Vol 25, No 3 (2023): Пульмонология и оториноларингология


Allergic rhinitis: pathogenesis, diagnosis, treatment: A review

Rebrova S.A.


Allergic rhinitis (AR) is one of the most common diseases in the world, often combined with bronchial asthma. The lecture discusses modern ideas about the mechanisms of pathogenesis, diagnosis and treatment of AR, which allows to develop a personalized approach to patients with AR.

Consilium Medicum. 2023;25(3):147-151
pages 147-151 views

Topical therapy of otitis media in children: A review

Radtsig E.I., Polunin M.M., Egina A.D., Bondareva D.G.


Various types of otitis are common in the pediatric population. The use of otoscopy techniques by primary care doctors (pediatricians, family, and general practitioners) has significantly expanded the diagnostic capabilities of the primary examination of the child. However, it requires many specialists to know the principles of patient management with various types of otitis media. The article addresses the principles of routing and drug therapy for patients with various types of otitis media. The focus is on ear drops (formulation, indications for using specific drugs, safety, and age-related aspects).

Consilium Medicum. 2023;25(3):152-156
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Therapy of acute respiratory viral infections in adults in outpatient clinical practice: new opportunities for the prevention of bacterial complications (Results of the observational program RAPORT)

Yakovlev S.V., Dvoretskiy L.I., Petrov V.A.


The frequency of routine prescription of systemic antibacterial drugs in outpatient practice is still unreasonably high despite the desire to reduce them. Under the auspices of the Alliance of Clinical Chemotherapists and Microbiologists, the observational program RAPORT was conducted to assess the therapeutic potential (including bacterial complications preventing) of Raphamin in routine clinical practice in adults with acute respiratory viral infection (ARVI). The program included 14,033 patients aged 18–97 years with ARVI who received an investigational drug (ID) as monotherapy (93%) or in combination with basic therapy (7%). The frequency of prophylactic prescribing antibacterial drugs was 0.6%. It was shown that fever duration was 2.31±1.38 days, and the duration of the disease – 3.6±1.52 days. In 99.4% of patients, ID allowed to avoid the development of bacterial complications and prescription of antibacterial drugs. ID showed a stable therapeutic effect – in patients who started treatment late, as well as in patients with a moderate course of ARVI, there was no delay in recovery. The results obtained a broad prospect for the use of ID in order to minimize the number of bacterial complications and the frequency of use of antibiotics in ARVI, which may reduce rate of resistance of topical pathogens in the future.

Consilium Medicum. 2023;25(3):157-162
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Сhitotriosidase activity in prediction of poor prognosis in COVID-19 hospitalized patients

Schelkanovtseva E.S., Mironova O.I., Solovev K.A., Berestova E.A., Balakhonov A.A., Nagornov I.O., Fomin V.V., Panferov A.S.


Background. The identification of early predictors of poor outcomes of new coronavirus infection is necessary for optimizing patient management algorithms for hospitalized patients with COVID-19.

Aim. To study the role of chitotriosidase activity as a marker of unfavorable outcomes in COVID-19 hospitalized patients.

Materials and methods. The prospective observational single-center study included 347 patients with COVID-19 hospitalized in university clinic. In addition to the standard laboratory analysis (complete blood count, C-reactive protein, ferritin, creatinine, international normalized ratio, etc.) the blood serum chitotriosidase activity was determined at all the patients on admission. Primary endpoints were mortality from all causes and performing invasive ventilation (IV) and/or non-invasive ventilation (NIV). This study was approved by the Local Ethics Committee №12-21 (Clinical Trial Registry: NCT04752085).

Results. A total of 347 patients were enrolled in this study (average age 66 years, females 182 – 52.5%), 30 patients (8.6%) died during the hospitalization, 39 (11.2%) performed IV or NIV. Along with age more than 65 (odds ratio – OR 10.81, 95% confidence interval – CI 2.64–44.22) and Neutrophil-Lymphocyte Ratio higher than 7 (OR 15.89, 95% CI 3.09–81.65) chitotriosidase activity higher than 170 ng/hr/ml (OR 4.23, 95% CI 1.45–12.35) were independent predictors of mortality during hospitalization. Neutrophil-Lymphocyte Ratio higher than 5.6 (OR 11.22, 95% CI 2.37–53,1) and сhitotriosidase activity higher than 151 ng/hr/ml (OR 3.17, 95% CI 1.31–7.67) have been evaluated as predictors of performing IV/NIV.

Conclusion. Chitotriosidase level more than 151 nmol/h/mL could be considered as an early predictor of severity and poor prognosis in hospitalized patients with COVID-19.

Consilium Medicum. 2023;25(3):163-167
pages 163-167 views

A clinical case of a patient with an anomaly in the development of the inner ear and refractory stimulation of the facial nerve after a coronavirus infection and meningitis

Kuzovkov V.E., Levin S.V., Lilenko A.S., Sugarova S.B., Tanaschishina V.A., Korneva I.S.


Background. Thanks to the development of technology and new surgical approaches, it has become possible to perform cochlear implantation (CI) in patients with malformations of the inner ear. The experience of this type of rehabilitation has more than 15 years in Russian practice and more than 20 years in the world. Unfortunately, the COVID-19 pandemic has added not only one more cause of deafness, but also etiological factor of the complications. The purpose of this paper is to describe a clinical case of facial nerve stimulation (FNS) in a CI user with an inner ear malformation and a coronavirus infection complicated by meningitis. A clinical case demonstrating a combination of all these etiological factors of FNS has not been previously described in the scientific literature.

Aim. To describe a clinical case of FNS in a CI user with an inner ear malformation and a coronavirus infection complicated by meningitis.

Materials and methods. In 2017 4 years old patient underwent cochlear implantation on her right ear in Saint Petersburg Research Institute of Ear, Throat, Nose and Speech. In May 2022 the patient was admitted to the infectious diseases department of the medical institution with the diagnosis: coronavirus infection (confirmed), severe course; complication: purulent meningoencephalitis. After recovery, the patient complained of facial muscles twitching when using the speech processor of the cochlear implant. In order to correct the non-hearing sensation, the patient was sent to the Saint Petersburg Research Institute of Ear, Throat, Nose and Speech for rehabilitation in June 2022. During repeated fitting, it was possible to improve the reactions to sounds. Phoneme discrimination has improved. Positive dynamics was registered against the background of the changed settings. The average hearing thresholds using 3-phase stimulation were 42.5 dB. However, it was not possible to completely eliminate the FNS, and the compulsory settings of the speech processor did not allow the patient to achieve sufficient speech intelligibility.

Conclusion. Meningitis after CI can cause an increase in the transmittance of the inner ear tissues to electric current and, as a consequence, the development of the FNS. Modern technologies make it possible to rehabilitate such patients, including those with abnormalities of the inner ear. To increase the effecacy of rehabilitation, special coding strategies are used including the 3-phase stimulation.

Consilium Medicum. 2023;25(3):168-172
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Immunomodulating agent Galavit for the prevention of frequent acute respiratory viral infections after COVID-19: A review

Rosatkevich A.G.


Many convalescents of the new coronavirus infection caused by the SARS-CoV-2 virus, including mild and moderate severity, have frequent acute respiratory viral infections (ARVI) and other diseases of the ENT organs during the first 6 months after recovery. A well-known problem of COVID-19 is immune disorders due to the negative impact of the virus on the immune system, which is associated with various consequences described as a post-COVID syndrome. One of the manifestations of post-COVID syndrome is a decrease in infection resistance due to the immunodeficiency state. In particular, exacerbations of bacterial and viral ENT diseases, frequent ARVI, and exacerbation of herpes virus infection were reported. Moreover, the infections tend to be prolonged, cyclic, and often recurrent, significantly reducing patients' physical activity and quality of life. ARVI symptoms, accompanying the post-COVID syndrome, negatively affect the general condition of patients. Immunocorrection can interrupt the vicious circle of recurrent ARVI and restore impaired immunity after COVID-19. The immunomodulatory drug Galavit® has a pathogenetic basis for use in the post-COVID period to restore the immune system. It was shown effective in preventing frequent recurrent ARVI and herpes virus infection in patients in the post-COVID period. The article shows the experience of using Galavit® in coronavirus infection convalescents with frequent episodes of acute respiratory infections.

Consilium Medicum. 2023;25(3):173-178
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Historical aspects of fungal sinusitis, topical issues of early diagnosis and medical care on clinical example: A review

Lengina M.A., Abdullin V.М., Shapovalova V.V., Frolova V.D., Kravchenko A.Y., Klepikov S.V.


Inflammatory diseases of the nose and paranasal sinuses provoked by fungal contamination have been on the rise over the past decades. The cause of infection, according to the literature, is more often accidental ingestion of filling material, fragments of teeth and small parts of the implant into the sinuses, followed by fungal contamination. Diagnosis of fungal sinusitis, as a rule, is not difficult, but if the use of modern technological capabilities of research and differential analysis is refused or ignored, the verification of the diagnosis may be erroneous and the routing of the patient will not be determined correctly. In the context of early diagnosis and timely treatment of inflammatory diseases of the nose and paranasal sinuses, of course, a brief historical overview reflecting the importance of the existing problem will be useful for doctors, and the given clinical example will largely help to avoid mistakes.

Consilium Medicum. 2023;25(3):179-186
pages 179-186 views

Fundamentals of phoniatry (lecture)

Stepanova J.E.


Phoniatry is a branch of otorhinolaryngology and deals with issues related to the diagnosis, treatment and prevention of voice disorders. Violations of voice function, especially in persons of voice-speaking professions, worsen the quality of life, affect interpersonal relationships, create difficulties in communication, and in some cases lead to professional unfitness. It is known that about 6% of the population suffers from voice disorders, and laryngeal diseases are 5–6 times more common among specialists of voice-speaking professions. The invention of the laryngeal mirror became a landmark event in the emergence of laryngology, and subsequently phoniatry. The process of voice formation is provided by the voice apparatus, which consists of four departments and forms a single functional system. The vibrations of the vocal folds are a complex physiological process as a result of which sound appears. But this sound is not like the voice we hear. He acquires his unique timbre in the resonator department. It is possible to assess the state of voice function with the help of video endostroboscopy of the larynx and acoustic research methods. These diagnostic methods complement each other and create the most objective representation of the voice and its disorders.

Consilium Medicum. 2023;25(3):187-193
pages 187-193 views

Acute mixed vestibulopathy. History case from the vestibulologist practice. Case report

Lilenko S.V., Luppov D.S.


Patients with acute vestibulopathy are among the most uneasy (in terms of severity of symptoms) and challenging (in terms of determining the level of damage). At the same time, the methods of traditional otoneurological examination often do not allow to reveal the cause of unexpected balance disorders. In order to determine the degree of vestibular function decompensation and develop the tactic for the urgent treatment, Saint Petersburg Research Institute of Ear, Throat, Nose and Speech uses both screening methods included in the Vestibular Passport and computerized vestibulometry techniques. Methods of oculomotor and postural reactions assessment are described in details using the example of case history. The high diagnostic significance of the results of instrumental vestibulometry using the Frenzel glasses, foam pad, computer electrooculography, video oculography and computer dynamic posturography is demonstrated. The therapeutic tactics of managing a patient with acute mixed vestibulopathy is shown.

Consilium Medicum. 2023;25(3):194-197
pages 194-197 views

Algorithm for selecting patients for cochlear implantation. Lecture for physicians

Levin S.V., Levina E.A., Kuzovkov V.E., Koroleva I.V., Dvorianchikov V.V.


At the present stage in the world there are many methods for restoring hearing in humans, but, unfortunately, not all methods are effective for high-grade hearing loss or deafness. Carrying out timely rehabilitation of patients with a deep degree of hearing loss, especially in childhood, is extremely important for social and psychological adaptation in society. In patients with severe hearing loss, cochlear implant surgery is the most effective treatment. This operation is possible while maintaining the anatomy of the inner ear and the conduction of the auditory nerve. This lecture details the general principles of rehabilitation of patients with hearing impairments of various etiologies, the tactics of selecting patients for cochlear implantation, which is of great importance for choosing a method for treating patients with hearing loss and their psychosocial adaptation.

Consilium Medicum. 2023;25(3):198-203
pages 198-203 views

COVID-19 and cochleovestibular disorders: A review

Ovchinnikov A.Y., Miroshnichenko N.A., Savranskaya K.V., Zaitsev A.A.


COVID-19 is an urgent problem for healthcare in various countries of the world, as it is characterized by high rates of morbidity and mortality, and is also accompanied by a wide range of complications. These include smell and taste disorders, cochleovestibular disorders and delayed neurological disorders. The purpose of this article is to describe the audiovestibular disorders associated with novel COVID-19 infection, including possible side effects of ototoxicity associated with the use of drugs used in treatment protocols for this disease.

Consilium Medicum. 2023;25(3):204-207
pages 204-207 views

Analysis of the clinical efficacy of vaccination against pneumococcal infection in patients with chronic obstructive pulmonary disease and bronchiectasis

Ignatova G.L., Blinova E.V., Antonov V.N.


The article presents data on the analysis of the clinical efficacy of vaccination against pneumococcal infection in patients with chronic obstructive pulmonary disease (COPD) in combination with bronchiectasis during a 5 years follow-up period.

Materials and methods. The study included male patients (n=62) with COPD in combination with bronchiectasis. The primary endpoints were changes the severity of dyspnea using mMRS score, forced expiratory volume in 1 second (FEV1), number of exacerbations of COPD, hospitalizations, and a rate of pneumonia. The prognostic indices BODE, DOSE, ADO were also calculated. 13-valent conjugate pneumococcal vaccine PCV-13 were used for vaccination.

Results. It has been established that when vaccination is included in the management plan for COPD patients with bronchiectasis, the severity of dyspnea decreases, the lung function stabilize not only in the short-term, but also for at 5-years follow-up. Vaccination with PCV-13 significantly reduce number of exacerbations, a rate of pneumonia and hospitalizations during the 5-years follow-up. Vaccination of pneumococcal infection improves the quality of life and prognosis for COPD patients with bronchiectasis.

Conclusion. Vaccination of pneumococcal infection in patients with COPD and bronchiectasis can reduce the number of exacerbations, incidence of pneumonia and the number of hospitalizations, improve the prognosis and survival of patients using PCV-13 by maintaining efficacy for 5 years of follow-up.

Consilium Medicum. 2023;25(3):208-212
pages 208-212 views

Functional disorders of the respiratory system in combat chest injury

Savushkina O.I., Astanin P.A., Malashenko M.M., Pyhtin I.V., Kuzmina E.R., Zaitsev A.A.


Background. Gunshot injuries occupy one of the leading places in a number of injuries (combat injuries) that occur in military conflicts.

Aim. To study the effect of gunshot wounds of the chest (penetrating and non-penetrating), as well as closed chest trauma on the respiratory function.

Materials and methods. The study included 78 patients with a diagnosis of combined trauma, including a gunshot penetrating/non-penetrating wound of the chest or closed chest injuries. The median period from injury to the time of lung function tests was 17 [15; 22] days.

Results. A prospective cross-sectional study was performed. All patients (100% males) underwent spirometry, body plethysmography, and diffusion test. The total sample was divided into two groups: group 1 (median age 27.5 [23.0; 36.0] years) – 68 patients with gunshot penetrating chest wound, group 2 (median age 26.5 [20.0; 30.5] years) – 10 patients with gunshot non-penetrating wound or closed chest trauma. In group 1, the medians of the vital capacity, forced vital capacity, inspiratory capacity, forced exhalation volume in 1 second, lung diffusion capacity (determined by the value of the carbon monoxide transfer-factor – DLCO) and alveolar volume were reduced. In group 2, pulmonary ventilation parameters were within normal values while the median of DLCO was reduced. There were no statistically significant differences between the groups.

Conclusion. Both gunshot penetrating wounds of the chest and gunshot non-penetrating wounds of the chest and closed chest injuries have a negative impact, including on the respiratory function, to a greater extent on lung diffusion capacity. It is necessary to create programs of drug correction and longer rehabilitation treatment of this category of patients.

Consilium Medicum. 2023;25(3):213-217
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National Medical Research Center for Pulmonology: experience of the first year of work and development prospects: A review

Avdeev S.N., Voznesenskiy N.A., Merzhoeva Z.M., Nikitina L.Y., Berikkhanov Z.G.


The article highlights the main activities of the National Medical Research Center for Pulmonology of the Sechenov University. The main results of clinical, analytical and educational activities are outlined. The prospects for the development of the pulmonological service of the Russian Federation, current problems and their solutions are determined.

Consilium Medicum. 2023;25(3):218-222
pages 218-222 views

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