Vol 26, No 03 (2024): Оториноларингология и пульмонология

Aim. To compare the dynamics of the clinical course of chronic adenoiditis in children and evaluate changes in the levels of products of oxidative modification of proteins in pharyngeal tonsil tissues under the influence of physical methods.

Materials and methods. The study involved 84 patients with a clinical picture of chronic inflammation of the brain and hypertrophy of the adenoid vegetations of the 3rd degree, who were referred for surgical treatment as planned. All patients belonged to the age group from 3 to 15 years. The envelope method was used, patients were randomized into 3 groups. Group 1 (n=32) included children who did not receive exposure to physical methods in the preoperative period; Participants in the 2nd group (n=27) received low-frequency ultrasonic (LFU) therapy in combination with red spectrum photochromotherapy (FCT) in the preoperative period, and participants in the 3rd group (n=25) received NUS cavitation monotherapy before surgery. Statistical data were obtained using the SPSS Statistics 19.0 software package. The nonparametric Kruskal–Wallis test was used to identify differences between independent groups; for pairwise comparison of groups, the Mann–Whitney test was used.

Results. Analysis of the results showed that the severity of the studied signs in the study groups was comparable to each other on the 1st day, i.e. before starting treatment. The results of endoscopic examination are graded from 0 to 3 points. the severity of nasal obstruction and difficulty nasal breathing in group 1 (control) on day 1 was 7.7 points, in group 2 – 7.4 points, in group 3 – 7.5 points. Patients underwent anterior and posterior rhinoscopy. The best result was obtained in the group using LFU cavitation in combination with FCT. There was a significant decrease in the size of the pharyngeal tonsil and the absence of discharge on the surface of the adenoid vegetations, which reflects the high clinical effectiveness of this method of treatment.

Conclusion. The use of LFU cavitation in combination with FCT in the treatment of chronic adenoiditis in children leads to improved nasal breathing and a decrease in the amount of discharge in the nasal cavity.

Acute respiratory viral infections are widespread diseases, poorly controlled infections and are characterized by moderately pronounced constant growth. The use of vitamin-mineral complexes (nutraceuticals) for nonspecific prevention and treatment of acute respiratory viral infections is experiencing a “second youth” thanks to new data accumulated during the novel coronavirus infection (COVID-19) pandemic. As part of the review, we examined the possible impact of deficiency of the microelements selenium and zinc, vitamins A, E and C on various aspects of the course of ARVI: nonspecific prevention, treatment and rehabilitation. We searched for relevant sources in the PubMed and Scopus information databases, including the time period up to 04.07.2024. The presence in the arsenal of a practicing physician of 2 forms of the vitamin-mineral complex Selzinc® at the outpatient stage of medical care will increase the effectiveness of nonspecific prevention of ARVI in the pre-epidemic period, especially in “frequently ill adults with ARVI,” as well as the treatment of ARVI as adjuvant therapy and subsequent rehabilitation.

Gusher syndrome is a rather rare condition complicating surgical interventions on the stapes. It is characterized by profuse effusion of perilymphatic fluid from the vestibule into the lumen of the tympanic cavity during fenestration or removal of the foot plate of the stapes and rapid filling of the volume of the tympanic cavity and the external auditory canal with perilymph. This is due to increased pressure of perilymph fluid in the inner ear cavity in some developmental anomalies. Preoperative diagnosis of gusher syndrome can be difficult when the CT scan does not show any abnormalities in the anatomy of the inner ear canal and inner ear structures. The rarity of this phenomenon greatly complicates the procedure of its study, as well as the development of optimal schemes of therapeutic and diagnostic tactics in a real clinical situation. A clinical case of a combination of congenital isolated middle ear developmental anomaly and gusher syndrome is studied. A patient with suspected otosclerosis underwent stapedoplasty at Saint-Petersburg Research Institute of Ear, Throat, Nose and Speech. During the operation, abundant perilymphorrhea "Gusher" symptom was obtained, as well as thickening of the stapes legs and thin tendon of the stirrup muscle were revealed. The postoperative diagnosis was changed from otosclerosis to congenital isolated anomaly of middle ear development (isolated ankylosis of the stapes), gusher syndrome. The tactics of management of a patient with otosclerosis and isolated middle ear anomaly are similar. CT of temporal bones and virtual CT endoscopy should become the standard of examination of patients before surgical treatment. The use of cartilage and supracartilage is a safe way to stop perilymphorrhea in patients with gusher syndrome.

Asthma, caused by eosinophilic inflammation of the airways, is caused by exposure to allergen, is well treated with glucocorticostroids or monoclonal antibodies to interleukin-4 and 5, but some patients do not develop an answer to this therapy. The given type of asthma is classified as non-eosinophilic asthma. Depending on the proportion of infiltrating cells, non-eosinophilic asthma can be divided into neutrophil asthma (NA), mixed granulocytic asthma, and small ranulocytic asthma. It should be noted that the NA criteria are not clearly defined. For example, in one study, inflammation is thought to be neutrophilic with less than 2.5% of eosinophils and more than 65% of neutrophils in the sputum, while in another study 61% of neutrophils and more are thought to be. The role of neutrophils in asthma has been studied, but there is debate about the presence of NA. Several studies have shown that neutrophilic inflammation is associated with severe asthma and the risk of increased asthma. The article considers pathogenesis, definition, biomarkers NA and potential therapy NA.

Background. Currently, there is no «golden standard» in terms of correction of adherence to treatment of patients with tuberculosis and its adequate assessment. This paper presents the experience of applying the 3D lung reconstruction method, which was used among patients with tuberculosis to modify their level of adherence, as well as to increase the effectiveness of treatment and change the indicators of anxiety and depression.

Aims. To give a brief description of the level of adherence to treatment and the overall effectiveness of chemotherapy in newly diagnosed patients with tuberculosis according to the data of the department for patients with respiratory tuberculosis of the Nizhny Novgorod Regional Clinical Tuberculosis Dispensary. To increase the level of adherence to treatment and increase the effectiveness of chemotherapy in newly diagnosed patients with destructive forms of pulmonary tuberculosis using additive technologies using the method of three-dimensional reconstruction of lung tissue. To assess and correct the dynamics of manifestations of symptoms of anxiety and depression among newly diagnosed patients with destructive forms of pulmonary tuberculosis using additive technologies using the method of three-dimensional reconstruction of lung tissue.

Materials and methods. The present work is based on a retrospective-prospective analysis of the results of treatment of newly diagnosed patients with destructive forms of pulmonary tuberculosis (167 people), who were observed in the Nizhny Novgorod Regional Clinical Tuberculosis Dispensary. The patients included in the study were divided into two groups. For patients of the 1st group, lung models were made, among them a questionnaire was conducted using the MMAS-4 questionnaire and the HADS scale. For patients of the 2nd group, lung models were not made, and no survey was conducted.

Results. According to the results of the study in the department for patients with respiratory tuberculosis of the Nizhny Novgorod Regional Clinical Tuberculosis Dispensary (observation period from 2016 to 2020), a negative trend was found in an increase in the number of unauthorized departures from the structural unit and violations of the regimen among patients. A course of polychemotherapy was recognized as effective in the 1st group (in terms of bacterial excretion) in 93.0% of patients (64/69), and in the 2nd group (the same indicator) – in 67.3% (66/98); χ²=16.940, df=1; p<0.001. The largest number of abacilated patients was observed in the 1st group. In the case of showing patients three-dimensional anatomical tactile models of the lungs, the probability of closing decay cavities increased by 32.2% (γ-test=-0.322; p=0.034). The absence of the demonstration of personalized three-dimensional anatomical tactile models of the lungs contributed to an increase in the occurrence of disadvantage in the outcome of therapy by 77.2% (γ-test=-0.772; p<0.001). The chance of achieving an effective course of chemotherapy was 4.2 times higher among patients of the 1st group (odds ratio 4.267, 95% confidence interval 1.523–11.953). In the absence of data on the patient’s interaction with the tactile pulmonary model, the risk of noncompliance increased by 47.6% (γ-test=-0.476; p=0.020). After the use of three-dimensional anatomical tactile models of the lungs among patients of the 1st group, their level of adherence to treatment increased (according to the MMAS-4 questionnaire) with a result of 4 points [4; 4] – maximum score of the MMAS-4 questionnaire – (W=2278, Z=-7.267; p<0.001) and the psychological load significantly decreased (according to the HADS scale) with a score of 7 points [5; 10] – «no significant symptoms of anxiety and depression» (W=2405, Z=-7.165; p<0.001).

Conclusion. The use of additive technologies in the anti-tuberculosis organization has made it possible to improve the profile of adherence of tuberculosis patients to polychemotherapy, increase the effectiveness of treatment, and correct indicators of anxiety and depression among newly diagnosed patients with destructive pulmonary tuberculosis.