Vol 23, No 3 (2021)

Nowadays, the share of odontogenic maxillary sinusitis according to various authors can reach 40% among all sinusitis. The literature review of the diagnostic and treatment features of odontogenic maxillary sinusitis is done. The use of modern methods of radiation examination allows us to identify the cause of sinusitis and reveal its odontogenic nature. The main thing in the treatment of odontogenic sinusitis is the elimination of the stomatogenic cause of the disease. There are several different types of surgical treatment of maxillary sinus disease: Caldwell-Luke operation, endoscopic transnasal approach with access through the lower and/or middle nasal passage. Our clinical experience of treatment of 36 patients with odontogenic maxillary sinusitis at the ENT department. Odontogenic maxillary sinusitis does not have specific symptoms. There are no recommendations how to choose any approach according to pathology, anatomy, additional diseases etc.

Acute rhinosinusitis is one of the most common diseases in the world, characterized by acute inflammatory processes in the nasal cavity and paranasal sinuses, lasting less than 4 weeks. According to statistics, in Russia, this disease is recorded in 6-15% of the population annually, in European countries in every seventh person, while there is a tendency to an increase in the incidence. Acute viral rhinosinusitis has the highest incidence among all rhinosinusitis and occurs in most patients in a mild form, however, untimely treatment of inflammation of the nasal mucosa can lead to obstruction of the natural anastomoses, impaired physiological ventilation and drainage of the paranasal sinuses, stagnation of secretions with further development acute bacterial rhinosinusitis. The overuse of local vasoconstrictor drugs (intranasal decongestants) leads to the development of drug-induced rhinitis, long-term imbalance of autonomic innervation of the nasal mucosa and edema, called "rebound syndrome". In the article we consider the issues of etiology, pathogenesis, features of the course of rhinosinusitis. The principles of differential diagnosis of viral and bacterial rhinosinusitis are stated, taking into account the latest recommendations and research in this area. The features of the use of the most frequently used topical preparations in acute rhinosinusitis in the practice of an ENT doctor have been analyzed.

Introduction. There are various sleep disorders that are striking and depressing at the same time in their diversity. One of the urgent problems that modern medicine is working on is problems with breathing during sleep, including obstructive sleep apnea syndrome (OSAS). The prevalence of this disease in children ranges from 1.2 to 5.7%. Adenotomy is an absolute indication for children with OSAS and adenoid hypertrophy. Aim. To study the frequency of occurrence of the OSAS in patients admitted to their hospital otorhinolaryngological department of Rauhfus Children’s Municipal Multi-Specialty Clinical Center of High Medical Technology for the planned surgical treatment of adenoid hypertrophy; to assess the effect of adenotomy on the course of OSAS in children. Materials and methods. 42 children aged from 4 to 12 years were examined; all patients underwent computer-based pulse oximetry, rhinomanometry, and nasopharyngeal endoscopy. Results. After adenotomy, nasal patency in children improved significantly: from 289.26 ml/s to 467.00 ml/s; the mean night saturation and desaturation nadir values in children during treatment improved from 97.31 to 97.68% and from 87.58 to 91.52%, respectively; sleep apnea syndrome was detected in 88% of all patients; 1 month after adenotomy, in 66.67% of the examined children OSAS was not detected.

In 5% of cases in the nasopharynx of an adult can be found a neoplasm with benign or malignant nature. Clinical manifestations of such pathology are next: persistent dysfunction of the auditory tubes, nasalness and postnasal drip syndrome. Endoscopy of the nasopharynx, computed tomography of the sinuses and magnetic resonance imaging of the head are the main diagnostic criteria for detecting neoplasms in this area. The tactics of treatment depends on the dysplasia type of the pathological process and varies from endoscopic one-stage resection to chemoradiation treatment. Using the example of two clinical cases, we will consider an algorithm for diagnosis and treatment the patients.

Lacrimation is one of the most common symptoms in ophthalmic practice. Most patients first visit an ophthalmologist, but the otorhinolaryngologist also plays an important role in determining the etiology of the disease and in the choice of management for such patients. This review presents a literature search that addresses the diagnosis and treatment of patients with epiphora. Identifying the cause of lacrimation is the main factor in making the correct diagnosis and choosing the optimal treatment method. Endonasal dacryocystorhinostomy is of particular importance. The multidisciplinary approach of the ophthalmologist and otorhinolaryngologist allows for the success of the epiphora treatment.

The article is devoted to an urgent problem - the correction of hearing impairment in patients with concomitant diseases. The results of a comparative analysis of data from patients with somatic diseases who underwent cochlear implantation (CI) for severe to profound hearing loss hearing loss of the fourth degree and deafness under local and general anesthesia are presented. Materials and methods. On the basis of the National Medical Research Center for Otorhinolaryngology of the Federal Medical-Biological Agency of Russia, CI was performed under local anesthesia for 10 patients with concomitant diseases, which represented difficulties for the use of general anesthesia (main group). All patients in the preoperative stage precisely informed about each stage of the surgery and with the cue-cards (with questions) to maintain contact with them during CI. The control group consisted of 10 patients who underwent CI under general anesthesia. CI was performed according to a standard technique. After the operation, a survey of patients of both groups about subjective sensations during the operation and in the early postoperative period was carried out.Results. CI under local anesthesia takes an average of 18±5.2 min, taking into account the time of anesthesia, which is 15±5.3 min less than with general anesthesia (p<0.001). When performing CI under local anesthesia, clear thresholds for recording acoustic reflexes stapedial muscle are determined, since in this case the effect of muscle relaxants is excluded. Against the background of local anesthesia, the necessary effect was achieved rather quickly, there was no increase in blood pressure to high numbers, patients answered all the signs and questions by reading the information from the cue-cards. A survey of patients revealed a good tolerance to local anesthesia. The number of patients in the main group which had a complaints in the early postoperative period was less than in the control group (p<0.05). The duration of hospital staying in patients of the main group averaged 1.15 days (from 1 to 3 days), which is significantly less than in the control group - from 3 to 7 days, on average 4.05 days (p<0.05). When conducting CI under local anesthesia, none of the patients showed a destabilization of comorbidity pathology in the postoperative period.Conclusion. CI under local anesthesia in patients with concomitant pathology has several advantages over general anesthesia. The use of local anesthesia will increase the availability of CI for elderly comorbid patients and mitigate the risks of general anesthesia.

The term “long COVID-19” describes the long-term effects of the novel coronavirus infection COVID-19. Patients with severe COVID-19 who require hospitalization, as well as those who are on outpatient treatment with mild clinical forms of the disease, often report persistent fatigue, shortness of breath, pain, cough and other respiratory and extrapulmonary symptoms for weeks and months. The generally accepted time frame that separates the duration of the acute and subacute phase of infection from the long COVID-19 is 28 days. The article describes the duration and the course of clinical disorders caused by COVID-19 and their persisting after the end of the acute phase of the disease. In addition, the current understanding of the causes of long-term consequences and the possibilities of drug and non-pharmacological correction are presented.

The article discusses the issues of vaccine prevention of influenza and pneumococcal infections during the ongoing pandemic of the new coronavirus infection COVID-19. Statistical data on the prevalence of these infections at the current time are provided. Co-infection can increase the symptoms of the diseases in these cases, and managing this condition is important for certain groups of patients. Respiratory viruses induce the attachment of pneumococcus, Pseudomonas aeruginosa and Hemophilus bacillus to the epithelial cells of the respiratory tract. The WHO position on influenza vaccination in the context of the COVID-19 pandemic is presented, and its main provisions are analyzed. Recommendations on the use of the main types of vaccines are given. Currently, the priority is to use 4-valent vaccines that ensure the development of the most stable immunity. In the Russian Federation, such a vaccine that meets all WHO recommendations is Ultrix Quadri, a tetravalent inactivated split influenza vaccine. The drug is a mixture of protective surface and internal antigens of influenza viruses of type A [subtypes A(H1N1) and A(H3N2)] and type B (Yamagata line and Victoria line). The use of vaccination schemes for pneumococcal infection was also discussed.

Two clinical cases on the diagnosis of lymphangioleiomyomatosis without surgical lung biopsy are presented.

The modern approach to the prevention and treatment of acute respiratory viral infections consists in the use of drugs that increase the body’s defenses, helping to create a barrier to the penetration of the virus. Immunomodulators exhibit a nonspecific effect in acute respiratory viral infections, which makes it possible to use them against various types of respiratory viruses without accurate laboratory diagnostics and expands clinical capabilities. In the first part of the review, the features of sodium aminodihydrophthalazinedione and the experience of its use in respiratory pathology are considered. The pandemic of the novel coronavirus infection (COVID-19), spread by the novel coronavirus SARS-CoV-2, has become a challenge to health systems around the world. The second part of the review reviews the results of the first studies on the use of sodium aminodihydrophthalazinedione for the prevention and treatment of new coronavirus infection. Recently, much attention has been paid to the long-term consequences of the postponed coronavirus infection. In the final part of the review, various aspects of the “post-COVID syndrome” are discussed and the possibilities of aminodihydrophthalazinedione sodium at the stage of rehabilitation after a coronavirus infection are discussed.