Vol 23, No 9 (2021)


Extracellular traps as an important part of the pathogenesis in chronic rhinosinusitis

Svistushkin V.M., Nikiforova G.N., Vorobyeva N.V., Dekhanov A.S.


Chronic rhinosinusitis is one of the most common diseases in the structure of ENT pathology. A combination of several factors often leads to the chronicity of this disease, which significantly complicates the choice of treatment tactics while maintaining persistent inflammation in the mucous membrane of the nasal cavity and paranasal sinuses. The emergence of new data on changes occurring at the cellular-molecular level significantly affects the understanding of the processes occurring during the pathogenesis of chronic rhinosinusitis and other diseases of the ENT organs. In recent years, more and more information has been accumulating on the role of neutrophils and eosinophils, as well as on such an immune response mechanism as the formation of extracellular traps in the structure of diseases of the upper and lower respiratory tract. The review presents current information on the effect of neutrophilic and eosinophilic extracellular traps on the chronic inflammatory process in the mucous membrane of the respiratory tract using the example of chronic rhinosinusitis.
Consilium Medicum. 2021;23(9):395-399
pages 395-399 views

The relevance of the situational use of nasal decongestants in modern clinical practice

Morozova S.V., Keda L.A.


Nasal decongestants (ND) are representatives of the pharmacological group of а-adrenomimetics and are widely used in clinical practice. These drugs are successfully used as symptomatic therapy of acute rhinosinusitis (AR), as well as as part of the complex therapy of acute otitis during unloading therapy for the auditory tube. The use of ND is necessary before conducting an endoscopic examination of the nasal cavity, for a better assessment of the state of the ostiomeatal complex, the olfactory cleft, as well as differential diagnosis of various forms of rhinitis and dysosmia. ND are indispensable in the prevention of complications of AR, such as acute eustachiitis, exudative otitis media and acute otitis media. Also, these drugs are used in the prevention of the development of aerotitis and ear barotrauma. The most commonly used nasal medications of medium and long duration of action, such as xylometazoline and oxymetazoline. This article presents clinical studies demonstrating the high efficacy and safety of these drugs as part of the treatment of AR. It is shown that oxymetazoline and xylometazoline are well tolerated by patients with a minimum number of adverse events. Modern representatives of ND are such drugs as Otrivin express 0.05% with the aroma of menthol, the main active ingredient of which is oxymetazoline, Otrivin 0.1% Moisturizing formula and Otrivin 0.1% with menthol and eucalyptus, which includes xylometazoline as the main active ingredient. These drugs have confirmed their effectiveness and safety in a large number of clinical studies and can be recommended as local vasoconstrictors.

Consilium Medicum. 2021;23(9):400-405
pages 400-405 views

Smoking effect in patients following benign laryngeal lesions excision

Rakunova E.B., Starostina S.V., Svistushkin V.M.


Background. Patients with benign laryngeal lesions usually complain on hoarseness, increased vocal effort, fatigue, stain, and if the lesion is large enough, a feeling of dyspnea with phonation. These symptoms considerably deteriorate the quality of life of the patients especially voice professionals. Aim. To optimize the treatment of patients with benign laryngeal lesions. Materials and methods. In the ENT Department of Sechenov First Moscow State Medical University (Sechenov University) a total of 90 patients presented with BLL were studied. All patients underwent microlaryngoscopy under general anesthesia and were divided into 3 groups depending on the surgical method that has been used: "cold-steel" instruments (n=30), radiofrequency ablation (n=30) and semiconductor laser (n=30) with wavelength of 1.94 mkm. Patients of each group were divided into smokers and non-smoking persons. We assessed preoperative and postoperative fibrolaryngoscopy during 6 month follow up period. Results. Earlier involution of postoperative reactive inflammation of vocal cord tissue (in 7 days after surgery) was observed in group 3, comparing with 14 days and longer period in group 1 and group 2 (p<0.0001). Reactive tissue inflammation was significantly higher in all smokers comparing to non-smoking patients (p<0.0001). Conclusion. The data we have obtained provide the basis for choosing semiconductor laser as a better surgical instrument while performing phonosurgical procedures. The proposed surgical technique makes it possible to reduce the recovery period in patients with benign laryngeal lesions. At the same time, it is important to recommend to quit smoking for the patients undergoing phonosurgery.
Consilium Medicum. 2021;23(9):406-409
pages 406-409 views

Relationship between the state of the lymphoid-pharyngeal ring and xerostomia syndrome

Morozova S.V., Pawlushina E.M.


Xerostomia is a condition that develops with a decrease in saliva secretion (hyposialia) or cessation of saliva secretion (asialia) and is characterized by dryness in the oral cavity. Xerostomia is widespread in different age groups, but is most common in older age groups. In a number of diseases, for example, in Sjogren's disease, xerostomia is the leading symptom complex and determines the severity of the clinical picture. Chronic inflammatory diseases of the pharynx, such as chronic tonsillitis and chronic pharyngitis, may be accompanied by a pronounced decrease in saliva secretion. Timely conservative treatment of inflammatory diseases of the pharynx has a positive effect on the dynamics of the course of xerostomia. To diagnose this condition, patients are advised to undergo sialometry. Xerostomia can be observed in the long term after bilateral tonsillectomy and, which forces patients to seek medical help. To eliminate dryness in the oral cavity after otorhinolaryngological interventions, in particular after bilateral tonsillectomy, saliva substitutes are widely used in practical otorhinolaryngology. Data on the relationship between the state of the lymphoid-pharyngeal ring and xerostomia syndrome are presented in the modern literature by single publications, and therefore, studies of the relationship between inflammatory diseases of the pharynx and the level of saliva secretion are certainly of significant scientific and practical interest. Treatment of patients suffering from both subjective and objective xerostomia requires an interdisciplinary approach with the participation of a dentist, otorhinolaryngologist and doctors of other specialties (gerantologist, endocrinologist, rheumatologist, psychotherapist). Modern methods of surgical treatment of patients with chronic tonsillitis and xerostomia using radio wave methods, high-energy laser radiation, coblator should be considered as an alternative to classical bilateral tonsillectomy.
Consilium Medicum. 2021;23(9):410-420
pages 410-420 views

Intranasal fluticasone propionate in the pharmacotherapy of allergic rhinitis

Astafieva N.G., Gamova I.V., Kobzev D.Y., Perfilova I.A., Udovichenko E.N., Aleschina L.V.


Rhinitis is one of the most common diseases and this term is used as an umbrella diagnosis for patients with different clinical phenotypes of the disease (allergic, non-allergic, infectious, etc.). Recognizing the high socio-economic burden of the disease and complexities of choosing an optimal therapy, it is important to focus on interdisciplinary interactions, which are reflected in modern clinical guidelines created by experts from ARIA, EAACI, EPOS, as well as national and professional societies. Patients with rhinitis symptoms often self-medicate, use the advice of pharmacist, receive recommendations from general practitioners in outpatient practice, and very few patients get specialists (ENT or allergist-immunologist) advice; herefore, in many cases, optimal criteria for disease control (symptoms, quality of life, objective measurements) cannot be achieved. Currently international professional communities have developed innovative therapeutic approaches based on knowledge of the phenotypes/endotypes of rhinitis to achieve such a control. Physicians in both primary and specialized care are encouraged to use step therapy. This approach to treatment is based on the control of disease symptoms, and intranasal corticosteroids (InGCS) are considered to be the most effective anti-inflammatory drugs for long-term control of rhinitis, especially in moderate-severe/severe cases. This well-proven efficacy of InGCS and their advantages over other classes of drugs make them the first-line therapy in the treatment of allergic rhinitis (evidence level A), as well as the drugs of choice for non-allergic rhinitis and rhinosinusitis. This review discusses fluticasone propionate, one of the in-demand InGCS, which has been the cornerstone of the treatment of allergic rhinitis for many years.
Consilium Medicum. 2021;23(9):421-429
pages 421-429 views

Review of the experience of using herbal drugs for the treatment of acute rhinosinusitis from the standpoint of evidence-based medicine

Bachert C.


General background. The overuse of antibiotics, including for the treatment of uncomplicated acute rhinosinusitis (ARS), has contributed to the emergence of antibiotic-resistant bacterial strains and has led to the need for alternative therapies. The review provides an assessment of the quality of evidence for the use of phytotherapy in ARS in order to determine its position among other therapies and future directions of research. The MEDLINE database was searched for randomized controlled studies of Sinupret®, Pelargonium sidoides extract (pelargonium), Cyclamen europaeum (cyclamen), cineole and GeloMyrtol®. We also searched for results from studies of a nasal spray with N-acetylcysteine and mometasone furoate (MF) in order to compare the effectiveness of herbal preparations with these traditional agents indicated for ARS. Main content. The strongest evidence was obtained for Sinupret®, followed by Pelargonium sidoides extract. Their use for treatment of ARS is supported by double-blind, placebo-controlled studies demonstrating both clinical efficacy and safety. Comparisons with traditional treatments such as topical glucocorticosteroids were found only for Sinupret® and they showed comparable efficacy, but in a small group of patients. For other herbal drugs, the pooled level of evidence was low. The search identified 2 small, placebo-controlled, randomized studies of cyclamen nasal spray. In two studies, it was impossible to make conclusions about the safety and efficacy of cyclamen nasal spray and reported no efficacy of cyclamen in reducing symptoms. We found only one randomized placebo-controlled study of GeloMyrtol® and cineol. The mention studies have showed a reduction in ARS symptoms with these two drugs, but larger studies are needed to confirm these findings. There are few studies that directly compared herbal drugs. In one randomized study, cineol was compared with Sinupret®, but the results need to be confirmed in further studies. Studies of N-acetylcysteine are limited to small clinical trials, while the use of MF nasal spray has been confirmed with results comparable in evidence to Sinupret® for the respective indications. Conclusions. There are modern studies that demonstrate the efficacy and safety of herbal drugs for ARS treatment. Given that the evidence for Sinupret® is the strongest and comparable to that for the widely available topical corticosteroid, MF, Sinupret could be considered for the treatment of uncomplicated ARS.
Consilium Medicum. 2021;23(9):430-440
pages 430-440 views

Upper respiratory tract diseases in patients with cystic fibrosis

Sinkov E.V.


Among ENT organ diseases in patients with cystic fibrosis, chronic rhinosinusitis is leading. The respiratory epithelium lining the surface of the upper and lower respiratory tract has the same structure. And as a result, in patients with cystic fibrosis, along with the bronchial tree, the upper respiratory tract is involved in the inflammatory process, while chronic rhinosinusitis develops. Impaired drainage leads to stagnation of infected thick mucus. Timely examination and treatment of upper respiratory pathology in patients with cystic fibrosis is needed. In surgical treatment, the method of choice is extended FESS. Observation by an ENT physician and conservative treatment of polypose rhinosinusitis should be carried out throughout the life of a patient with cystic fibrosis.

Consilium Medicum. 2021;23(9):441-444
pages 441-444 views

A study of the potential of medicinalplant extracts in suppression of SARS-CoV-2 replication: a pilot study

Pellegrin M.L., Rohrhofer A., Schuster P., Schmidt B., Peterburs P., Gessner A.


Relevance. Medicinal products of plant origin have long been successfully used in the treatment of various diseases, including those of viral etiology. Nevertheless, their effect on the replication of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has not been studied so far. Objective. To evaluate the potential of drugs based on validated plant extracts - RE (Bronchipret, Bronchipret TP, Tonsilgon N, Sinupret extract, Tonsipret) with respect to their ability to suppress SARS-CoV-2 replication in vitro. Materials and methods. Vero cells (Vero) incubated with RE of different concentrations were infected with SARS-CoV-2 virus. After 48 h the virus replication (the number of viral RNA copies in cell culture supernatant) was determined by quantitative polymerase chain reaction. Results. SARS-CoV-2 RNA copy number under the action of non-cytotoxic concentrations of Bronchipret TP decreased by 1000 times and by 10 times under the action of drugs Tonsilgon N and Tonsipret. Conclusion. Some of the studied REs in vitro demonstrated promising antiviral activity. It is advisable to conduct further, including clinical, studies of their activity against SARS-CoV-2 in the treatment of coronavirus infection (COronaVirus Disease 2019 - COVID-19).
Consilium Medicum. 2021;23(9):445-450
pages 445-450 views

Allergic rhinitis and bronchial asthma: a double blow to the respiratory system. How to achieve control

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23-25 июня в Москве состоялся 17-й Международный междисциплинарный конгресс по аллергологии и иммунологии, прошедший под эгидой Года науки и техники в России. Отечественные и зарубежные эксперты представили результаты актуальных исследований, обсудили подходы к терапии и профилактике заболеваний на основании клинических рекомендаций. В рамках мероприятия проводились мастер-классы, клинические разборы сложных случаев, научно-практические школы по актуальным вопросам. Предлагаем вашему вниманию обзор докладов, прочитанных на симпозиуме конгресса «Аллергический ринит и бронхиальная астма: двойной удар по дыхательной системе. Как добиться контроля», прошедшего при поддержке компании MSD.
Consilium Medicum. 2021;23(9):451-459
pages 451-459 views

Mesenchymal stem cells in tuberculosis therapy

Remezova A.N., Gorelova A.A., Muraviev A.N., Vinogradova T.I., Gorelov A.I., Gorbunov A.I., Orlova N.V., Yudintseva N.M., Nashchekina Y.A., Sheykhov M.G., Yablonsky P.K.


Tuberculosis, caused by the obligate intracellular microorganism Mycobacterium tuberculosis, is one of the oldest known infectious diseases in humans. Modern therapy of tuberculosis, consisting of several antibacterial drugs, is long-term, toxic and requires high compliance from the patient, therefore, the development of new therapeutic strategies that would minimize the duration of treatment and prevent the formation of drug-resistant forms of mycobacteria is relevant and important. Cellular therapy now holds the promise of potential complementary therapeutic options for the treatment of drug-resistant tuberculosis. In recent years, the possibilities of using mesenchymal stem cells in the treatment of tuberculosis of various localization have been widely studied. The use of such cells in conjunction with standard anti-tuberculosis therapy holds great promise for shortening the duration of treatment and reducing the formation of drug-resistant mycobacteria. This article describes the possibilities of using mesenchymal stem cells in the treatment of tuberculosis in patients, including those with extensive and multidrug resistance, as well as the mechanisms of interaction of mesenchymal stem cells with M. tuberculosis.
Consilium Medicum. 2021;23(9):462-465
pages 462-465 views

Levofloxacin in the treatment of community-acquired infections of the lower respiratory tract: a look through a quarter of a century

Sinopalnikov A.I.


This review is devoted to the 25th anniversary of the beginning of the widespread use of the prototype of "respiratory" fluoroquinolones levofloxacin in clinical practice. The article presents the evidence of clinical and microbiological efficacy, as well as good tolerability of levofloxacin obtained during numerous clinical studies, as well as evidence of long-term successful use of the antibiotic in real clinical practice, which determines its unique place in modern schemes of antibacterial therapy of adult patients with community-acquired lower respiratory tract infections.
Consilium Medicum. 2021;23(9):466-476
pages 466-476 views

Clinical observation of the course of new coronavirus infection in a patient with subacute form of hypersensitive pneumonitis

Kuklina G.M., Akhmedova A.Z., Makariants N.N.
Consilium Medicum. 2021;23(9):477-479
pages 477-479 views

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