Congenital cholesteatoma of the mastoid process is less common than its other temporal bone locations. OBJECTIVE:To summarize current data on the clinical manifestations and diagnosis of congenital cholesteatoma of the mastoid process. MATERIAL AND METHODS:A bibliographic search was done in the eLibrary, PudMed, and ScienceDirect databases using the keywords: "mastoid process" and "cholesteatoma". Articles were selected based on their relevance to congenital cholesteatoma of the mastoid process. Only reports describing cholesteatoma localized exclusively to the mastoid process without involvement of the tympanic cavity or antrum, confirmed by radiological examination data and intraoperative findings, were considered. A total of 28 publications were selected, which described 37 cases of congenital cholesteatoma of the mastoid process. RESULTS:Based on the severity of clinical symptoms and destructive changes, the following stages of congenital mastoid cholesteatoma development were identified: Stage I - the cholesteatoma is asymptomatic and constitutes an incidental finding; Stage II - nonspecific symptoms appear: swelling behind the ear, pain in the retroauricular region and neck, and intermittent ear discharge (through a fistula in the posterior wall of the external auditory canal while the eardrum remains intact). Radiological and intraoperative findings reveal destruction of the mastoid cortex, the posterior wall of the external auditory canal, and the mastoid apex without exposure of the dura mater of the posterior cranial fossa; stage III - headache and dizziness also manifest. There is destruction of the inner mastoid wall with exposure of the dura mater of the posterior cranial fossa, compression of the cerebellar hemisphere and/or endolymphatic sac, destruction of the posterior semicircular canal wall, involvement of the sigmoid sinus and the jugular bulb in the process. CONCLUSION:It is important to note that congenital mastoid cholesteatoma is asymptomatic for a long period. Unlike middle ear cholesteatoma, it does not impair hearing and is invisible on otoscopy. Consequently, it is diagnosed only in adulthood, following the development of mastoid destruction and the involvement of surrounding structures.
Long-latency (or cortical) auditory evoked potentials (LLAEP/CAEP) reflect the cortical processing of acoustic signals. This method is currently utilized in audiological, neurological and neurolinguistics research. LLAEP were first discovered serendipitously in 1939 during neurophysiological investigations of cortical bioelectrical activity. Subsequent studies established the reliability of LLAEPs as a biomarker for the maturation of central auditory system in individuals with normal hearing and those with hearing impairment, as well as in users of hearing aids or cochlear implants. LLAEP have also been investigated as a method for assessing cognitive auditory processing, such as speech discrimination abilities. This review outlines the history of LLAEP research, the principal trends in its investigation across different periods, and the specific contributions of Russian scientists to the field.
OBJECTIVE:Study of a clinical case of chronic mucormycosis of the paranasal sinuses in the Perm region, analysis of publications on the topic. MATERIAL AND METHODS:This article describes a clinical case of chronic mucormycosis of the paranasal sinuses, diagnosed in the otolaryngology department of the Perm Regional Clinical Hospital in 2021. An analysis of scientific papers on the topic of "chronic mucormycosis of the paranasal sinuses" was performed in the electronic search databases eLibrary and PubMed as of September 2025, using the keywords: chronic mucormycosis of the paranasal sinuses, chronic rhino-orbital mucormycosis, chronic rhino-orbito-cerebral mucormycosis (we used Russian and English languages). RESULTS:Chronic mucormycosis of the paranasal sinuses developed in a 68-year-old patient with insulin-dependent type 2 diabetes mellitus. The diagnosis of mycosis was established in the Department of otorhinolaryngology of the Perm Regional Clinical Hospital 6.5 months after the onset of complaints and was verified by pathohistological examination of intraoperative material from the left maxillary sinus. Treatment included left extranasal maxillary sinusotomy, antifungal therapy with posaconazole, and correction of glycemic levels. A search query in the eLibrary gave a negative result. Two reviews from 1996 and 2016, as well as case reports, were found in the PubMed database. Publications lack a classification of mucormycosis that identifies uniform time criteria for the chronic form; some indicate a duration of more than 4 weeks. The average disease duration worldwide is approximately 7 months. The causes of this chronic, sluggish course of the disease are not fully understood.
In medicine, a reference range (RR) is a range of values considered normal for physiological parameters in healthy individuals, with parameters within the RR considered within the normal range. A reference limit is a value mathematically derived from a reference distribution, defined such that a specified proportion of reference values lie above or below it. Currently, there are no established standards for reference ranges and limits for the parameters of the pyriform aperture region. OBJECTIVE:To determine the reference ranges and limits of the parameters of the pyriform aperture region. MATERIAL AND METHODS:The reference range and limits of the present study were determined for the following parameters of the piriformis width measured using cone beam computed tomography data in 577 individuals of the Central European type of Caucasian race (≥18 years, 273 men and 304 women) divided into age groups (18-44, 45-59, 60-74, ≥75 years): maximum width of the pyriform aperture (WPA), width of the nasal cavity at the level of the attachment of the anterior bony end of the inferior nasal turbinates (WNCp), width of the pyriform aperture in the projection of the attachment of the anterior bony end of the inferior turbinates (WPAp), length of the pyriform ridge (LPR) and angle of the pyriform ridge (APR). The lower reference limits (LRL), calculated in mm as μ (mean value) ± 1.96σ (standard deviation) and μ±3σ, were used as an anatomical reference for the relative and absolute narrowness of the parameters of the width of the pyriform aperture region. RESULTS:For men, regardless of age, the LRLs are respectively: WPA - 20.82 and 19.06; WNCp - 19.15 and 17.18; WPAp - 19.28 and 17.34. For women, regardless of age, the LRLs are respectively: WPA - 19.34 and 17.57; WNCp - 18.74 and 16.78; WPAp - 18.79 and 16.96. For women in the younger age group (18-44 years), the LRLs are respectively: WPA - 18.29 and 16.32; WNCp - 17.7 and 15.6; WPAp - 17.88 and 15.92. The reference range for the length and angle of the piriformis ridge is written as the lower and upper reference limits for men and women, respectively: LPR in mm ([0; 4.36] and [0; 4.22]), APR in degrees ([70.8; 113.05] and [69.76; 108.69]). CONCLUSIONS:The results of the study should be used in a possible surgical algorithm for the treatment of chronic nasal obstruction as a reference range and limits for the parameters of the piriformis region.
AIM:To assess the potential use of a combined topical preparation in the form of ear drops containing chloramphenicol, clotrimazole, beclomethasone dipropionate, and lidocaine in the treatment of patients with acute otitis externa, based on the clinical presentation and characteristics of the microbiological profile. MATERIALS AND METHODS:A retrospective analysis of medical records of 168 patients with acute otitis externa over a 5-year period was performed. The study included children older than 6 years and adult patients. All patients underwent otorhinolaryngological examination, culture-based microbiological testing of discharge from the external auditory canal with species identification, CFU/mL counts and analysis of antimicrobial susceptibility data for clinically significant bacterial isolates according to laboratory reports, as well as local therapy with a combined topical preparation in the form of ear drops containing chloramphenicol, clotrimazole, beclomethasone dipropionate, and lidocaine. In cases where inflammation spread to the skin of the auricle, a combined ointment containing chloramphenicol and methyluracil was additionally used. Treatment efficacy was assessed based on the dynamics of subjective symptoms and objective signs of inflammation; tolerability was evaluated according to the presence of adverse events. Statistical analysis included calculation of mean values and proportions. RESULTS:Positive clinical dynamics were observed with the use of the combined topical ear drop preparation in patients with acute otitis externa: therapy resulted in regression of the main symptoms in 96.4% of patients, including reduction of otalgia, edema, hyperemia of the external auditory canal skin, and pathological discharge. CONCLUSIONS:Combined topical therapy with an ear drop preparation demonstrated high efficacy and a favorable safety profile in the treatment of acute otitis externa in children older than 6 years and adult patients, providing positive clinical dynamics in 96.4% of patients.
OBJECTIVE:The purpose of the review is to analyze modern approaches to the diagnosis of voice disorders using AI and acoustic analysis, as well as to evaluate their effectiveness and prospects for implementation in clinical practice. RESEARCH DESIGN:A review of domestic and foreign literature sources on the use of computer acoustic analysis and AI technologies in the diagnosis of diseases of the vocal apparatus is carried out. MATERIAL AND METHODS:The material for the analysis was publications in scientific journals, the results of clinical trials, data on the use of specialized software systems (PRAAT, MDVP, LingWaves) and machine learning-based systems (SVM, CNN, RNN and their combinations). Data on diagnostic accuracy, interpretability of results, and applicability in real clinical practice were considered. RESULTS:Acoustic analysis of the voice makes it possible to detect pathological changes in the early stages, before the appearance of pronounced symptoms. The PRAAT and MDVP programs have become the standard in assessing the spectral and temporal characteristics of a voice. The introduction of AI has significantly improved diagnostic accuracy (up to 95-97% in individual studies). Machine learning algorithms and deep neural networks automate diagnostics, allow you to identify hidden patterns and use data obtained even from mobile devices. However, there are still unresolved issues of database standardization, interpretability of models, and ethical and legal aspects of their implementation. Despite the high efficiency of technologies, their use requires the development of uniform standards, ensuring the transparency of algorithms and multidisciplinary interaction of specialists.
Knowledge of the anatomical features of the structures of the temporal bone is important in the practice of an otosurgeon. Nevertheless, information on the high bulb of the internal jugular vein is extremely scarce in the available medical literature. The search and analysis of modern scientific publications from publicly available information resources, including review articles, original research, monographs, observations of clinical cases, and textbooks from domestic and foreign authors, has been carried out. The features of clinical manifestations and differential diagnosis with high standing of the bulb of the internal jugular vein were reported. The importance of careful preoperative preparation and prevention of intraoperative complications was noted.
OBJECTIVE:To evaluate the clinical effectiveness and practical feasibility of telemedicine technologies in the management of patients with vestibular disorders. MATERIAL AND METHODS:The study included 174 patients presenting with complaints of dizziness. During the remote consultation stage, a diagnostic concept was formulated based on patient complaints, medical history, and previously performed examinations. Subsequently, 166 patients underwent in-person evaluation to verify the clinical diagnosis and assess concordance with the preliminary hypothesis. Over a 6-month period, remote follow-up was conducted, analyzing repeated teleconsultations and the need for in-person visits. RESULTS:Complete or partial concordance between the remote diagnostic concept and the final clinical diagnosis was observed in 97.5% of cases, with complete concordance in 65.0%; complete discrepancy was identified in 2.5% of patients. In 29.5% of patients, a combination of multiple otoneurological diagnoses was established, and in 10.4% of cases a differential diagnostic spectrum of nosologies remained. During the 6-month follow-up, 73.6% patients actively used teleconsultations, and 20.0% patients required repeated in-person examinations. In acute vestibular syndromes, in-person visits were significantly more frequent, whereas in episodic and chronic forms, remote monitoring predominated. In the episodic vestibular syndrome group, patients with benign paroxysmal positional vertigo had significantly more repeat in-person examinations than patients with Ménière's disease and vestibular migraine. After 6 months, positive clinical dynamics were observed in the majority of patients, including those who received interdisciplinary consultations with related specialists. CONCLUSION:The use of telemedicine technologies in the management of patients with vestibular disorders ensures a high level of diagnostic consistency, enables efficient allocation of in-person consultations based on the clinical situation, thereby reducing the burden on specialized care, and maintains continuity of care. A promising direction for further research is the development of standardized telemedicine algorithms for diagnosis, monitoring, and multidisciplinary interaction, taking into account the high prevalence of combined forms of vestibular pathology.
The article examines the impact of functional tests on the acoustic characteristics of professional singers. Particular attention is paid to an objective analysis of changes in the main acoustic parameters before and after performing exercises. OBJECTIVE:To identify and characterize changes in the acoustic parameters of the voice of professional vocalists following physical, respiratory, and vocal loading. MATERIAL AND METHODS:The study involved 82 professional vocalists aged 18 to 65 years. Voice recordings were obtained from each vocalist to extract acoustic parameters before and after loading. Squats, respiratory loading, and vocal exercises were used as the loading conditions. RESULTS:Vocal exercises led to an increase in fundamental frequency (p<0.036) and a decrease in Jitter (p<0.04), while Shimmer showed no significant change. Physical exercise caused a pronounced decrease in Jitter (p<0.024), whereas breathing exercises had no significant effect on any of the acoustic voice parameters of the professional vocalists. CONCLUSIONS:The use of loading in the context of voice production significantly contributes to the improvement of acoustic voice characteristics and an increase in vocal endurance. The combined use of exercises of various orientations possesses high rehabilitation potential for restoring vocal function.
OBJECTIVES:To develop and internally validate a new prognostic classification system for juvenile nasopharyngeal angiofibroma (JNA) involving the skull base, aimed at improving risk stratification for massive intraoperative blood loss and tumor recurrence. The model's performance was compared with two established systems: Fisch-Andrews and UPMC (University of Pittsburgh Medical Center). MATERIAL AND METHODS:Using multivariable logistic and Cox regression analyses, we created a point-based risk model (GVV score) incorporating three clinical and radiological parameters: (1) Tumor volume, scaled using a coefficient of 0.055; (2) Growth pattern: tumour extension limited to the nasal cavity, nasopharynx, pterygopalatine fossa and/or paranasal sinuses (1 point); involvement of the infratemporal fossa and/or orbit without intracranial extension (2 points); presence of intracranial extension (3 points), destruction of the greater wing of the sphenoid bone (2 points), destruction of the pterygoid process (1 point), and post-pterygopalatine extension (1 point); (3) Vascularization: complete embolization (-1 point), history of prior intervention (+1 point). Patients were stratified into three risk groups based on total score: I stage (<2.0), II stage (2.0-5.79), III stage (≥5.8). For recurrence: low (<5.0), intermediate (5.0-6.99), high risk (≥7.0). Internal validation included AUC analysis, Brier score, Hosmer-Lemeshow test, 10-fold cross-validation, and Net Reclassification Improvement (NRI). Predictive performance was compared with the Fisch-Andrews and UPMC systems. RESULTS:We analyzed 143 patients treated surgically between 2014 and 2024. The new model showed superior performance for predicting massive blood loss (AUC=0.761 vs. 0.597 and 0.574), transfusion (0.739 vs 0.669 and 0.662), and blood loss >15% of circulating volume (0.776 vs 0.726 and 0.675), compared to Fisch-Andrews and UPMC. Recurrence prediction was comparable (AUC=0.713). The model also demonstrated lower Brier scores and more accurate classification of patients without adverse events. High-risk patients had a 6.6-fold greater risk of recurrence (p=0.001). CONCLUSION:This novel classification system provides more accurate and clinically interpretable risk stratification for JNA than current staging systems. External validation in independent cohorts is warranted to support its broader clinical use.
Violations of specific immune defense and weakening of nonspecific resistance of the body during inflammatory diseases of the upper respiratory tract necessitate a complex intervention using I eat drugs with immunomodulatory effects. For practicing doctors, immunomodulators are of particular interest. lators of natural origin obtained from active substances of medicinal plants. PURPOSE OF THE REVIEW:To analyze the effectiveness of the clinical use of the drug Tonsilgon N for chronic infections. tions of the upper respiratory tract in adult and pediatric patients and its impact on the prevention of exacerbations. MATERIAL AND METHODS:A search of publications was carried out in the databases PubMed, Embase, Cochrane Library, ClinicalTrials.gov, eLibrary.ru, Google Scholar. The results of randomized and non-randomized controlled trials were analyzed. observational studies for 2000-2026. RESULTS:The review included information from 20 studies. The collected data showed the ability of the drug Tonsilgon N increases immunological resistance and prevents the development of exacerbations of chronic infections tions. Analysis of published works indicates the high preventive effectiveness of the drug Tonsilgon N: its use statistically significantly reduces the incidence of acute respiratory viral infections, helps relieve local manifestations of inflammation, reduces the average duration of exacerbations. Decrease noted the need for antibiotic therapy when using the drug Tonsilgon N in children of different age groups and in adults. CONCLUSION:The research results have convincingly proven the effectiveness of the drug Tonzilgon N in relation to cupping prevention of exacerbations and prevention of relapses of chronic upper respiratory tract infections.
An experimental in vivo model of cisplatin-induced ototoxicity (CO) is a prerequisite for developing methods to prevent hearing loss resulting from cisplatin (CP) chemotherapy. However, there are no clear guidelines regarding its design in a research model as widely used as the Wistar rat. OBJECTIVE:To develop and validate a model of auditory analyzer injury in Wistar rats that reflects the specific nature of cisplatin-induced ototoxicity. MATERIAL AND METHODS:The study was conducted on male Wistar rats of SPF status, n=24, weighing 300-340 g. CP was administered in doses of 6, 8, 10, and 12 mg/kg as a single intraperitoneal injection to four groups of 6 rats (12 ears). Survival, body weight and audiological parameters were assessed. Otoacoustic emissions at the distortion product frequency (DP OAE) and auditory brainstem responses (ABR) were examined at baseline and on day 30 of the experiment. The amplitude of DP OAE was assessed at 8 and 10 kHz; ABR was assessed during monaural stimulation with 20 and 30 kHz tones in a free sound field. Additionally, plasma creatinine levels and histological preparations of cochleae and kidneys were assessed. RESULTS:A single administration of CP at a dose of 8 mg/kg or higher in Wistar rats is associated with acute mortality. A CIOT model allowing for animal survival is achieved using CP at a dose of 6 mg/kg. In this case, by the end of the experiment, a decrease in the amplitude of the OAE in the 10 kHz range was noted (p=0.043); for the ABR, an increase in the threshold by 10-15 dB in response to a 20 kHz stimulus was observed in 3 out of 12 ears, along with a decrease in the amplitude of the second peak (p=0.012). Histological sections of the temporal bones revealed partial neuronal death in the spiral ganglion of the cochlea's main turn. Kidney tissue showed irreversible damage characteristic of tubulo-interstitial nephritis. However, plasma creatinine levels remained within the reference range. CONCLUSION:A single intraperitoneal administration of CP at a dose of 6 mg/kg allows the establishment of a model of acute CO in adult Wistar rats, characterized by moderate depression of audiological parameters and irreversible pathomorphological changes in the neurons of the spiral ganglion. The absence of mortality and biochemical signs of nephrotoxicity indicates specific damage to the peripheral component of the auditory system without the additional ototoxic influence of renal failure factors.
OBJECTIVE:To evaluate the diagnostic significance of nasal fractional exhaled nitric oxide (nFeNO) in patients with acute rhinosinusitis (ARS) and determine its relationship with clinical and instrumental parameters. MATERIAL AND METHODS:The study included 44 patients with moderate acute rhinosinusitis and 33 healthy volunteers. The nFeNO level was measured using a portable electrochemical gas analyzer (NOBreath). Endoscopic assessment was performed using the modified Lund-Kennedy scale (m-LK), radiological assessment using the Lund-Mackay scale (LM), and symptom severity assessment using the SNOT-22 questionnaire. Measurements were performed at baseline, on days 7-10, and on days 30-35 of treatment. RESULTS:Baseline nFeNO levels in ARS patients were significantly lower than in the control group (p<0.05). In unilateral lesions, decreased nFeNO levels were observed both on the affected and contralateral sides. During treatment, nFeNO levels increased and reached values comparable to the control group by days 30-35 (p>0.05). A stable negative correlation of moderate to high strength was found between nFeNO levels and the severity of clinical and radiological changes assessed by the m-LK and LM scales. The correlation with SNOT-22 scores was weak. CONCLUSION:NFeNO is a non-invasive biomarker of inflammation in ARS reflecting the severity of the pathological process and may be used for objective assessment of disease progression and treatment efficacy.
The diagnosis of voice disorders remains a persistent challenge in otorhinolaryngology, as the analysis of complex data demands specialized clinical expertise. A promising approach involves the implementation of artificial intelligence (AI) and machine learning methods, which can automate the analysis of acoustic voice parameters, objectively differentiating between norm and pathology. The creation of user-friendly, secure and accessible cloud-based platforms utilizing environments like Google Drive and Colaboratory reduces the need for expensive infrastructure. This is a critical prerequisite for the successful integration of AI into clinical practice.
OBJECTIVE:To identify and develop criteria for the tonsillogenic nature of reactive arthropathies in patients with chronic tonsillitis (CT). MATERIAL AND METHODS:This prospective cohort study enrolled 150 patients with CT aged 18 to 35 years. The main group (Group I, n=75) consisted of patients with CT and arthralgia, the control group (Group II, n=75) included patients with CT without joint syndrome. All patients underwent questioning, clinical and laboratory examination (including CRP, ASL-O, RF, ACCP, ANA on HEp-2 cells, EBV IgG, vitamin D). When indicated, joint radiography was performed. Patients with confirmed tonsillitis-associated arthropathy (n=69) underwent bilateral tonsillectomy (TE) with histological examination of the tonsils and follow-up assessment after 6 months. RESULTS:Patients with CT and arthralgia had a significantly more severe tonsillar history (frequent sore throats, paratonsillitis), and more often suffered from intoxication syndrome and low-grade fever (p<0.05). In the main group, elevated levels of CRP (36% vs. 20%), ASL-O (37% vs. 19%), vitamin D deficiency (32% vs. 11%), as well as serological markers of EBV reactivation (IgG to VCA and EBNA; OR up to 21.7) and autoimmune activity (ANA ≥1:160 in 32% vs. 11%; OR=4.44) were significantly more frequent. Six months after TE, joint syndrome resolved in all operated patients, with a significant decrease in CRP, ASL-O, ANA titers, and normalization of vitamin D levels (p<0.001). A diagnostic algorithm was developed to differentiate tonsillitis-associated arthropathies from rheumatic diseases. CONCLUSION:Chronic tonsillitis can be a cause of systemic joint syndrome. Bilateral tonsillectomy is an effective pathogenetic treatment for these patients. The proposed clinical and laboratory criteria optimize diagnosis and patient selection for surgical treatment.
INTRODUCTION:The internal and external head and neck lymphedema is one of the consequences of surgical and radiation treatment of laryngopharyngeal cancer. The current task is to develop lymphatic drainage techniques that are effective for internal lymphedema. OBJECTIVE:To evaluate semi-occluded vocal tract exercises effectiveness for internal lymphedema rehabilitaion in patients with laryngopharyngeal cancer. MATERIAL AND METHODS:64 patients with laryngopharyngeal cancer received radiation therapy in a single regime or as part of the combined treatment after surgery were included. All of them had internal lymphedema symptoms. Patients were stratified into 2 equal groups: group 1 was treated with conservative treatment. In group 2 semi-occluded vocal tract exercises were added to inhalation therapy. RESULTS:In group 2 there was a reliable decrease of mucus and moth in the larynx (p=0.0039) and reduction of saliva delay in the larynx and piriform sinuses (p=0.0008), as well as reliably better dynamics of the indicators as a subjective assessment of symptoms associated with swallowing and voice disorders by the patient, as well as voice quality by a ENT specialist using GRBAS. CONCLUSION:The application of exercises with semi-occlusion of the vocal tract in combination with local anti-inflammatory, mucolytic therapy demonstrates effectiveness in the comprehensive treatment of internal lymph-discharge ENT organs.
Surgical treatment of hearing loss due to otosclerosis is characterized by high clinical efficacy and ensures achievement of an air-bone gap of ≤10 dB in 58-97% of patients. However, acute sensorineural hearing loss as a complication of stapedoplasty occurs in 0.2-0.95% of cases after the primary intervention, in 2.9% after revision stapedoplasty and in 4.8% with the obliterating otosclerosis. Intraoperative adverse factors arising during stapedoplasty play the leading role in the development of early cochleovestibular disorders. On the other hand, the use of glucocorticosteroids (GCS) in the surgical management of patients with otosclerosis remains a subject of debate, as the indications for their use, optimal routes of administration, and clinical efficacy still lack sufficient scientific justification. OBJECTIVE:To determine the indications for and evaluate the efficacy of hormonal therapy methods in patients undergoing stapedoplasty for otosclerosis. MATERIAL AND METHODS:Between 2020 and 2023, a total of 112 patients with otosclerosis were examined and surgically treated. Among them, 83 were women and 29 were men; the mean age of the patients was 44±10.5 years. The diagnosis was based on data from otomicroscopy, pure-tone audiometry, acoustic impedance audiometry, and computed tomography of the temporal bones, which served to confirm the condition and identify factors that could adversely affect stapedoplasty outcomes. Functional results were assessed using pure-tone audiometry at days 2 and 7, as well as at 3, 6, and 12 months postoperatively. Considering the features of the intraoperative course, the dynamics of air-bone gap closure, and the GCS therapy regimen applied, the patients were divided into three groups. Group 1 consisted of 45 patients who did not receive GCS therapy. Group 2 included 54 patients, subdivided into 2 subgroups: 22 subjects (Group 2a) received topical GCS therapy using bioabsorbable collagen sponges impregnated with the drug and inserted into the round window niche, and 32 subjects (Group 2b) received systemic GCS therapy. The latter was administered due to an adverse intraoperative course to prevent postoperative complications. Group 3 consisted of 13 patients in whom GCS were used both topically and systemically due to adverse intraoperative factors during stapedoplasty and a subsequent increase in bone conduction thresholds detected on day 2 after surgical treatment. RESULTS:The key factors determining the need for GCS therapy were intraoperative features of the stapedoplasty procedure. In particular, intense tissue bleeding and a pronounced vestibular reaction during vestibulotomy (p≤0.001), as well as blood entering the vestibule and the "dry" vestibule phenomenon (p≤0.05), were significant. In addition, the development of cochleovestibular disorders in the postoperative period is associated not with individual factors, but with their combination. An analysis of the efficacy of topical and systemic dexamethasone in the early stages after stapedoplasty was done based on bone conduction threshold dynamics. In contrast to Group 2b, patients in Groups 1 and 2a showed no clinically significant increase in bone conduction thresholds or signs of cochleovestibular disorders. The results obtained in patients of Group 2a may be attributed to prolonged topical GCS exposure during the intraoperative period when using the developed technique. Despite the higher frequency of combined intraoperative complications in patients of Group 3, bone conduction thresholds remained stable in the postoperative period, which is associated with the use of combination GCS therapy. CONCLUSION:In patients with otosclerosis, glucocorticosteroid therapy is indicated for managing adverse intraoperative factors and elevated bone conduction thresholds after stapedoplasty. In cases of intraoperative adverse factors in the absence of cochleovestibular disorders in the postoperative period, the use of topical glucocorticosteroid therapy by placing a hemostatic sponge soaked in dexamethasone solution into the round window niche using the original technique is sufficient to achieve satisfactory functional outcomes. Combined topical and systemic glucocorticosteroid therapy is advisable for treating postoperative cochleovestibular disorders and preventing further progression of hearing loss.
OBJECTIVE:To evaluate the effectiveness of combination therapy based on triamcinolone and bovhyaluronidase azoximer in the treatment of patients with cicatricial stenosis of the larynx and trachea. MATERIAL AND METHODS:The study included 30 patients with cicatricial stenosis of the larynx and trachea, aged 18-70 years. All patients underwent primary laryngotracheoplasty followed by stenting. In addition to standard postoperative therapy, all patients received adjuvant antifibrotic therapy with triamcinolone and bovhyaluronidase azoximer according to the developed regimen. Efficacy was assessed by visual control of healing, endoscopic monitoring of the airway lumen over 12 months, and the SF-36 quality of life questionnaire before and after treatment. RESULTS:According to visual assessment of the healing process, the exudation phase asted with a mean of 4.2±1.1 days, and postoperative pain subsided on day 5. Fibrin reorganization and epithelialization were achieved by days 9-12. Excessive growth of granulation tissue was observed in only 3 (10%) patients and was successfully controlled with additional injections of triamcinolone. Endoscopic monitoring revealed a low restenosis rate (6.7%), with the lumen remained stably patent in 93.3% of patients. Complete decannulation was achieved in 50% of the cohort. Results of the SF-36 questionnaire showed a significant improvement in quality of life: scores on the physical and social functioning scales increased more than 1.5-fold. This indicates a reduction in psychological distress and the patients' successful reintegration into social life. CONCLUSION:Combined use of adjuvant therapy with triamcinolone and bovhyaluronidase azoximer reduced the incidence of restenosis and significantly improved the postoperative outcomes. Accelerated healing, minimized complication rates, and a significant improvement in quality of life confirm the high clinical efficacy of the developed treatment algorithm for treating patients with cicatricial stenosis of the larynx and trachea.
OBJECTIVE:To evaluate the safety and efficacy of injection laryngoplasty using calcium hydroxyapatite in patients with unilateral laryngeal paresis or paralysis. MATERIAL AND METHODS:The study included a retrospective analysis of data from 27 patients (6 men, 21 women) who underwent this procedure between 2020 and 2025. In total, 39 procedures were performed in the study group under local or general anesthesia, 1-4 interventions per patient. The objective examination included computerized acoustic voice analysis with assessment of Jitter (%), Shimmer (%), and HNR (dB). RESULTS:A statistically significant improvement in voice function was achieved: the median Jitter decreased from 2.4% to 1.0%, Shimmer from 12.7% to 5.2%, and HNR increased from 7.2 dB to 15.2 dB. Ultimately, permanent medialization was required in 3 patients due to unsatisfactory results; 1 patient developed a complication in the form of acute bacterial laryngitis with a pronounced systemic inflammatory reaction. In 8 cases, calcium hydroxyapatite injection was administered to patients in the early period (within 3 months) after the onset of vocal fold paresis. These patients had developed vocal fold paresis after thyroidectomy and required rapid voice restoration. CONCLUSION:Injection laryngoplasty using calcium hydroxyapatite significantly improves voice quality in patients with unilateral vocal fold mobility disorders.
Nasal mucus cytology (rhinocytology) is a simple and non-invasive diagnostic method that can help doctors identify rhinitis phenotypes and clarify the diagnosis in patients with protracted rhinitis (runny nose and/or nasal congestion for more than 3 weeks). Aim of the work is to evaluate rhinocytology data in children referred by otolaryngologists to an allergist-immunologist to clarify the causes of protracted rhinitis. STUDY DESIGN AND CONDITIONS:A one-time retrospective study of children with protracted rhinitis observed in Moscow Children's Clinic No. 94 in the period 2022-2023. The analysis of rhinocytology results was carried out based on the data from the EMIS database. MATERIAL AND METHODS:The study included data from 344 rhinocytograms obtained from patients aged 2-18 years with persistent rhinitis (runny nose/nasal congestion for more than 3 weeks) referred by otolaryngologists for consultation with an allergist-immunologist in the period from October 1, 2022 to June 30, 2023. Exclusion criteria: acute respiratory inflammatory diseases; acute inflammatory process in the paranasal sinuses; nasal polyps; curvature of the nasal septum; previously undiagnosed (not confirmed by allergological examination) diagnoses of seasonal, episodic or year-round allergic rhinitis in the patient; grade 2-3 adenoids, as well as acute or chronic rhinosinusitis according to examination and X-ray examination (or computed tomography of the paranasal sinuses). RESULTS:Analysis of rhinocytograms in children with symptoms of prolonged rhinitis allowed us to identify two main types of changes in the cellular composition of nasal mucus: 1). cytological profile of non-allergic rhinitis, characterized by an increase in the number of inflammatory cells: neutrophils and / or lymphocytes (from a moderate amount to - completely in the field of vision with a normal level of eosinophils) - in 56.6% of cases; 2). cytological profile of mixed rhinitis with an increase in the level of inflammatory cells in combination with hypereosinophilia of more than 15% in the field of vision - in 10.6%. From the mixed rhinitis group (n=36), 2 patients had large accumulations of flora (bacteria) in the rhinocytogram in combination with an increased number of eosinophils. In 28.4% of children, significant changes in the rhinocytogram were not found. In 4.4% of cases, the material for research was insufficient. Overall, infectious-type pathological changes were significantly more common among the examined patients (59.3% [95% CI: 54.0-64.6]), while mixed-type changes were 5 times less common (10.9% [7.6-14.3%], p<0.001). CONCLUSIONS:According to rhinocytograms, the majority of children with persistent rhinitis referred by otolaryngologists to an allergist-immunologist had infectious-type inflammation, while mixed-type cytological changes were less common. Rhinocytograms can assist physicians in diagnosing allergic and non-allergic rhinitis, clarifying the type of inflammatory changes in the nasal cavity, and optimizing treatment for children with persistent rhinitis.
