Anti-inflammatory therapy as part of the treatment of exudative otitis media (EOM) that develops in rhinitis and rhinosinusitis is included in various treatment regimens. If conservative therapy for EOM is ineffective, surgical intervention in the form of various variants of adenotomy and removal of secretions from the tympanic cavity is considered. The authors selected and described in detail a clinical case of observation and treatment of EOM in a 7-year-old child, which allowed to highlight approaches to the diagnosis of the disease, assess her concomitant diseases, choose a method for surgical treatment and conservative therapy with a drug containing tuaminoheptane and acetylcysteine. Eustachian tube drainage followed by the use of an anticongestive drug to treat rhinosinusitis in a 7-year-old girl with EOM showed high effectiveness. The advantages of the drug are as follows: a direct unloading effect, the possibility of evacuation of thickening secretions from the nasal cavity and nasopharynx due to the drug containing acetylcysteine and tuaminoheptane. Thus, the tubular dysfunction in children can be associated with various reasons: inflammatory processes in the nasopharynx and paranasal sinuses (viral and bacterial infection), allergic (exposure to various allergens). EOM may develop in all types of tubular dysfunction in children. The adverse effects of long-term tympanostomy in chronic EOM has led to the search for alternatives. The long-term eustachian tube drainage can be regarded as this method. The anticongestive agent for rhinosinusitis can be used in children with EOM from the age of 6 years. The advantages of the drug include a direct unloading effect, minimal contraindications, restoration of nasal breathing without systemic exposure in frequently ill children, and the possibility of evacuation of thickening secretions from the nasal cavity and nasopharynx. In summary, an anticongestive agent containing acetylcysteine and tuaminoheptane can be recommended for use in paediatric otorhinolaryngological practice to treat acute and subacute rhinitis in children with EOM.

Abstract

Introduction. The presence of opportunistic pathogens within the nasal cavity is one of the important factors in the pathogenesis of acute rhinosinusitis and exacerbation of chronic rhinosinusitis. On top of that, the frequently prescribed ill-founded and uncontrolled use of antibiotics leads to the development of immunoresistance, which contributes to the lack of effectiveness of conservative treatments. This article discusses the therapeutic option for patients with acute rhinosinusitis and exacerbation of chronic rhinosinusitis in the form of a silver proteinate drug in the complex treatment.

Aim. To evaluate the effectiveness of the silver proteinate drug in the complex treatment of acute rhinosinusitis and exacerbation of chronic rhinosinusitis.

Materials and methods. A total of 60 adult patients of both sexes aged 20 to 50 years were included in the study. The first study group (a treatment group) included 30 patients (15 with acute rhinosinusitis and 15 with exacerbation of chronic rhinosinusitis). The second group (a comparison group) also included 30 patients (15 with acute rhinosinusitis and 15 with exacerbation of chronic rhinosinusitis). The treatment group received the silver proteinate drug + decongestants + irrigation therapy + topical corticosteroid therapy as part of the complex treatment. The comparison group received standard therapy: irrigation therapy (solutions to rinse nasal cavities) + decongestants + topical corticosteroid drugs.

Results. Comparative analysis of re-assessment scores for the patients’ status against the timing of use of the silver proteinate drug (Sialor®, tablets for solution for topical use, 200 mg) in the complex treatment showed pronounced improvement in the form of rapid relief of symptoms of the disease and recovery in patients with acute rhinosinusitis and exacerbation of chronic rhinosinusitis in both study groups.

Conclusion. This brings us to the conclusion about the effectiveness and safety of the silver proteinate drug Sialor® in the complex treatment of patients with acute rhinosinusitis and exacerbation of chronic rhinosinusitis, which allows us to recommend it for widespread use in otorhinolaryngological practice.

Introduction. Acute otitis media is a widespread multifactorial disease characterized by inflammatory changes in the mucosa of all parts of the middle ear. One of the most important tasks in the early stages of the disease is adequate anesthesia of patients. The article provides a retrospective assessment of the efficacy (speed of analgesia) and tolerability of topical use of Otipax® (lidocaine + phenazone) in adult patients with acute otitis media before perforation, the timing of its use is justified.

Aim. To assess the efficacy and tolerability of topical Otipax® in adult patients with pre-perforated acute otitis media prescribed by a physician in routine practice.

Materials and methods. Outpatient maps of 50 adult patients with acute otitis media were analyzed.

Results. In almost all 50 patients after the use of Otipax®, the analgesic effect occurred after 3 minutes. The analgesic effect remained on average for 35–40 minutes, then the pain gradually resumed, but in dynamics there was a decrease in its intensity. Hearing loss and ear congestion were initially noted in all patients, by the 3rd visit these complaints persisted, but their intensity was significantly lower, on the 10th day of observation there were no subjectively impaired hearing in any of the patients, which corresponded to acumetric and tuning fork data. The anti-inflammatory effect of Otipax® after a day provided a significant decrease in the intensity and area of hyperemia and infiltration of the eardrum. After 10 days, almost all patients had no otoscopic signs of otitis media. No adverse events were reported during the follow-up period.

Conclusions. The use of Otipax® (lidocaine + phenazone) ear drops complies with the clinical guidelines of the Ministry of Health of the Russian Federation in 2021 for the treatment of patients with acute otitis media before perforation, effectively and safely, is the method of choice for reducing ear pain in patients already at the primary appointment.

Rhinosinusitis, as in the pre-ovoid era, are still the most common diseases in the practice of an otorhinolaryngologist. According to the results of the analysis of medical documentation conducted at the clinic of the St. Petersburg Scientific Research Institute of Ear, Throat, Nose and Speech, more and more patients associate the diseases of the nasopharyngeal space that have appeared in them and the increase in the number of exacerbations of existing chronic diseases of this area with a coronavirus infection. In this regard, we decided to consider approaches to the treatment of rhinosinusitis by summarizing the available data and considering individual clinical cases of patients with sinusitis and COVID-19. Antibiotic resistance associated with uncontrolled administration of antibacterial drugs when infected with SARS-CoV-2 has also become one of the frequent problems at present. Therefore, our article considers the most relevant method in this case, based on the use of phytotherapy. According to the literature, the most effective phytopreparations are preparations containing standardized myrtol, which reduces the viscosity of the mucus of the paranasal sinuses and nasal cavity, increases the frequency of beating of the cilia of the ciliated epithelium, thereby contributing to an increase in the speed of mucociliary transport. Standardized myrtol also has an anti-inflammatory effect by reducing the concentration of leukotrienes and prostaglandin, neutralizing free OH radicals, inhibiting oxidation processes myrtol reduces toxic effects on the nasal mucosa and paranasal sinuses, and also acts on pathogenic flora as a bacteriostatic drug. Clinical recommendations of the Ministry of Health of the Russian Federation from 2021 according to the treatment of acute sinusitis and the European recommendations of the European Position Paper on Rhinosinusitis and Nasal polyps (EPOS 2020), based on the data of controlled studies presented in them, the use of phytopreparations in the treatment of acute and chronic sinusitis is confirmed both in combination with antibacterial therapy and without antibacterial drugs in combination with irrigation therapy and the use of topical decongestants.

The problem of acute tonsillopharyngitis remains relevant despite a huge amount of research. According to modern clinical guidelines, practically the only indication for prescribing systemic antibacterial therapy remains the GAS etiology of acute tonsillopharyngitis. At the same time, in clinical practice there are often cases of patients independently and unjustifiably starting to take systemic antibacterial drugs due to severe pain, which they were unable to relieve with the use of topical drugs. Most cases of acute tonsillopharyngitis are of a viral etiology. According to the modern guidelines, there is almost the one and only indication for antibiotics in patients with acute tonsillitis. Taking into account, the timing of a standard microbiological study, special clinical scales are used to quickly assess the clinical picture, according to which the patient scores a certain number of points depending on whether certain criteria are met. The most widely used is the McIsaac scale, which takes into account, in addition to the clinical picture, the patient’s age. At the same time, in clinical practice there are often cases of patients independently and unjustifiably starting to take systemic antibacterial drugs due to severe pain, which they were unable to relieve with the use of topical drugs. Thus, timely prescription of topical drugs effective for pain relief occupies an important place in the management of patients with both viral and bacterial acute tonsillopharyngitis. The article presents a series of clinical cases of acute tonsillopharyngitis, which can be characterized by the complexity of differential diagnosis. Using their own observations as an example, the authors demonstrate the importance of timely effective topical therapy, in particular with the antiseptic drug Mitraseptin-PRO (benzyldimethylmyristoylaminopropylammonium).

Introduction. The problem of infectious pathology of the pharynx and tonsils, manifested by sore throat, does not lose relevance. In the absence of indications for systemic antibacterial therapy, the main role of etiotropic treatment passes to topical use of drugs, including in the form of gargling. One of these is hydroxymethylquinoxalindioxide (Dioxidin®), which has recently received a new dosage form.

Aim. To present an overview of the efficacy and safety of two dosage forms of Dioxidin® in the treatment of infectious and inflammatory pathology of the pharynx and tonsils.

Materials and methods. The results of evaluating the efficacy and safety of 0.1% and 0.025% Dioxidine solutions for oropharyngeal rinsing in the treatment of adult patients with acute tonsillopharyngitis (ATP) or exacerbation of chronic tonsillitis (eCT) obtained during controlled comparative multicenter clinical trials conducted in 2017–2020 were analyzed.

Results. By day 9 ± 1 of follow-up, relief of all local signs of inflammation according to pharyngoscopy was observed in 87% of patients with ATP or eCT who used 0.1% solution for rinsing and in 84% of patients with ATP who used 0.025% Dioxidine solution for rinsing. The severity of sore throat, assessed using a visual analog scale, by the specified time decreased by 63 points in the group using 0.1% solution and by 50 points according to the study of the effectiveness of 0.025% Dioxidine. 0.1% Dioxidine solution was more effective than 0.02% nitrofuran solution, and at a concentration of 0.025%, the effectiveness of Dioxidine was comparable to 0.01% benzyldimethyl[3-(myristoylamino)solutionpropyl]ammonium chloride. Both studies demonstrated a high level of safety of the two dosage forms of Dioxidine, which has no statistically significant differences from the safety assessments of comparison drugs.

Conclusion. The presented data confirm the high efficacy and safety of 0.1% and 0.025% Dioxidin® solutions and suggest the possibility of implementing a differentiated approach to the treatment of inflammatory tonsillar pathology using two dosage forms of the drug.

Introduction. When using the drug dornase alfa in children with cystic fibrosis (CF) in the form of inhalations through a compressor inhaler with a pulsating aerosol supply, a high concentration of aerosol is achieved in the nasal cavity and paranasal sinuses, which reduces the severity of rhinological pathology, namely chronic rhinosinusitis, including those with nasal polyposis. There is also a positive effect on the function of external respiration, due to a decrease in the negative impact of rhinological pathology on the respiratory tract, primarily due to descending infection.

Aim. To evaluate the effect of intranasal dornase alfa therapy as part of a complex treatment on lung function and indicators of physical development in children with CF.

Materials and methods. The study compared the effectiveness of the drug dornase alfa for chronic rhinosinusitis with nasal polyposis using different types of drug delivery in children who did not receive targeted therapy for CF. A group of children who received two inhalations of dornase alfa (n = 43), information about patients in this group was taken from the 2020 register, and a group of children who received inhalation of dornase alfa only in the lower respiratory tract were compared (n = 28), information about patients in this group was taken from the 2016 register.

Results. The effect of additional intranasal inhalation of the drug dornase alfa was observed in the form of an increase in FEV and FVC. In addition, there was an improvement in body weight and height in the group of patients receiving intranasal inhalations, but the identified difference did not reach significant values.

Conclusion. The results obtained in the form of an increase in FEV1 and FVC allow us to draw a conclusion about the effectiveness of prescribing additional intranasal inhalation of the drug dornase alfa.

Inflammatory processes of the upper respiratory tract and pharynx occupy a leading position both in terms of the frequency of visits to an otolaryngologist and in the variety of pathogenic factors that cause processes accompanied by sore throat. With an inflammatory process occurring in the lymphoid ring of the pharynx, symptoms are usually caused by local factors, so local treatment, both anti-inflammatory and analgesic, is especially important. However, according to the literature, in most cases systemic antibacterial therapy is prescribed. According to modern concepts, it is known that systemic antimicrobial agents should be prescribed strictly according to indications, since the viral etiology of the inflammatory process is the most common. Based on this point of view, non-steroidal anti-inflammatory drugs are effective. In turn, according to many studies, preparations of the lysine salt of ketoprofen have shown their effectiveness in relieving symptoms without leading to the development of obvious side effects. Based on a review of literature data, it is shown that the lysine salt of ketoprofen has a wide therapeutic potential, good tolerability, and ease of use, which allows us to recommend this drug for use in patients with acute inflammatory processes in the pharynx caused by both microbial and viral agents. This drug is one of the most effective because there is no interaction with other drugs, and it can be used as part of combination therapy with antiseptics. If it is necessary to carry out antibacterial therapy for the treatment of an acute or exacerbation of a chronic process in the pharyngeal cavity, the drug of choice can be considered a third-generation semisynthetic cephalosporin antibiotic for oral administration with a broad spectrum of action, cefixime.

Introduction. Chronic rhinosinusitis (CRS) with underlying cystic fibrosis (CF) is one of the most challenging inflammatory diseases of the paranasal sinuses (PNS). The treatment of CF in general and CF-associated CRS in particular keeps developing exponentially: special drug delivery systems have been invented, drugs purpose-developed for the treatment of patients with CF (dornase alfa) are used, and radicality of surgical intervention is increasing. In recent years, CF innovative targeted therapy has been introduced. It aims to improve the course of the bronchopulmonary infectious and inflammatory process, nutritional status and pancreatic function, but its efficacy in relation to the PNS condition is still insufficiently studied.

Aim. To evaluate the efficacy of ivacaftor/elexacaftor/tezacaftor therapy for CF sinonasal manifestations in children and to determine possible parallels of the CRS course vs other characteristics of the CF course.

Materials and methods. A total of 15 children with CF receiving triple targeted therapy were included in the first series of observations. Computed tomography (CT) scans were assessed using the Lund-Mackay scores (LMS) before and 7.6 ± 3.0 months after starting the therapy. In addition, the changes in sweat chloride levels and pulmonary function test results were taken into account. The control group included 11 patients with comparable initial radiographic data who did not receive such therapy.

Results and discussion. The treatment group showed a significant improvement in the PNS condition in the form of a decrease in the LMS scores from 15.6 ± 4.5 to 2.1 ± 3.0 (p = 0.001) with inhomogeneous changes vs different PNS groups. A certain parallelism between changes in the CT view and the level of sweat chlorides and pulmonary function test results was reported. In the control group, a nonsignificant deterioration in the course of CRS was observed (from 12.3 ± 6.3 to 14.6 ± 4.9 scores according to LMS; p = 0.108).

Conclusions. The study demonstrated high efficacy of CF triple targeted therapy with ivacaftor/elexacaftor/tezacaftor in relation to the severe CRS with a rapid onset of effect in the form of PNS pneumatization restoration according to CT findings.

Introduction. The issue of diseases of the lymphopharyngeal ring in childhood remains extremely relevant in the outpatient practice of otorhinolaryngologists.

Aim. To study the effectiveness of the use of bacterial lysates (IRS-19, Imudon) in frequently ill children with adenoid hypertrophy, exacerbation of chronic adenoiditis at the outpatient stage of treatment.

Materials and methods. Examination and treatment of 67 children (35 girls and 32 boys) with hypertrophy of the pharyngeal tonsil and/or exacerbation of chronic adenoiditis at the age of 3 to 14 years (average age was 8.7 ± 6.2 years) was carried out based on two state polyclinics in Samara during the period from May 2023 to August 2023. The patients were divided into 2 groups matched by sex and age: the control group (n = 33) and the main group (n = 34), which additionally used topical bacterial lysate IRS-19 and a mixture of bacterial lysates Imudon. Complaints were assessed, ENT examination, endoscopic endonasal revision of the nasal cavity and nasopharynx, acoustic impedancemetry was performed, study of smears-prints from the structures of the pharyngeal tonsil, a serological blood test (ELISA) with the determination of IgG and IgM for herpes viruses (types I, II, IV, VI), cytomegalovirus and Epstein-Barr virus were conducted on the first day of treatment, on the 10th day of treatment and in dynamics after 3 months.

Results. By the 10th day in the main group, nasal congestion decreased in 73% of cases, discharge from the anterior nasal cavity in 78% of cases; the size of adenoid vegetations decreased and reached grade I in 34.4% of cases, grade II adenoids were detected in 49.3% of cases, in the control group the size of adenoids corresponded to grade II (50.5% of cases) and grade III (34.7% of cases). In dynamics, after 3 months of observation, children in the main group, using bacterial lysates (IRS-19, Imudon), showed a significant decrease in episodes of ARVI and adenoiditis, in contrast to the control group, where the incidence was 2.3 times higher.

Discussion. A significant decrease in the frequency of complaints from patients in the main group and a more pronounced decrease in the size of the pharyngeal tonsil were revealed.

Conclusions. Thus, the results of the study indicate the therapeutic and preventive effectiveness of including bacterial lysates (IRS-19, Imudon) in complex therapy in children with hypertrophy of the pharyngeal tonsil and/or exacerbation of chronic adenoiditis.

Introduction. In the complex therapy of acute rhinosinusitis, topical drugs with different mechanisms of action and influence on the main links in the pathogenesis of acute infectious lesions of the mucous membrane of the paranasal sinuses are widely used. Local drugs with antibacterial, as well as mucolytic and vasoconstrictor effects do not inhibit mucociliary clearance, have a convenient release form and ensure dosing accuracy with each use.

Aim. Evaluation of the clinical effectiveness of the use in complex therapy of a topical antibiotic of the aminoglycoside group in combination with a drug having vasoconstrictive and mucolytic effects of domestic production in the treatment of acute bacterial rhinosinusitis.

Materials and methods. The study involved 30 patients with a verified diagnosis of acute bacterial rhinosinusitis of moderate severity aged 18 to 68 years, who were divided into two groups. Patients of the first group (n = 15), in addition to complex treatment (antibacterial, antihistamine and unloading therapy, anti-inflammatory and puncture treatment), used a drug with a bactericidal effect from the group of aminoglycosides (Tramicent). Patients of the second group (n = 15) supplemented the same treatment with a drug with mucolytic and vasoconstrictive action (Rhinostein®). The effectiveness of therapy was evaluated based on the results of three visits to the doctor within two weeks.

Results. The positive dynamics of the subjective and objective status of patients in both study groups was noted. By the 3rd visit (10–14 days), the severity of clinical manifestations in patients who used two drugs Tramicent and Rhinostein® as additional therapy was 2 times lower than at the first visit compared with the group of patients who used only Tramicent as additional therapy. The absence of complaints after treatment in the 2nd group was noted by 15% of the examined, in the 1st – 10%.

Conclusions. Topical drug from the group of aminoglycosides containing the active substance framycetin sulfate (Tramicent) in the form of a spray is a safe and effective remedy in the complex therapy of bacterial rhinosinusitis, and its use in combination with the drug mucolytic and vasoconstrictive action (Rhinostein®) significantly reduces the duration of treatment and improves the quality of life of patients.

Currently, allergic sensitization is considered as one of the key causes of the development of chronic inflammatory processes in the nasal cavity and paranasal sinuses. The choice of optimal drugs for the treatment of allergic rhinitis still remains a relevant, socially significant and interdisciplinary problem. The article analyzes the modern strategy for the treatment of allergic rhinitis and assesses the incidence of comorbid pathology associated with allergic sensitization in patients with this pathology. In accordance with the latest clinical guidelines, a discussion of a stepwise approach to the treatment of allergic rhinitis was carried out. Based on data from a number of studies, the advantages of prescribing intranasal corticosteroids (InGCS) and leukotriene receptor antagonists (ALR) in the treatment of allergic rhinitis, including when combined with bronchial asthma and chronic rhinosinusitis with nasal polyps, have been identified. Among the officially registered drugs for the basic treatment of allergic rhinitis, the characteristics of the original intranasal spray mometasone furoate and the leukotriene receptor blocker montelukast are described in detail. The discussion describes the possibilities of potentiating the effects of topical corticosteroids through combination with leukotriene receptor antagonists. A clinical example demonstrates the feasibility of using a combination of the intranasal corticosteroid Nasonex with the leukotriene receptor blocker Singulair to control the course of allergic rhinitis and chronic rhinosinusitis with nasal polyps and, as a consequence, prevent the development of remodeling of the respiratory tract mucosa in such patients. During a follow-up examination after 3 months of therapy, the patient noted a subjective improvement in general well-being, nasal breathing, sense of smell, normalization of sleep, and a significant decrease in nasal discharge. There is no need for decongestants, sneezing is not a concern, and there is no respiratory discomfort. The combined use of ALR and InGCS enhances the anti-inflammatory effect of therapy.

Introduction. Allergic rhinitis is a common disorder that significantly impairs the children’s quality of life. The problem is particularly pertinent in relation to the paediatric population living in areas with advanced manufacturing industries, where well-known trigger factors, being added by increased concentration of pollutants in the atmospheric air, further complicate the selection of an effective course of treatment.

Aim. To determine the effectiveness of a course of treatment with an antihistamine medicine Cetirizine based on the assessment of quality-of-life criteria for children with intermittent allergic rhinitis (IAR) in the Chelyabinsk region.

Materials and methods. A prospective study of 147 children with respiratory allergic diseases living in the Chelyabinsk region was conducted. The quality of life of children who received a course of treatment with the antihistamine medicine was assessed using the Paediatric Quality-of-Life inventory (PedsQL) that consisted of combined Likert scales (school life, social, physical functioning, etc.), clinical symptoms were assessed using a developed visual analogue scale.

Results and discussion. The assessment findings confirmed that the use of Cetirizine in the complex therapy of intermittent allergic rhinitis and associated comorbid conditions made it possible to significantly improve the clinical symptoms and quality of life of children over the entire treatment period.

The most striking positive response in the form of decreased nasal obstruction was seen during the prescribed treatment in patients of Groups 1 and 2. Thus, the filling VAS ratings for children with mild to moderate IAR showed that only 10 (20%) patients in Group 1 experienced mild nasal breathing difficulty. Patients with severe IAR reported a decrease in nasal obstruction only by the end of two-month treatment.

Conclusion. Cetirizine demonstrated a good effect of blocking H1-histamine receptors, high bioavailability, good tolerability and safety in the treatment of allergic rhinitis in children with comorbid conditions.

Introduction. Allergic rhinitis (AR) in conjunction with acute infectious rhinosinusitis (ARS) can lead to increased inflammation and contributes to a more severe course of ARS.

Aim. To study the effect of some non-sedating H1-antihistamines on the severity of clinical presentations in adult patients with ARS and underlying AR as part of routine medical practice.

Materials and methods. Group 1 (75 patients) and Group 2 (85 patients) were generated through simple randomization from the patient population with ARS and underlying AR, who were prescribed benzhydryl-piperazinyl-butylmethylxanthine succinate (Teoritin® MF, 4 mg/day) or desloratadine (INN, 5 mg/day), respectively. The course of therapy was 14 days. The estimated parameters included changes in indices of nasal symptoms, rhinoscopic and non-nasal symptoms during follow-up visits, time to reach zero indices, the proportions of patients, whose symptoms reduced after 3 and 7 days of treatment, the need for the use of nasal decongestants and changes in quality of life measures.

Results and discussion. During the first 3 days of treatment, nasal breathing improved in 91% (95% CI 81–96%) of patients in Group 1 vs 56% (95% CI 45–67%) in Group 2, p < 0.001; rhinorrhea was relieved in 76% (95% CI 65–85%) and 62% (95% CI 51–72%) in Groups 1 and 2, respectively. By Day 7 of treatment, complete restoration of nasal breathing was observed in 71% of patients in Group 1 (95% CI 59–80%), and in 41% (95% CI 31–52%) in Group 2 (p = 0.014); rhinorrhea was relieved in 61%

(95% CI 49–72%) of patients in Group 1 and 37% (95% CI 27–48%) in Group 2, p = 0.001. Decongestants were used by 20%

(95% CI 12–31%) of patients in Group 1, and by 35% (95% CI 25–47%) of patients in Group 2, p = 0.031. The between-group difference was significant in terms of duration and frequency of adjuvant therapy, p < 0.05.

Conclusion. In comparison with desloratadine, it provided a more pronounced reduction of nasal and non-nasal symptoms, as well as relief of rhinoscopic signs of inflammation in a shorter time. The use of Teoritin® MF contributed to the reduction in the need (duration and frequency) for nasal decongestants.

The topicality of the issue of treating chronic diseases of the larynx is beyond dispute. Given the increased load on the vocal apparatus, no downward trend in disease incidence is observed. The percentage of patient visits to an otorhinolaryngologist with complaints of prolonged changes in voice timbre, vocal fatigue, and difficulties with voice control is 7–12%. Chronic productive formations of the larynx account for up to 55–70% of pathologies in the proliferative upper respiratory disease pattern. If not treated promptly, chronic diseases of the larynx can significantly affect a person’s ability to speak, swallow and breathe normally. Today, various methods for surgical treatment of chronic diseases of the larynx are used: both classical cold instruments and high-energy laser systems. The history of laser medicine dates from the late 1960s and is associated with the introduction of a high-intensity device emitting a photon stream in the infrared range into medical practice. The first carbon dioxide lasers were difficult to use (they were large in size and had complex technical settings), but at the same time they showed high resection and coagulation qualities, and it earned them their popularity. Over 3 thousand new laser devices representing a practical interest for laryngeal surgery have appeared on the medical market for more than 60-year period. Despite the fact that fundamental research demonstrates the positive results of phonosurgery with high-power devices, many otolaryngologists continue be in awe of lasers. The article presents the results of the use of traditional devices in phonosurgery for chronic diseases of the larynx and draws conclusions about the effectiveness and safety of high-power devices.

Introduction. Cartilage graft has been used in otosurgery since 1959. Cartilage resistance to pressure drops in the tympanic cavity and blood supply deficit in the early postoperative period favorably distinguish it from autofascia. When performing myringoplasty, it is important to create conditions for the formation of a neotympanic membrane that has the same three-dimensional spatial configuration as the native tympanic membrane with full contact of the membrane with the bone tympanic ring and the handle of the malleus. Also, the formation of the neotympanic membrane (myringoplasty) is a key step in tympanoplasty with ossiculoplasty, which ensures not only the restoration of the tightness of the tympanic membrane, but also the contact and proper fixation of the distal part of the prosthesis used to replace the lost elements of the auditory ossicular chain.

Objective. Evaluate the effectiveness of closed-type tympanoplasty by using a combined autofascial-autocartilaginous flap.

Materials and methods. A study group was formed, including patients who underwent tympanoplasty of types 1–3 according to M. Tos according to the proposed method of using an autofascial-autocartilaginous flap (343 patients), and a comparison group, including patients who underwent type 1 tympanoplasty with using autofascia (54 patients).

Results. Long-term anatomical results showed greater stability of the neotympanic membrane formed by the proposed method (2% reperforations). Functional results in the range of speech frequencies had no significant differences. Comparison of functional results in the high frequency range demonstrated a significant advantage of the proposed technique.

Conclusion. The conclusion is drawn that the proposed method of forming a neotympanic membrane close in configuration to the native tympanic membrane provides a high functional result with a reduction in the gap in sound conduction between the diseased and healthy ear to 5–10 dB at frequencies of 0.5–16 kHz.

Introduction. In the world there is an increase in the proportion of elder people in the demographic group of society. The problems of treatment and diagnosis of diseases associated with age due to this are considered more significant in clinical practice. Among of the most common age-related diseases: cognitive impairment, hearing loss and depression. Researchers have found that hearing loss is the most significant modifiable risk factor for cognitive impairment. Also, hearing impairment, according to several experts, is the cause of depression. Cochlear implantation is one of the main methods of rehabilitation in case of profound impairment of auditory function in elder people.

Aim. Evaluate the rehabilitation potential of cochlear implantation on cognitive function in elder people.

Materials and methods. A prospective study, were selected 35 patients (15 men, 20 women), candidates for cochlear implantation. Average age at the start of the study was 65 ± 9 years. Cognitive function was assessed using the RBANS-H, HI-MoCA, sound quality assessment using the HISQUI₁₉, depression and anxiety level assessment using the HADS. Studies were conducted before surgery, 6 and 12 months after the activation of the cochlear implant.

Results. There was an increase in cognitive function, assessed by the RBANS and HI-MoCA. In addition, the patients showed a decrease in the levels of depression and anxiety, assessed by the HADS test.

Conclusions. Cochlear implantation, as a method of rehabilitation of deep hearing impairment in elder people, has shown high efficiency on cognitive function, and decrease of depression and anxiety in the postoperative period.

In modern otomicrosurgery, there are significant successes of surgical treatment in the volume of tympanoplasty, but despite this, the problems of surgical treatment of chronic purulent otitis media are still relevant. One of the unsolved problems is the effective restoration of perforations of the tympanic membranemyringoplasty. The termination of infection of the tympanic cavity and the effect on the functional result of surgical treatment in chronic inflammatory diseases of the middle ear depends on the performance of this stage of tympanoplasty. The application of the layering method, the use of fascial-cartilage grafts, the formation of the neotimpanal membrane at the natural level is certainly the key to success in eliminating even total perforations of the tympanic membrane. However, it was noted that in the early postoperative period, the issue of effective flap vascularization and prevention of septic complications is of primary importance. Prolonged tamponade of the external auditory canal, the use of local and systemic antibacterial therapy reduces the risk of complications, but significantly increases the period of hospitalization, and hence the period of disability. It is observed that in large otorhinolaryngological surgical centers, mostly nonresident patients are in bed for several weeks. These patients are waiting for tamponade removal and evaluation of the effectiveness of surgical treatment, which, no doubt, is perceived positively from the point of view of the treatment process, but goes against the criteria for the effectiveness of specialized high-tech medical care. Therefore, many experimental and clinical studies have been conducted at present, which are aimed at finding an effective plastic material that contributes to the correct formation of the neotimpanal membrane, prevention of inflammation in the surgical wound area and shortening the period of engraftment of meattimpanal flaps. Considering the above, based on the latest data from domestic and foreign otorhinolaryngologists, in this article we offer our solution to the problem of effective performance of myringoplasty. It is noted that there is a need to study various materials for faster and more effective engraftment of the tissues of the tympanic membrane. The percentage of unsatisfactory morphological and functional outcomes, according to domestic and foreign authors, mainly in the plastic of suband total defects, remains high. The problem of surgical treatment of patients with chronic purulent otitis is of urgent importance for otosurgeons. The aim of the work was to study the use of biodegradable hydrogel in the healing of postoperative wounds in the surgery of chronic purulent otitis media. Description of a clinical case in a patient with chronic purulent otitis media using a biodegradable gel.

Introduction. Chronic tonsillitis (CT) remains an urgent challenge in outpatient practice of not only otorhinolaryngologists, but also multi-discipline specialists – primary care physicians and general practitioners.

Aim. To study the effectiveness of Tonsilgon® N at the outpatient care stage in CT patients with and without comorbidities. Materials and methods. 62 patients (30 to 56 years of age, average age 43.8 ± 13.2 years) with compensated CT were treated. The patients were divided into two groups: Group 1 (n = 30) included patients with compensated CT, Group 2 (n = 32) – patients with compensated CT and comorbidities: diabetes mellitus was detected in 40.6%, autoimmune thyroiditis in 43.7%, psoriasis in 15.7% of examined patients.

Results and discussion. Evaluation of treatment outcomes using a 10-point visual analogue scale showed a significant (p < 0.05) health improvement in patients of both groups who received Tonsilgon® N. The examination showed a 1.8-fold decrease in the severity of the local symptom of CT – hyperemia and a roll-like thickening of the edges of the pillars of the fauces in patients of both groups by the 7th day of treatment. The trends of changes were characterized by uniformity, amounting to 0.09 ± 0.02 scores in Group 1 and 0.1 ± 0.02 scores in Group 2 (p < 0.05) by the 14th day of treatment. In CT patients without comorbidities, exacerbations that developed within 3 months were only observed in 6.6% of patients, and occurred in a mild form, which made it possible to abandon the use of antibacterials for systemic use; in Group 2 with comorbidities, they were more common and developed in 12.5% of patients.

Conclusion. The high rate of successful treatment outcomes confirms the safety of the drug as an effective agent to relieve the severity of CT symptoms.

Introduction. Autoimmune rheumatic diseases are attributed to a systemic process that develops in many organs, including the larynx. Complaints of impaired vocal function in patients with this pathology require a thorough clinical and endoscopic analysis.

The purpose of the study. To determine the clinical-endoscopic changes of the larynx in patients with impaired vocal function in autoimmune rheumatic diseases..

Materials and methods. 31 (100%) patients aged 25 to 84 (41 ± 15) years with autoimmune rheumatic diseases applied to the phoniatric department of the St. Petersburg Research Institute of ENT. There were 3 men (10%), 28 women (90%). All patients complained of impaired vocal function, 5 of the examined (16%) were also concerned about breathing disorders during exercise or at rest.

Patients were grouped into three groups: systemic lupus erythematosus 4 (13%) people, systemic vasculitis 10 (32%) people, rheumatoid arthritis 17 (55%) people.

Videolaryngoscopy, videolaryngostroboscopy, autofluorescence endoscopy, NBI – endoscopy (according to indications) were used to make the diagnosis.

Results. The distribution of laryngeal pathology by nosological forms in patients with аutoimmune rheumatic diseases was as follows. The most numerous were groups with functional dysphonia of the hypotonic type 10 (32%) and bamboo nodules of 8 (26%) patients. Chronic laryngeal stenosis was diagnosed in 5 (16%), and chronic catarrhal laryngitis and soft nodules of the vocal folds in 3 (9.5%) people in each group (respectively). The smallest number of patients suffered from ulcerative necrotic changes of the larynx and pharynx – 2 (7%).

Conclusion. Thus, laryngeal changes in аutoimmune rheumatic diseases had both specific manifestations and non-specific ones. The latter include functional dysphonia of the hypotonic type, chronic catarrhal laryngitis, soft nodules of the vocal folds. Bamboo nodules of the vocal folds, ulcerative necrotic diseases, chronic laryngeal stenosis (infiltrative and scarring) were specific for patients with аutoimmune rheumatic diseases.

Introduction. Currently, the main way to assess olfactory disorders is olfactory tests. A necessary condition for adequate diagnosis is that the odors used in tests correspond to the sociocultural characteristics of the population; the identified flavors must be well recognizable. The use of unadapted tests distorts the results and leads to a false diagnosis of the pathology in a person with a normal sense of smell. The research for identification of the most known odors is an important stage in validation of the existing tests and in the development of new ones.

Aim. Determination odors in various regions of the Russian Federation.

Materials and methods: 3000 people from 8 federal districts of the Russian Federation took part in the study. This study was conducted using a questionnaire based on a Likert scale. The subject was required to assess his level of familiarity with each odor from the proposed list, assigning it a score from 1 to 5. In total, the questionnaire listed 100 names, including 16 names of odors, the standard set of the 3rd stage (assessment of identification ability) Sniffin’ Sticks Test, 40 names of odorants of the University of Pennsylvania Psychophysical Test (UPSIT) and 44 odors found in the everyday life of the population of our country.

Results. In the first 25 positions of the most recognizable smells, in descending order, there are: 1) coffee; 2) orange; 3) garlic; bleach; 5) mint; 6) tobacco smoke; 7) gasoline; 8) tangerine; 9) lemon; 10) smoke from a fire; 11) onion; 12) strawberry; 13) apple; 14) alcohol; 15) fish; 16) mown grass; 17) chocolate; 18) acetone; 19) banana; 20) hot bread; 21) rose; 22) lilac; 23) melon; 24) watermelon; 25) cucumber. Among the 16 odors of the 3rd stage of identification of the standard set “Sniffin’ Sticks Test” – 43.75% are included in the first 16 positions of recognizable odors of the Russian rating, and among the 40 odors of the UPSIT olfactory test – 52.5%.

Conclusions: This study showed which odors are well recognized by the Russian population and confirmed that cultural adaptation as a necessary procedure before routine use of olfactory tests.

The presented own clinical observation showed that functional dysphonia can be one of the clinical manifestations of EhlersDanlo syndrome: it is the deep layer of the own plate of the vocal fold, containing a large amount of collagen, that is most susceptible to changes in this pathology. The patient of the vocal voice for many years: a picture of hypotonic dysphonia was revealed during video pharyngostroboscopy – gaping of the laryngeal ventricles, non-closure of the vocal folds throughout by 1.5–2 mm. Acoustic analysis of the voice showed a decrease and instability in the amplitude of the pitch frequency, a narrowing of the dynamic range, a decrease in the intensity of the voice in the area of individual tones of the transient register, an increase in the level of noise components in the spectrum. The patient underwent a course of neuromuscular electrophonopedic stimulation No. 12 in combination with taking B vitamins for three weeks; after that, an increase in voice endurance was subjectively noted, however, according to the results of phonetography, spectrography and videolaryngostroboscopy, no visible positive dynamics was noted. The rheumatologist revealed hyperextension and increased traumatism of the skin, increased folding of the palms and flat feet. DNA sequencing revealed mutations in the genes and confirmed the diagnosis of Ehlers-Danlo syndrome.

Introduction. Sudden sensorineural hearing loss is manifested by sudden or rapid hearing loss without obvious disturbances in the outer and middle ear. Often the cause of this condition is not established. At the moment, various methods are used in the treatment, including corticosteroids, which are most often used as primary therapy. Recent studies demonstrate the effectiveness of topical steroid administration.

Aim. Assess the effectiveness and safety of various methods of topical and standard systemic use dexamethasone in the treatment of patients with acute sensorineural hearing loss, as well as to determine the optimal timing of therapy.

Materials and methods. 61 patients with this disease were treated in the study. 20 of them received dexamethasone transtubarly, 21 – transtympanic, and 20 – systemically. Audiological examination was performed on all patients before treatment, at discharge, a month and six months after discharge. All participants regularly assessed their discomfort on a 10-point scale. Results. The results of treatment demonstrated the effectiveness of both systemic and local steroid therapy in patients with sensorineural hearing loss; however, with topical use of the drug, the proportion of patients with complete hearing restoration was greater. Transtympanic introduction of steroids after radiowave myringotomy turned out to be the most comfortable for patients the level of discomfort was 1.5 points out of 10, while against the background of transtubal administration of the drug and systemic treatment it was 4.5 and 2.3 points, respectively.

Conclusions. The method of transtympanic administration of corticosteroids in patients with acute sensorineural hearing loss after radiowave myringotomy is a reliable and effective method of drug delivery to the windows of the labyrinth. This approach allows you to visually control the process of introducing the medication into the tympanic cavity. Transtympanic and transtubal methods of steroid administration are comparable in effectiveness to classical systemic steroid therapy in the treatment of patients with acute sensorineural hearing loss.

Introduction. During the COVID-19 pandemic, access to elective specialized healthcare has decreased significantly. In addition to economic, social, cultural, organizational and language factors, access to healthcare also includes geographic factors. In our country, geographical barriers are an important negative factor hampering access to healthcare for patients living far from regional and federal centres.

Aim. This analysis provides an indirect view of the change in the availability of specialized medical otorhinolaryngological care. Describe the procedure for conducting a spatial analysis of the geographic accessibility of medical care.

Materials and methods. The study analyzed changes in the spatial characteristics of the place of residence of patients admitted for inpatient treatment at the St Petersburg Research Institute of Ear, Nose and Speech Throat before and after the onset of the COVID-19 pandemic. The study materials used anonymized data of 32,304 patients who were treated in a 24-hour hospital at the St Petersburg Research Institute of Ear, Nose and Throat and Speech from January 2016 to December 2022. Descriptive statistics, spatial statistics, non-parametric methods for testing hypotheses (Wilcoxon criterion for independent samples), odds ratio for binary factors and outcomes processed in the R software environment, built on the basis of OpenStreetMap cartography with QGIS geocoding, were used as research methods.

Results and discussion. In the study, geographic patterns of places of residence (locations) of inpatients before and after COVID-19 were obtained, and a visual assessment of their changes was made. The distances between the place of residence of patients and the place of provision of ENT care were calculated, and hypotheses were tested on the equality of the average geographical distance to the places of residence of patients before and after the pandemic. A count of patients and areas of zones of nuclear assessment of the probability density of patient locations in the country before and after the pandemic was made. The design of the study was an observational analytical retrospective study of the spatial characteristics of inpatients, in which the event of the onset of the COVID-19 pandemic acted as a factor.

Conclusion. In general, after the resumption of planned inpatient otorhinolaryngological care, its availability, which can indirectly be assessed using a spatial statistical analysis of the places of residence of patients of a federal budgetary institution, has not changed.