Vol 25, No 3 (2023): Otorhinolaryngology and pulmonology

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.

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.

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.

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.

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.

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.

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.