Vol 26, No 9 (2024): Оториноларингология и пульмонология

The article analyzes the data of modern literature on the microbiota of ENT organs in normal and pathological conditions. The microbiota plays an important role in maintaining homeostasis by influencing metabolism, the immune system and human physiology. This complex of microorganisms includes bacteria, viruses and fungi that form the biofilm of otolaryngological organs, which prevents the penetration of pathogenic microorganisms. Different parts of the human upper respiratory tract have similar types of bacteria, but it differs dramatically at the level of families and genera. In addition, the balance of microbial flora depends on the immune system status, environmental factors, medication intake, age, race, lifestyle, as well as the health of other ENT organs. Changes in the nasal mucosa in allergic rhinitis are often associated with an increase in the content of bacteria. For example, Staphylococcus aureus can cause more severe nasal congestion in conjunction with protracted rhinitis and sinusitis. The production of bacterial proteinases contributes to easier penetration of allergens and activation of mucosal cells. The absence of microbiota can increase the response of the immune system and reduce the number of cells that contribute to the regulation of inflammation. This review presents an analysis of the composition of the normal microflora of otolaryngological organs and its effect on the occurrence of allergic rhinitis.

Chronic tonsillitis (CT) is a common infectious-allergic disease leading to severe general somatic complications, including rheumatic damage of joints and heart, kidney disease. Currently in Russia there is an increase in the number of patients with CT. Therapy for CT in outpatient practice is often limited to only washing the lacunae of the palatine tonsils, without the use of local drugs. We observed a 35-year-old patient with a diagnosis of chronic tonsillitis and a history of the disease of more than 1.5 years. A combined method of therapy was chosen, including treatment with the Tonsillor apparatus using low-frequency ultrasound therapy and local use of Viroxinol for irrigation of the tonsils and mucous membrane. As a result of the complex treatment, pronounced positive dynamics and a decrease in the clinical symptoms of CT were achieved.

In this lecture, some aspects of vestibular pathology propedeutics are highlighted. The necessity of careful vestibulosensory reactions analysis by different physicians (ENT specialist, neurologist, internist, general practitioner) is emphasized. Main patients’ complaints (vertigo and unsteadiness) are distinguished between. Special attention is paid to the classification of these vestibulosensory reactions on their duration and periodicity. The terms (sickness itself and balance disorders that may be concomitant symptoms of kinetosis) are clearly defined. Theories and clinical manifestations of sickness syndromes and motion sickness are described in details. Clinical variants of peripheral and central vestibular dysfunction are analyzed. The importance of computerized technics of vestibulometry (electrooculography, video oculography and computer dynamic posturography) in order to make a topic diagnosis of vestibular dysfunction and to assess visual-vestibular interaction in sickness is emphasized.

This article describes the approach to the petrous pyramid developed at National Medical Research Center of Otorhinolaryngology, namely an endoscopy – microscopy-guided modified trans-channel infra-promontorium approach with internal carotid artery retraction maneuver in patients with lesions of the petrous pyramid but with preserved hearing. A clinical report describing the apical cholesteatoma of the petrous pyramid and the use of this approach are presented. Anatomical and functional features after the surgery are also described. The purpose of this paper is advancing of the surgical approach to the petrous pyramid with the possibility of hearing preservation. The results of surgical treatment in lesions of the petrous pyramid were evaluated in the immediate and distant periods. The functions of facial mimic muscles were evaluated immediately after the surgery, in 6 months, and in one year. The functions of facial mimic muscles remained at the baseline level during the whole follow-up period. The pure tone audiogram demonstrated the preserved hearing function in the postoperative period. Complete elimination of the pathological process was achieved in all cases (n=15); according to the MRI of the temporal bones, no relapses occurred in a year. The surgical approach proposed for patients with the lesions of the petrous pyramid enables complete removal of the pathological process from the petrous pyramid with the preservation of hearing and facial functions, based on the subjective examinations (audiometry, facial function diagnosis) and radiology (CT and MRI of temporal bones) at the preoperative stage.

Background. Diagnosis of congenital malformations of the larynx in children is a difficult task for otorhinolaryngologists. The development and implementation of video endoscopic techniques has made a significant contribution to the understanding of anatomical changes in the larynx during CPR.

Aim. To study the clinical manifestations of congenital malformations in children over 6 years of age.

Materials and methods. Eighty three (100%) children with laryngeal malformations aged 6 to 18 years (10.1±0.6) were examined, who applied to the phoniatric department of the Saint-Petersburg Research Institute of Ear, Throat, Nose and Speech from 2002 to 2023. The number of boys is 39 (47%) people, girls – 44 (53%) people. The maximum incidence of children of both sexes was observed at the age of 8–12 years.

Results. It should be noted that in all patients, this pathology was detected for the first time when contacting a phoniatrist. Dysphonia is expressed from birth in 30 (36%) patients. Three children also complained of difficulty breathing from birth. In 15 (18%) children, the voice remained normal. The purpose of their visit is a preventive examination. Dysphonia in the remaining 38 (46%) children appeared during increased vocal load. The structures of the congenital malformations are presented as follows: tissue defects 36 (43%) people, organ defects 34 (41%) people, combined organ-tissue defects 10 (12%) people, neurogenic defects 3 (4%). None of the examined patients had congenital tumors. Hypoplasia or grooves of the vocal folds were diagnosed in 20 (23%) cases in the group of tissue VPR. Nine (11%) patients suffered from arytenoid cartilage dyschronia, and 7 (8%) patients suffered from dysplasia. Organ defects were represented by dystopia or “crossing” of the arytenoid cartilages in 29 (35%) and epiglottis dysgenesis in 5 (6%). Based on the clinical and endoscopic picture of the larynx, we have identified two degrees of dystopia. The first degree was diagnosed in 18 (21%), and the second in 11 (13%) children.

Conclusion. Patients with both tissue and organ cysts are characterized by the formation of nodules, cysts, mucosal hyperplasia, fusiform thickened edge of the vocal cord, chronic laryngitis, hypertrophy of vestibular folds. These changes should be considered as a compensatory and adaptive mechanism in conditions of forced vocalization due to anatomical changes in the larynx.

In the Russian Federation there is a positive trend in reducing the incidence of tuberculosis. However, there is a tendency to increase the prevalence of tuberculosis in the bronchi. According to foreign authors, the prevalence of bronchial tuberculosis ranges from 10% to 40%. There are no official statistics on the incidence of bronchial tuberculosis in the Russian Federation. The main contingent of bronchial tuberculosis lesions are young non-smoking women. At the same time, the most common target is the left main bronchus. Currently, no additional methods have been developed in the scheme of specific treatment of patients with pulmonary tuberculosis complicated by bronchial tuberculosis. It is important to understand that the eradication of MBT after an effective course of chemotherapy does not prevent the formation of cicatricial bronchial stenosis. It is also important to note that bacterial excretion in patients with bronchial tuberculosis is much more common than in patients with a comparable process in the lungs, but without bronchial damage. Consequently, tuberculosis of the trachea and bronchi has not only clinical, but also great epidemiological significance.

Induced tissue damage in target organs (kidneys, heart, eyes, liver, skin, nervous system) significantly contributes to the morbidity and mortality of patients from diabetes mellitus (DM). In recent decades, the question has been actively discussed: should the lungs be regarded as a target organ for diabetes? The c collected data demonstrate histological and functional lung disorders in DM patients. This suggests that the lungs are a target organ for diabetes. It is known that sirtuins regulate a number of physiological processes and affect obesity, insulin resistance, type 2 DM, heart disease and aging. In this review, we have tried to summarize the knowledge about the contribution of sirtuins to cellular regulation and the formation of pulmonary disease in patients with type 2 DM.