients, the quality of sleep was restored faster, the pain syndrome was stopped earlier, less often there was a need for systemic antibiotics and prolonged use of intranasal decongestants. The disease proceeded with fewer days of disability.
Conclusion. The study results have been shown to report the clinical efficacy of Respero Myrtol essential oils in the outpatient treatment of patients with acute rhinosinusitis.

Introduction. The article considers approaches to the management of patients with inflammatory diseases of the middle ear at the outpatient and hospital stages.
Aim. To substantiate the guidelines for endaural treatment of inflammatory ear diseases with Anauran® ear drops from the perspective of the best clinical efficiency.
Materials and methods. A total of 53 patients (106 ears) were examined, of which 21 patients were diagnosed with otitis externa diffusa (24 ears), 23 patients (25 ears) with acute catarrhal otitis media and 9 patients (9 ears) with epitympanitis in remission, who underwent type 1 tympanoplasty. The efficacy of Anauran® as part of combination treatment was compared in the following age groups: in patients over 18 years old (mean age 39.2 ± 11.1 years) and in children (mean age 9.8 ± 6.5 years).
Results and discussion. Absolute scores determined in assessing ear pain in the group of patients with acute otitis externa diffusa ranged from 3 to 9 scores; in the group with acute catarrhal otitis media – from 3 to 8 scores, in patients after tympanoplasty – from 2 to 8 scores. There was some difference in the assessment of the ear pain severity between children and patients over 18 years of age. The most short-term changes in ear pain occurred in children with acute otitis externa diffusa and acute catarrhal otitis media. As a result, the vast majority of patients showed a clinical effect on Day 7, which consisted in the recovery of the otoscopic status, a decrease in complaints by up to 96.3% in adults and up to 96.1% in children. The use of Anauran® ear drops in the complex management of patients with inflammatory diseases of the middle ear reduces the duration of treatment and eliminates problems with secondary bacterial infections in the postoperative period.
Conclusions. The findings support the high efficiency of Anauran® in the combination therapeutic treatment of inflammatory processes of the outer and middle ear.

The article evaluates the possibility of using silver proteinate to treat acute inflammatory diseases of the nasal cavity and paranasal sinus mucosa, as well as their complications. Acute rhinitis and rhinosinusitis are among the most common upper respiratory diseases. Viral pathogens are the main agents that trigger the pathological process. At the same time, the bacterial superinfection in some cases may develop due to viral infection, which promotes further development of lingering clinical symptoms up to a complicated course of the disease. The course of rhinosinusitis with underlying COVID-19 infection can be complicated by fungal superinfection and postnasal drip. For these reasons, topical drugs that could be used in the early stages of these conditions should have a number of properties, such as activity against most respiratory viruses and aetiologically significant bacterial pathogens; lack of opportunity to evolute and implement rapid resistance mechanisms in microorganisms; additive effects with other antibacterial drugs; acceleration of regeneration of the nasal cavity and paranasal sinus mucosa with underlying infectious alteration; vasoconstrictive and anti-inflammatory action, without causing an addictive effect, which enables repeated use of the drug in chronic diseases, as well as the absence of local and systemic toxic effects. Sialor (silver proteinate) has all the specified characteristics that were proved in various studies, and consistently demonstrated high clinical efficacy for many years.

One of the urgent tasks of the Ministry of Health of the Russian Federation, noted in the State report on the state of sanitary and epidemiological welfare of the population, is the improvement and implementation of diagnostic and treatment and prevention technologies. First of all, this concerns the continued growth of respiratory viral infections, seasonal influenza epidemics, where SARS-CoV-2 coronavirus infection occupies a special place, which often cause various otorhinolaryngological complications – acute and exacerbations of chronic tonsillopharyngitis, rhinosinusitis, tubotitis, purulent otitis media. In the treatment of bacterial sinusitis, in accordance with clinical recommendations, intranasal corticosteroids, elimination therapy, herbal remedies, and antibacterial drugs are used. Due to the period of the SARS-CoV-2 pandemic, a significant proportion of patients took large doses of antibacterial drugs, which caused an increase in the resistance of microorganisms to them. In this regard, it is possible to use immunostimulating drugs that stimulate cellular and humoral immunity, promote the development of a specific immune response and activate nonspecific defense factors such as lysozyme, mucin, lactoferrin and normalize mucociliary clearance. As a rule, the identification of a viral agent is carried out in case of a severe clinical course of the disease or complications from the ORL and other organs, and the use of immunostimulating agents in complex therapy is necessary at the earliest possible time of the disease. In this context, the use of immunostimulants containing polyvalent antigenic complexes, including bacterial lysates, the most common pathogens of respiratory infections, is justified. It is preferable in these cases to use lysates of bacteria obtained by mechanical destruction of bacterial cells, since they have a more pronounced non-specific immunostimulatory and specific vaccinating effect.

Relevance in research infectious and inflammatory diseases of the upper respiratory tract caused by high prevalence, variability of clinical manifestations and severity of the disease with the risk of developing complications. Respiratory diseases are a cause of functional and morphological disorders of the respiratory tract mucosa which is a protective barrier against various damaging agents. It is necessary to use complex drugs that preserve and restore the physiological activity of the mucous membrane as much as possible. In this regard, there is a great interest of plant medical product (extract of the roots of pelargonium sidovid is the chief active ingredient) which causes stimulation of nonspecific protective mechanisms, the beating frequency of the cilia of the ciliated epithelium, the activity of NK cells, phagocytes, modulation of the synthesis of interferon and proinflammatory cytokines, the expression of adhesive molecules, chemotaxis. We can notice moderate direct antibacterial and antiviral properties of extract. The pharmacotherapeutic efficacy of the plant medical product containing an extract of pelargonium sidovid roots was analysed in our research to treatment of respiratory diseases. There is a literature review about efficacy and safety preparations containing liquid extract of pelargonium sidovid roots. The extract effectiveness is confirmed by the results of clinical investigation: children and adults are digest the drug, greatly facilitates the course of diseases, prevents the development of complications, and reduces the duration of acute respiratory infections. Extract of the roots of pelargonium sidovid is easy to use and dosage. All these properties make it possible to include this medical product in the complex therapy of inflammatory diseases of the respiratory tract.

Hydroxymethylquinoxaline dioxide, better known as Dioxydin®, holds a special place among topical antimicrobials. The drug has the proven bactericidal action against a wide spectrum of aerobic and anaerobic bacteria, showed good results in otorhinolaryngology as a topical drug to treat bacterial diseases of upper respiratory tract and ear. The authors performed the search for publications among the sources of electronic libraries, such as National Electronic Library (NEB), eLIBRARY, Cyberleninka, Rucont, as well as electronic search engines Pubmed and Google Scholar for the period from 2015 to 2022. The literature analysis resulted in 9 domestic studies, including 6 prospective comparative (4 randomized) studies, two prospective non-comparative studies, and one retrospective descriptive study. The prospective studies involved 400 patients, and the retrospective study analysed the administration in 150 patients. In these studies, hydroxymethylquinoxaline dioxide (Dioxydin®) was used to treat culture-proven infections of upper respiratory tract and ear, both acute and exacerbations of chronic ones. In addition to 0.5% and 1% solutions, which are widely used in ENT practice and need to be prediluted, two new formulations of the drug, fully ready for use, also draws attention: Dioxydin® 2.5 mg/ml, ear drops, and Dioxydin® 0.25 mg/ml, sore throat gargle for topical use. A retrospective review of papers on the use of hydroxymethylquinoxaline dioxide (Dioxydin®) for the topical treatment of upper respiratory tract and ear diseases caused by bacterial agents shows high efficacy, safety and low risk of resistance development. It is promising to conduct studies demonstrating additional therapeutic activity of the Dioxydin®.

Introduction. Allergic rhinitis (AR) is a common condition that has considerable impact on patients’ quality of life. Moreover, it is the risk factor for asthma development. Therefore, achieving control of AR remains crucial.
Aim. To analyze comparative efficacy of fixed-dose combination of olopatadine hydrochloride – mometasone furoate versus combination of intranasal corticosteroids with second generation oral antihistamines.
Materials and methods. Seventy-five patients (ages 19–59) mainly with moderate severity of AR enrolled the study. Group 1 (29 patients) was given a fixed-dose combination of olopatadine hydrochloride – mometasone furoate (Ryaltris) in 2 sprays (25/600 mcg) in each nostril twice daily, whereas group 2 (46 patients) – intranasal corticosteroids with second generation oral antihistamines for 14 days. The efficacy was evaluated using validated questionnaires and scales (TNSS, TOSS, VAS, SNOT-22) before, during and after the treatment is complete.
Results and discussion. We revealed AR and allergic conjunctivitis symptoms improvement as well as quality of life parameters. Nevertheless, disease control was achieved earlier (on day 2 of treatment) in group 1, while in group 2 – only on day 4.
Conclusions. Our study showed comparable efficacy of fixed-dose combination of olopatadine hydrochloride – mometasone furoate (Ryaltris) and combination of intranasal corticosteroids with second generation oral antihistamines. However, fixed-dose combination topical therapy is associated with lower risk of adverse reactions and leads to early control of AR and allergic conjunctivitis symptoms. Besides, fixed combination use adjusts adherence to treatment.

Introduction. This article analyzes the effectiveness and safety of complex treatment of children with diseases of the lymphoepithelial pharyngeal ring against the background of persistent allergic rhinitis.
Objective. Study the efficacy and safety of adenotomy in children with persistent allergic rhinitis.
Materials and methods. 124 children participated in the study. Two groups were formed: a control group of children receiving medical treatment and a main group – complex (medical and surgical treatment). When contacting the polyclinic, an examination was carried out by an otorhinolaryngologist. An allergist-immunologist confirmed the diagnosis of persistent allergic rhinitis, assessed the quality of life of children, using a questionnaire for patients with allergic diseases in pediatrics PRQLQ together with an otorhinolaryngologist. The condition of the dental system was evaluated by a pediatric dentist. A pediatrician conducted a physical examination of all children one, three and six months after the start of the study.
Results and discussion. After comprehensive (surgical and drug) treatment, children experienced a significant decrease in nasal obstruction, a decrease in the incidence of respiratory diseases, as well as increased physical activity and improved emotional status, inflammatory phenomena in the pharynx and nasopharynx decreased by 70.9% according to visual analog scales compared to the day of discharge from the hospital. Analysis of the results of the study showed that conservative treatment in combination with surgical intervention on the lymphoid structures of the pharynx in the presence of indications in patients with persistent allergic rhinitis is safe and more effective than using only a therapeutic approach.
Conclusions. Thus, the preliminary results of the observed period demonstrate the effectiveness and safety of surgical intervention on the lymphoid structures of the pharynx in children with persistent allergic rhinitis. The complex method of treatment of combined pathology is safe and effective and has a beneficial effect on the somatic status and quality of life of children.

Introduction. Аllergic rhinitis is characterized by IgE-mediated inflammation and widely distributed in both adult and pediatric populations. The contact between allergen and mucous membrane is followed by sneezing, rhinorrhea, nasal blockage. It may affect the quality of life and result in upper and lower airway diseases. The treatment aims to reduce or eliminate symptoms, prevent exacerbations and complications. The optimal treatment should maintain a habitual way of patient’s life. Intranasal corticosteroids in combination with selective antagonist of the leukotriene receptor drug – montelukast (Ektalust) have high efficiency and optimal dosing regimen.
Aim. The study was to conduct a literature search for effectiveness of selective antagonist of the leukotriene receptor – montelukast (Ektalust) in treatment of allergic rhinitis.
Materials and methods. The search was executed using RSCI and MEDLINE by keywords.
Results and discussion. Patients with allergic rhinitis who received combination therapy with intranal glucocorticosteroids in combination with montelukast noted a better result in assessing the quality of life and reducing clinical manifestations, compared with patients who received monotherapy.
Conclusions. Based on the available data it can be concluded that montelukast (Ektalust) in combination with intranasal corticosteroids may improve quality of life due to reduction of symptoms of allergic rhinitis, especially in conjunction with asthma.

The periodicals published over the past 5 years showed that interest in the issue of surgical treatment of chronic otitis media, including one complicated by cholesteatoma, did not wane despite the large accumulated experience of schools in otosurgery around the globe. In our opinion, there are currently some significant problems of terminology in the clinical anatomy of the ear, in particular, the nomenclature of the upper floor of tympanic cavity, which negatively affects the comparison and reproducibility of the results of surgical treatment of chronic otitis media. The critical analysis of the current classification of middle ear cholesteatoma proposed in 2017 and validated in Russia in 2021 demonstrates certain difficulties in using the pathohistological term “cholesteatoma”, as well as the basic inaccuracy in defining the concept and structure of the anterior parts of the epitympanum. The work aims to develop and present a new classification of pathological middle ear epidermization (cholesteatoma), which is based on the pathophysiology of middle ear ventilation. The modern concepts on the mechanisms of middle ear ventilation reveal its important role in developing the pathological epidermization and secondary cholesteatoma. The use of three-dimensional modelling of airway ventilation makes it substantially easier to follow the pathophysiological mechanisms of development of tympanic membrane retraction. The tympanic diaphragm consists of more than 10 composite elements. Understanding the pathophysiological principles underlies the proposed classification of pathological middle ear epidermization (cholesteatoma), which is based on the prevalence of middle ear and surrounding anatomical formation injuries. The pathological process area is coded using the abbreviation of the National Medical Association of Otorhinolaryngologists. In this abbreviation, each letter corresponds to a specific anatomical region. The tympanic diaphragm represents the boundary between the regions. Each letter is assigned an index corresponding to the degree of pathological epidermization invasion into the structures of the middle ear, temporal bone and cranial cavity. The authors provide a table, which serves as a visual aid for ease of coding the diagnosis. Examples of how to formulate a diagnosis in accordance with otoscopic illustrations are given.

The article discusses application of various methods for nasal septum perforation healing (NSP). The types and options of surgical treatment in the historical aspect are described. These operations have a number of disadvantages, such as: the complexity of the material taking, the risk of inflammatory reaction and scar formation, as well as other postoperative complications leading to a relapse of the disease. Effectiveness of various allo- and autografts that used to restore the defect of the nasal septum is observed. Publications of regenerative medicine methods to eliminate perforation of the nasal septum are analyzed. Implantation of stromal cells, scaffolds; growth factors or their combinations is used. Such approaches make possible the restoration of the damaged tissue due to targeted and controlled cell differentiation, accompanied by the synthesis of the intercellular matrix and a decrease in inflammatory processes. In preclinical and clinical studies, special attention is paid to stromal cells. Mesenchymal stromal cells (MSCs) of bone marrow, adipose and other tissues are most often used. The regenerative effects of mesenchymal stromal cells are realized through the secretion of a wide range of anti-inflammatory mediators, cytokines and trophic factors, the positive effects of cell therapy of this type of cells should not be associated with the differentiation of implanted cells into cells of damaged tissues. The use of various materials for the treatment of NSP is also described with an assessment of their effectiveness and future prospects.

Introduction. It is not always possible to create a perforation in the footplate of the stirrup with the help of classical microinstruments during stapedoplasty, which will exactly correspond to the required parameters, moreover, these tools can be dangerous in some cases, since it is possible to provoke the footplate to enter the ear labyrinth, mobilizing it.
Aim. To determine the efficacy and safety of various methods of stapes surgery in otosclerosis with an assessment of the frequency of intra- and postoperative complications.
Materials and methods. In the Clinic of Ear, Throat and Nose Diseases of the I.M. Sechenov First Moscow State Medical University of the Ministry of Health of Russia (Sechenov University) a number of experimental and clinical studies were conducted, partial results of which we decided to retrospectively compare and analyze. The data of the first group of patients were taken from the results of a study with a CO₂ laser. The data of the second group of patients were obtained from the results of a study with a diode (blue) laser with a wavelength of 445 nanometers. The data of the third group of patients were collected from archival data of medical histories from 2020 to 2022, who used a set of micro-tools for stapedoplasty (manual micropeforator, microneedle).
Results. The data obtained showed similar results in the CO₂ and blue laser groups. The main difference in the group of patients who underwent stapedoplasty with classical microinstruments was a longer operation time compared to laser stapedotomies, as well as a greater number of intraoperative difficulties associated with the mobilization of the foot plate of the stapes during manipulations with a manual perforator.
Conclusions. The use of blue laser and CO₂ laser in stapedotomy procedures shows promising results in terms of surgical accuracy and speed of the operation. Further research should compare the long-term effects of these three methods to determine the most effective and safest.

Introduction. Cochlear implantation is very effective due to the known tonotopic organization of the cochlea. These data are used in the distribution of signals along the channels of the cochlear implant electrode. The more accurate and natural the stimulation of the auditory nerve fibers, the better the perception of speech, sounds and speech intelligibility.
The aim of the study was to compare the clinical and anatomical settings of the cochlear implant processor.
Materials and methods. The study included 63 patients aged 2 to 60 years using cochlear implantation system, implants with a standard long electrode array (31.5 mm). All participants underwent computed tomography (CT) of the temporal bones with a step of 0.6 mm or less. CT data were processed using Otoplan and Sliser 3D software. The geometric dimensions of the cochlea, the length of the cochlear canal, the angular position and tonotopic frequency of each electrode were calculated, and a 3D reconstruction of the cochlea and electrode was built.
Results. The correction of the frequency filters of the electrodes and the anatomical adjustment of the processor were performed according to the data obtained in the Otoplan program. A comparison was made between the clinical and anatomical setting. After the redistribution of frequency filters, patients noted a more natural sound, improved speech intelligibility. Thus, with anatomical adjustment, an exact correspondence is achieved between the central frequency of each electrode channel and the tonotopic frequency of the cochlear zone, individually determined by computed tomography.
Conclusions. A new tool has appeared that allows you to significantly improve the quality and provide an individual approach to setting up processors after cochlear implantation.

Introduction. In the otosurgeon practice, there are often cases of exacerbation of chronic suppurative otitis media (CSOM) refractory to conservative therapy. The direct irritant effect of gastric contents due to the gastroesophageal reflux disease (GERD) often leads to alteration of the middle ear mucosa and persistence of the inflammation process.
Aim. To substantiate the significance of GERD therapy in the treatment of CSOM exacerbation refractory to the standard conservative therapy protocols.
Materials and methods. The study group included 42 patients aged 19 to 67 years (mean age 47.6 years), 13 men and 29 women, who received treatment and daily observations of the attending otorhinolaryngologist. Of these, 31 patients were users of oral nicotine products (chewing gum, smoking, tobacco heating systems). The conservative treatment of CSOM was carried out in accordance with the medical care standards and clinical guidelines as in force on the time of the treatment process. The conservative treatment of GERD was carried out in accordance with the clinical guidelines approved by the Russian Gastroenterological Association.
Results and discussion. 25 patients were diagnosed with isolated incompetence of the gastric cardia, 13 — with incompetence of the gastric cardia accompanied by reflux esophagitis, 4 — with hiatal hernia. The efficacy of anti-reflux therapy for chronic otitis media exacerbation was assessed on Day 10 after start of the therapy. Due to the gastroenterological therapy, the “dry” ear status could be achieved in 34 patients, which made it possible to offer them reconstructive intervention in the future. 5 patients achieved the CSOM remission by the end of the first month of anti-reflux therapy. 3 patients failed to achieve the state of CSOM remission
Conclusions. The high efficacy of anti-reflux therapy for the management of CHSO exacerbation refractory to the standard conservative therapy regimens at the level of 81% allows us to recommend further research to prove the causal relationship between GERD and ineffectiveness of treatment of ear pathology.

Cough is one of the most common symptoms in primary care. Despite the fact that a persistent cough resolves on its own in most cases and does not require special treatment, it can significantly reduce the quality of life and require large financial costs for treatment. Infectious and inflammatory diseases of the upper respiratory tract are one of the most common pathologies accompanied by cough. Protracted cough can significantly aggravate the course of the disease, and its duration for more than 4 weeks may indicate a chronic process. Drug therapy should be specific and combined, i.e. it should be aimed at the etiology of the disease, the pathogenetic mechanisms underlying it, and at alleviating symptoms, which leads to a speedy recovery of the patient. The article describes the causes leading to a prolonged cough in infectious and inflammatory diseases of the upper respiratory tract, the principles of differential diagnosis and some features of the treatment of persistent cough. Options for both etiotropic and pathogenetic therapy, as well as symptomatic treatment with ivy leaf extract and non-drug methods are given.
In cases of infectious and inflammatory diseases of the upper respiratory tract and bronchi accompanied by a non-productive cough, adding of common ivy leaf extract to the treatment allows us to predict relief of sputum discharge, and, consequently, an improvement in the patient’s condition as early as on Day 4-5. It is important to note that this drug should not be used in combination with any antitussive drugs, as it makes it difficult to evacuate thin secret and results in its congestion in the airways. A clinical case of polyetiologic chronic cough combined treatment using reflexology is presented.

Ramsey-Hunt syndrome is a rather complex interdisciplinary problem for diagnosis and treatment. Often, diagnosis requires the participation of different specialists: otorhinolaryngologists, neurologists, infectionists. Classic manifestations are quite typical (vesicular rash on the skin of the outer ear, on the eardrum, ear pain and lesion of the mimic muscles as a result of peripheral facial nerve paralysis). However, Hunt himself described various variants of pathological changes of the outer ear and pharynx in combination with lesions of the trigeminal, vestibule-cochlear, glossopharyngeal, abducens and vague nerves. The optic nerve is rarely involved, viral encephalitis and vasculitis of the brain may develop. The literature cites traditional treatment schemes that include a combination of antiviral and glucocorticosteroid drugs. However, the duration of the therapy, specific doses of the drugs continue to be discussed. Untimely initiation of antiviral and corticosteroid therapy and/or inadequately selected dosages provoke the progression of the disease, increase the risk of complications and adverse outcomes. The prognosis gets worse when combined with another pathology (diabetes mellitus, oncopathology, HIV infection). Therefore, the search of new Ramsey-Hunt syndrome’s methods and treatment regimens is essential. We have previously described the use of photodynamic therapy in the treatment of this pathology in a patient with a first-time revealed HIV infection. On our opinion, taking into account the herpes-viral etiology of the disease, drugs that have immunomodulatory effect, a protective effect on the affected tissues, regulating the intensity of inflammatory response, can be applied in the therapy of this pathology. The use of the immunomodulatory drug sodium aminodihydrophthalazinedione in complex therapy, especially in patients with a history of aggravating factors, can increase the effectiveness of treatment and reduce the risk of recurrence.

Introduction. The article presents the physiology of nasal breathing, as well as the problem of nasal obstruction and the mechanisms of its development. Topical issues of rhinitis medicamentosa are discussed, based on the pathogenic links of this condition. It has been established that there is no single treatment regimen for rhinitis medicamentosa at the moment.
Objectives. To evaluate the effectiveness and safety of the use of intranasal drugs in patients with medical rhinitis.
Materials and methods. A comparative study of the clinical use of the complex preparation Frinozol®, the active substances of which are the decongestant phenylephrine and the antihistamine drug cetirizine, intranasal glucocorticosteroid Nosefrin®, as well as their combinations, was carried out in patients with rhinitis medicamentosa.
Results. The results showed that the use of Frinozol®, Nozefrin®, as well as a combination of these drugs leads to a decrease in the frequency of use of nasal decongestants, and in a larger percentage of cases or to the complete cessation of their use by patients with drug-induced rhinitis. The combination of Frinozol – Nozefrin is somewhat more effective. However, a number of patients resume the use of nasal decongestants after some time, which leads to the need for additional courses of conservative therapy. In the course of the observational study, we noted excellent and good tolerability of the drugs, and patient satisfaction with the treatment in all groups.
Conclusions. The problem of drug-induced rhinitis remains unresolved, which is why the search for optimal and effective schemes for the conservative treatment of this disease continues. The use of intranasal glucocorticosteroids and topical antihistamines can significantly reduce the frequency of use of nasal decongestants, or completely abandon their use.

Introduction. In a pandemic, doctors and other staff working alongside them are among those at risk of infection on a daily basis.
Aim. To identify aspects of the COVID-19 pandemic that are relevant to healthcare workers.
Materials and methods. An online survey was conducted among employees of healthcare organizations. The study included 269 people, the analysis was carried out in the R software environment. The first group included medical workers who had direct contact with patients with COVID-19; the second group – workers whose contact with the infected was not recorded.
Results and discussion. The results of the survey were analyzed both for the sample as a whole and for groups. In the survey, 84.8% of respondents expressed concern about the pandemic, and among contacts, anxiety was 3 times more common than among non-contacts (OR = 3.07 [1.14; 10.43]). Respondents rated their awareness of SARS-CoV-2 highly: the contact group was more confident in the completeness of the information provided than the non-contact group. The preparedness of clinics for a pandemic was not highly rated. Contact persons – 84%, non-contact persons – 71% felt a high risk of infection at the workplace. A more pronounced lack of protective equipment was felt by respondents from the group of contact workers. Self-restriction of social contacts did not become a popular and statistically significant measure: health workers limited their contacts in 37.9% of cases, among them contacting – 55.4%, non-contacting – 44.6%. In the survey, it was proposed to assess what causes concern: the risk of isolation from the family and social environment was noted by 76.2% of respondents; fear of the danger of the disease itself - 36.2%; the consequences of one’s own infection for the well-being of the family and professional activities, as well as society as a whole - 34.8%; the risk of infecting family members and relatives is 33.0%.
Conclusions. These studies can provide significant assistance in planning health care to repel future threats of a similar nature.

Viruses are the most numerous biological creatures in the biosphere of the globe. Their number is huge ~ 1031, and bacteriophages are the most numerous group of environmental viruses. It is not surprising that in such an environment and in the human body and on its skin, a large community of various viruses has formed, representing a viral metagenome (virome). This virome includes not only viruses that penetrate into the cells of the human body and replicate in them using cell material, but also viruses that target only bacteria, namely bacteriophages. The ability of lytic bacteriophages with high specificity to kill certain bacteria was discovered in the 1920s. XX century. In this regard, lytic bacteriophages have been proposed and successfully used for the treatment of acute intestinal infections. However, the advent of antibiotics, the use of which was initially more effective for the treatment of bacterial infections, has led to the abandonment of phage therapy in Western countries. The return of attention of scientists and practical healthcare professionals to the use of bacteriophages as drugs occurred due to the formation and spread of multidrug resistance of pathogenic bacteria to the most commonly used antibacterial drugs. The incidence of various bacterial infections is not decreasing. This review provides information on a number of successful clinical and experimental applications of bacteriophage preparations in various diseases that are caused by bacteria, or bacterial inflammation has arisen as a complication of the underlying disease. It is very important that bacteriophages have a synergistic effect with antibacterial drugs. Bacteriophage therapy is considered as a potentially effective method of treatment.

Chronic rhinosinusitis is a polyetiological heterogeneous disease that is characterized by inflammation of the nasal mucosa and paranasal sinuses. The clinical picture of this pathology may include nasal congestion and rhinorrhea. Studies on the pathogenesis of chronic rhinosinusitis have yielded insufficient results, however, a number of factors that predispose to the development of this disease are currently identified according to clinical guidelines. Among these are both anatomical anomalies and some chronic diseases (rhinitis, atopy), immune system disorders (immunodeficiencies), etc. Mucoactive drugs are used in the treatment of acute and chronic rhinosinusitis to restore the transport function of the upper respiratory tract epithelium. Their mechanism of action is aimed at restoring mucociliary clearance. This therapy also affects the viscous discharge, which is produced during rhinosinusitis and accumulates in the paranasal sinuses and nasal cavity, worsening the course of the inflammatory process. Specialists distinguish the following forms of mucoactive drugs: mucolytics, mucokinetics and mucoregulators. The article considers the aspects of the clinical use of herbal mucolytics for the treatment of acute and chronic rhinosinusitis, in the pathogenesis of which the nasal mucosa edema plays a key role. The authors summarise the most conclusive evidence to date on the need to use herbal mucolytics in the complex therapy of acute and chronic rhinosinusitis. The modern topical therapy of acute and chronic rhinosinusitis in the otorhinolaryngology practice is presented. Herbal medicinal products have a proven secretolytic and anti-inflammatory effect, accelerate the relief of symptoms and reduce the recovery time of patients. The clinical guidelines recommend to prescribe these drugs in addition to the complex therapy of rhinosinusitis to patients suffering from ARS and CRS, who has no contraindications.

Acute respiratory viral infection is one of the most common infectious diseases. Clinical manifestations vary from time to time and from person to person and, as a rule, include intoxication and catarrhal syndromes. ARVI is more often caused by such causative agents as pneumoviruses, human metapneumovirus, coronaviruses, rhinoviruses, adenoviruses and bocaviruses. Among diseases of the ENT organs, ARVI can cause rhinosinusitis and pharyngitis. The inflammation that occurs in the mucosa causes its dystrophy and necrosis, which leads to the dysfunction of mucociliary clearance. As a result, an optimal environment for the development of bacterial flora is created. Bacterial rhinosinusitis needs antibiotic therapy. These drugs can act locally and systemically. It is well known that topical drugs have fewer side effects and result in a greater active substance concentration directly at a site of inflammation. Currently, a nasal framycetin spray is used as a topical antibacterial therapy to treat bacterial rhinosinusitis and in the early postoperative period. Topical drugs have a good evidence base, fewer side effects, and are safe, even for patients with cystic fibrosis. Given the significant antibiotics load in patients with cystic fibrosis, any opportunity to delay re-administration of antibiotics is a positive thing. In this aspect, topical antibiotics that have no systemic adverse events, including negative effects on the normal human microbiome, and can be used to overcome the resistance of microorganisms in a varying degree due to the achievement of high active substance concentration directly in a focus of infection may have a certain therapeutic value. The article addresses issues of epidemiology, pathogenesis, clinical manifestations of acute respiratory viral infection, i. e. acute rhinosinusitis. In addition, the article describes the use of topical antibiotic therapy for the treatment of diseases of the nasal cavities and paranasal sinuses.

The high prevalence of inflammatory diseases of the upper respiratory tract brings this pathology to the forefront, occupying up to 90% of cases of contacting specialists among all infectious diseases. The main etiological factor in the occurrence of acute inflammatory diseases of the upper respiratory tract, such as rhinitis, rhinosinusitis, pharyngitis, is the defeat of a viral agent. At the same time, the damaging viral agents are extremely diverse. In turn, an incorrectly selected initial therapy can lead to a weakening of local nonspecific immunity, which in turn forms a starting point for the attachment of a bacterial infection and the development of acute bacterial rhinosinusitis. Due to the high prevalence of infections of the upper respiratory tract and unreasonable systemic antibiotic therapy, it is the main factor contributing to the growth of antibacterial resistance, and taking into account the wide range of infectious microbiota that contributes to the development of chronic pathology, the selection of adequate drugs for the treatment of inflammatory diseases of the upper respiratory tract remains relevant. If it is inappropriate to use antibacterial therapy, homeopathic preparations can be used both as monotherapy for uncomplicated forms of a viral disease, and in combination in cases where the safety of prescribed drugs is important to the patient. This is especially true in childhood, when the doctor is limited in the use of medicines. The purpose of this work is to familiarize physicians with the epidemiology, symptoms and modern principles of treatment of inflammatory diseases of the upper respiratory tract with an emphasis on risk factors. The analysis of Russian-language and English-language publications was carried out using the databases: eLibrary, PubMed, Russian Science Citation Index, Springer, Scopus, Scientific Research, Crossref.

The original desire of all people is the desire to look more attractive by improving their appearance and the most advanced direction, in achieving aesthetic superiority, cosmetic surgical interventions have been and remain. The leading place in the patient’s desires is occupied by aesthetic facial surgery, where the most popular and not always justified is the change in the shape of the external nose. To date, the techniques and techniques for performing aesthetic rhinoplasty have reached their perfection. But at the stage of selecting patients for aesthetic surgery on the external nose, doctors always face certain difficulties. The most common problems for plastic surgeons are created by patients with dysmorphophobia where, for example, the main motive for persons with dysmorphomania to make rhinoplasty is dissatisfaction with the size and shape of their own nose, which, in their opinion, prevents them from achieving success in their personal life, building a career, etc. Other patients with dysmorphophobic syndrome have low self-esteem, in their opinion, the ugly shape of the nose prevents marriage etc. In this context, an unsuccessful example of performing aesthetic rhinoplasty for a patient whose anamnesis was aggravated by polypous rhinosinusitis and bronchial asthma with an uncontrolled course is given. A brief review of the literature and presented clinical examples substantiate the need to address a number of important questions at the stages of selection and planning of aesthetic rhinoplasty: does the patient have mental disorders; what are the true reasons motivating the patient for surgery; whether there are any diseases of the upper respiratory tract, violations of the architectonics of the deep sections of the nasal cavity, preventing operations, etc.

Chronic Rhinosinusitis with Nasal Polyps (CRwNP) caused by T2 inflammation has a complex pathogenesis, for which treatment options include medical therapy (topical and systemic glucocorticosteroids, leuktriene inhibitors, etc.) and surgical therapy, often recurs and significantly reduces the quality of life for patients. Chronic rhinosinusitis with nasal polyps is common in patients with asthma and, particularly, severe asthma and an allergic reaction to nonsteroidal anti-inflammatory drugs. These conditions are in most cases associated with a common pathogenesis, including a type II immune response, hyperproduction of interleukins (IL) 4, 5 and 13, activation of eosinophils and tissue remodeling. Biological therapy which block the effect of IL-4, 5, 13 can significantly improve the condition of such patients. Dupilumab is a humanized IgG4 monoclonal antibody that targets the IL-4 receptor alpha chain (IL-4Rα), thereby blocking the action of IL-4 and IL-13. Currently, dupilumab is approved for asthma, CRwNP and atopic dermatitis. Dupilumab can reduce the number of exacerbations, treatment with systemic corticosteroids, improve the condition of the upper and lower respiratory tract and achieve an increase in FEV1 by 0.2–0.3 L, which leads to a significant control of these diseases. One of the topical issues is the choice of tactics choice of treatment tactics in patients with CRwNP, asthma and nasal septum deviation. This article presents a clinical case of a patient with severe asthma, CRwNP and deviated nasal septum receiving dupilumab for 4 months.