The literature review presents current data on the epidemiology, drug, and surgical treatment of laryngeal papillomatosis in adults. Possible prospects for further study of the prevalence and incidence of the disease and provoking factors of recurrence of the disease for the development of possible preventive measures are considered.

The article describes our experience in developing and training an artificial neural network based on artificial intelligence algorithms for recognizing the characteristic features of benign laryngeal tumors and variants of the norm of the larynx based on the analysis of laryngoscopy pictures obtained during the examination of patients. During the preparation of data for training the neural network, a dataset was collected, labeled and loaded, consisting of 1471 images of the larynx in digital formats (jpg, bmp). Next, the neural network was trained and tested in order to recognize images of the norm and neoplasms of the larynx. The developed and trained artificial neural network demonstrated an accuracy of 86% in recognizing of benign laryngeal tumors and variants of the norm of the larynx. The proposed technology can be further used in practical healthcare to control and improve the quality of diagnosis of laryngeal pathologies.

A clinical case of unilateral paralysis of the larynx due to the Collet — Sicard Syndrome is described. A patient with hoarseness due to paresis of the left half of the larynx of unknown origin underwent a comprehensive examination: CT scan of the neck, chest, MRI of the brain, ultrasound examination of the brachiocephalic arteries, consultation with a neurologist. Paresis of the left half of the larynx, left deviation of the tongue and uvula to the right, paresis of the left trapezius and sternocleidomastoid muscle, a decrease in the volume of the left half of the tongue with single fasciculations were diagnosed. Symptoms of damage to the IX, X, XI, and XII cranial nerves on the left were revealed, which corresponds to the syndrome of damage to the nerves of the caudal group in the jugular foramen. The disease arose against the background of acute bronchopneumonia. Treatment and phonopedic rehabilitation were carried out. During therapy, a complete restoration of the vocal cord palsy and the disappearance of neurological symptoms were noted. Timely diagnosis and proper treatment of a patient with Collet — Sicard Syndrome demonstrates good functional results.

OBJECTIVE:To evaluate the incidence of laryngeal papillomatosis (LP) and LP recurrence in adults and to determine the risk factors for the development of LP recurrence in adults in Moscow. To solve the tasks set, a survey of patients carried out, including the collection of complaints and anamnesis, a standard examination of the ENT organs, an assessment of the condition of the larynx, and a histological examination. MATERIAL AND METHODS:We conducted a retrospective analysis of the case histories of 299 patients with LP observed and treated at the Sverzhevsky Research and Clinical Institute of Otorhinolaryngology in the period 2010-2020. RESULTS:On average, over the entire study period, the prevalence of PG was 17.80%. It was found that out of 299 patients, 69.6% (n=208) had a relapse of LP. Papilloma of the larynx were more often localized in the glottis. 275 (92%) patients had a widespread form of LP. LP recurrences were significantly more common in women and in patients with an existing cicatricle process in the larynx. The relapse rate was higher in non-smokers (73.5% vs 47.8%; p<0.001). Although the recurrence rate was higher in patients with non-voice occupations (70.6% vs. 52.9%), there was no statistically significant association between relapses and the vocal professions (p=0.125). CONCLUSION:As a result of the study, a number of risk factors for laryngeal papillomatosis recurrent have been identified, and their study should be continued.

The literature review describes the experience of using the biofeedback method in the treatment of dysphonia of various etiologies. Indications for the use of this method and its effectiveness in a certain contingent of patients are discussed.

Systematic analysis of various indicators of the educational process becomes important to assess the effectiveness of the training of residents. One of the most common tools for monitoring the effectiveness of the educational process is a questionnaire of students.OBJECTIVE:To analyze the results of the assessment of the quality of training in the residency of the Sverzhevky Research Clinical Institute of Otorhinolaryngology according to the survey of residents.MATERIAL AND METHODS:The study includes the results of an anonymous questionnaire survey of a sample group of residents of the residency of the Sverzhevky Research Clinical Institute of Otorhinolaryngology of the second year of study.RESULTS:The data obtained allow us to judge the satisfaction with the quality of training of the absolute majority of the interviewed residents, their active use of specialized electronic search engines, a high assessment of the level of lectures, the desire to improve their surgical training. The importance for the professional development of residents of participation in weekly scientific and clinical conferences of the Sverzhevky Research Clinical Institute of Otorhinolaryngology, meetings of the Moscow Scientific Society of Otorhinolaryngologists, traditional annual scientific and practical conferences of otorhinolaryngologists of Moscow, as well as in the activities of the Youth Council of the Institute is noted.CONCLUSION:The results of the survey create prerequisites for improving the educational process, the formation of professional competencies and readiness for independent work among residents.

OBJECTIVE:To increase the effectiveness of the treatment of laryngeal pathology associated with gastroesophageal reflux disease (GERD), to determine the indications for the appointment of anti-inflammatory therapy to these patients.MATERIAL AND METHODS:120 patients were examined and treated, 58 of them men and 62 women, aged 30 to 82 years with GERD-associated laryngeal pathology. Three groups of patients were formed, comparable in age and gender, in accordance with the type of pachydermia in interarytenoid region; type 1 (40 patients) - pachydermia did not go beyond the middle of the interarytenoid cartilage (according to G.F. Ivanchenko), less than 3 mm, without signs of perifocal inflammation; type 2 (40 patients) - pachydermia of large size, extending beyond the middle of the interarytenoid cartilage with a spread to the entire interarytenoid region (according to G.F. Ivanchenko), often in combination with hyperkeratosis or epithelial dysplasia; type 3 (30 patients) - pachydermia of large size in combination with severe perifocal inflammation. All patients received antireflux therapy. Each group is divided into two subgroups: patients who did not receive anti-inflammatory therapy, and patients who received anti-inflammatory therapy, the basis of which was inhalation with degassed alkaline mineral water, as well as according to indications acetylcysteine, benzyldimethylammonium chloride 0.01% or hydroxymethylquinoxalindioxide, with severe swelling of the mucous membrane - budesonide. All patients completed the questionnaire "Reflux Symptoms Scale" before and after treatment.RESULTS:In group 2 patients (with type 2 pachydermia), the effectiveness of anti-inflammatory therapy was 75%. Of the 20 patients in this group, after inhaled therapy, 4 patients had pachydermia in interarytenoid region disappeared, 11 patients had type 1 pachydermia visualized, 5 (25%) patients had no pronounced dynamics. In group 3 patients (with type 3 pachydermia), the effectiveness of inhaled treatment was 100%, out of 15 patients after inhaled therapy, type 2 pachydermia was diagnosed in 8 patients, type 1 pachydermia - in 7 patients. In 4 patients, complex therapy led to the complete disappearance of reflux-associated laryngeal granulomas without surgical treatment. The effectiveness of inhaled therapy in relation to patient complaints after a month was 87%, while the effectiveness of treatment of patients without inhalation was 45%.CONCLUSIONS:Indications for the appointment of inhaled anti-inflammatory therapy in patients with reflux-associated pathology of the larynx are the presence of complaints of hoarseness, dryness, tickling, lump in the throat and chronic cough, endolaryngoscopic signs of exacerbation of chronic inflammation of the mucous membrane of the posterior larynx.

OBJECTIVE:To improve the diagnosis of laryngeal disease in patients with gastroesophageal reflux disease (GERD).MATERIAL AND METHODS:171 patients (89 (52%) men, 82 (48%) women) with non-erosive (39 (23%) people) and erosive (132 (77%) people) forms of GERD were examined. None of the patients made active complaints about the condition of the larynx and pharynx. The examination included a questionnaire, examination by an otorhinolaryngologist, and videoendolaryngoscopy.RESULTS:The survey revealed the presence of symptoms of otorhinolaryngological pathology in 74% of patients. Videolaryngoscopy revealed no laryngeal pathology in 55 (32%) patients, and signs of GERD-associated laryngitis were detected in 116 (68%) patients. The most common pathology was pachydermia in interarytenoid region - in 89 people, laryngeal granuloma was detected in 7 patients, leukoplakia - in 2 patients, chronic edematous polypous laryngitis - in 2 patients, benign laryngeal formations - in 9 patients. In patients with GERD (erosive and non-erosive forms), an asymptomatic course of chronic laryngitis associated with this pathology was observed in 44% of cases. In 52% of patients, pachydermia in interarytenoid region was diagnosed, of which every second had pronounced hyperplasia and folding of the mucous membrane in interarytenoid region, which must be differentiated from laryngeal cancer (in this case, patients should be under the dynamic supervision of an otorhinolaryngologist). Other precancerous formations of the larynx (granulomas and leukoplakia) were found in 5% of patients. Benign neoplasms of the larynx (polyps and cysts) were also detected in 5% of cases.CONCLUSIONS:Despite the high frequency of detection of otorhinolaryngological diseases in the examined patients with gastroesophageal reflux disease, none of the patients presented complaints related to the pathology of the larynx, which indicates the need for active detection of this pathology in this category of patients by questioning, questioning, as well as examination by an otorhinolaryngologist.

The authors of the article reviewed acoustic research methods in otorhinolaryngology. All acoustic diagnostic methods are divided into active and passive. Active acoustic methods are based on the emission of acoustic vibrations, in some cases with the subsequent reception and processing of reflected vibrations. Passive acoustic research methods are based on the recording and analysis of sounds arising during the physiological functioning of the studied organs and systems. In otorhinolaryngology, active acoustic methods of studying the ENT organ are more widespread: audiometry, acoustic impedance measurement, ultrasound examination of hearing, auditory evoked potentials, sonotubometry, acoustic rhinometry, ultrasound examination of soft tissues of the neck and paranasal sinuses. Among passive acoustic research methods, the greatest development in clinical practice in otorhinolaryngology was obtained by computer acoustic analysis of the voice - an assessment of the phonatory function of the larynx. Using similar technologies, a technique for acoustic analysis of nasal breathing was developed - a functional assessment of the external nasal valve. Separate groups of authors have carried out an experimental study of the sounds that occur when the auditory tube is opened. Achievements in acoustics and the introduction of advanced technologies in medicine create prerequisites for improving existing and developing new methods of acoustic analysis of the work of ENT organs.

The article deals with optimization of treatment policy for singers with chronic catarrhal laryngitis. The survey sample is 51 singers with chronic catarrhal laryngitis of the age from 29 to 54 and the length of time worked from 8 to 22 years. The following methods are used: anamnesis, microbiological investigation, voice evaluation according to Visual Analog Scale (VAS), microlaryngoscopy, videolaryngostroboscopy, voice acoustic analysis (MDVP Kay Pentax system), statistical processing of results. It is shown that the cause of chronic catarrhal laryngitis in professional singers is non-bacterial irritants that provoke the appearance of an inflammatory process in the larynx, as well as uncontrolled use of drugs that irritate and dry out the mucous membrane and imperfect vocal technique. Pathogenic flora as an etiologic factor in the occurrence of laryngitis does not play an important role. A comprehensive treatment scheme for chronic catarrhal laryngitis using inhalation therapy and drugs that improve trophic processes in the laryngeal mucosa, which allows to increase the effectiveness of treatment and achieve stable remission of the disease, is suggested.

The analysis of the causes of the pathology of the vocal apparatus in vocalists is carried out. 136 singers were investigated in age from 23 till 70 years old with length of service from 3 till 42 years. It is shown that the occurrence of diseases of the larynx is affected by the state of the vocal apparatus itself, the volume and intensity of the vocal load. Of great importance is the quality of the singer’s vocal training, his age and length of service, the availability of additional work (concert, pedagogical activity), the correspondence of the performed parts to the singer’s technical and acting abilities, domestic and social living conditions. The structure of voice apparatus diseases also depend on type of singer’s voice and his nervous system status. Prevention of impaired voice function in musical theater vocalists should be aimed at eliminating all provoking factors.

Новая инфекция COVID-19 бросила вызов мировой медицинской науке, и, как выяснилось, не все традиционные подходы, использовавшиеся ранее, оказались приемлемыми. В Москве 20 марта 2020 г. был зарегистрирован первый летальный исход от новой коронавирусной инфекции. На момент подготовки статьи в печать (через 6 нед) было зарегистрировано уже более 1000 смертей. Учитывая, что сохраняется прирост числа заболевших и, соответственно, умерших, выполнение анализа летальных исходов у первых (в хронологическом порядке больных) представляется исключительно актуальным. По мере накопления информации о новой коронавирусной инфекции наши действия и рекомендации по ее лечению будут меняться. Большинство лекарственных препаратов для лечения новой коронавирусной инфекции еще проходят клинические испытания. Вакцина не разработана, а данные по применению плазмы реконвалесцентов, гидроксихлорохина и ряда других препаратов недостаточны для выработки рекомендаций, отвечающих принципам доказательной медицины. Полагаем, что анализ первых 157 случаев смерти от новой коронавирусной инфекции — это лишь первый шаг к формированию тщательно выверенных рекомендаций по лечению COVID-19.

The article The article describes in detail the main stages of the diagnosis of voice disorders with an indication of the methods and major errors leading to an incorrect diagnosis. Since in some cases, impaired voice quality is the first and/ or only symptom of concomitant diseases of organs or systems of various etiologies, an expanded diagnostic search is required to make a correct diagnosis. The features of receiving of complaints and medical history from patients with laryngeal diseases, the guidelines for laryngoscopy are described. A description of the laryngoscopic vew is presented, which helps in the diagnosis of the initial stages of Reinke’s edema, hyperplastic laryngitis and early stages of laryngeal cancer. The relationship between the functional and organic pathology of the larynx is very close, it can be difficult to understand the root cause of voice disorder, this leads to incorrect treatment tactics, the progression and relapse of the disease. The causes of laryngeal diseases of an organic and functional nature, the features of the clinical picture and the differential diagnosis of voice disorders are considered. Cases of diagnosis, a clinic of chronic laryngitis, laryngomycosis, and laryngeal cancer are described; the main approaches to the treatment of laryngeal diseases are presented. The article will be useful to otorhinolaryngologists, phoniatricians of outpatient and inpatient care.

The paper describes 11 cases of local tumor-like amyloidosis (LTA) of the upper respiratory tract, among which laryngeal amyloidosis was most common. The clinical diagnosis of suspected local amyloidosis was made in only two cases. The diagnosis of local amyloidosis was established at a morphological examination of a distant neoplasm, by using special Congo red staining followed by polarizing microscopy. Attention is drawn to the localization and sequence of amyloid deposition and morphological changes related to the age of patients and the duration of the disease. The paper discusses the nature of local amyloidosis as stromal vascular proteinosis with the deposition of AL amyloid (immunoglobulin light chain amyloid) that are formed apparently by local immunocytes of the mucosa-associated lymphoid tissue (MALT) system. It emphasizes the need for the clinical monitoring of patients with LTA to rule out systemic amyloidosis.

The article describes the present-day approaches to the diagnostics and treatment of fungal infections of the larynx. The proportion of laryngomycosis in chronic inflammatory pathology is up to 24%, the main causative agents of laryngomycosis are yeast-like Candida fungi (up to 98%). The specific feature of treatment of patients with laryngomycosis is the combination of antimycotic therapy with complex laryngitis therapy. The optimal fungal laryngitis treatment method is the combined treatment with both systemic and topical antimycotics for 3 weeks using itraconazole (100–200 mg/day) or fluconazole (50–150 mg/day) and inhalations of 0.01% benzyldimethyl-myristoilamine-propylammonium solution or inhalations of amphotericin B. In case of combination of mycosis of larynx and pharynx, the treatment must be supplemented with topical pharyngomycosis therapy. The best results in the treatment of patients with fungal laryngitis are provided by combined antifungal therapy for 3 weeks in combination with endolaryngeal PhDT using 0.01% amethylene blue aqueous solution as a photosensitizer, and 0.3–0.5W laser radiation for 90–120 s under the control of indirect light guide microlaryngoscopy with diffusing tip using the apparatus Kreolka. Such combination of pharmacological and physical treatment methods has provided good results even in the patients in which the previous courses of antifungal therapy were ineffective.

The article deals with optimization of treatment policy for professional singers. The survey sample is 67 singers with vocal nodules of the age from 24 to 42 and the length of time worked from 3 to 28 years. The following methods are used: questionnaire survey (professional anamnesis, voice evaluation according to Visual Analog Scale (VAS), Spielberg-Hanin test), microlaryngoscopy, video endolaringostroboscopy, voice acoustic analysis (MDVP Kay Pentax system). The algorithm and evaluation criteria of vocal nodules treatment efficiency for the singers taking into account the specific character of their professional activity are proposed.

The objective of the present study was to elaborate the therapeutic algorithm for the treatment of laryngomycosis. We have examined a total of 430 patients suffering from chronic laryngitis including 100 ones (23.2%) having the fungal flora. Mycosis was diagnosed by the microscopic study of the stained preparations with the application of various techniques; moreover, cultivation in elective nutrient media was used. The yeast-like fungi of the genus Candida were identified in 98 (98%) and mold fungi of the genus Aspergillus in the remaining 2 (2%) patients. All these 100 patients were given the antifungal treatment. 98 of them presenting with candidal laryngitis were allocated to three groups. Group A was comprised of 33 patients who received the local treatment alone, group B contained 31 patients given only systemic therapy, and group C included 34 patients undergoing the combined treatment with the use of the medications possessed of both the local and systemic actions. The best clinical results were obtained in the patients of the latter group in which the therapeutic efficiency proved to be as high as 79.4%. It is concluded that all the patients suffering from laryngomycosis are in need of the combined treatment designed to eradicate the causative agent, restore the vocal function, and achieve the stable remission of the chronic inflammatory process in the larynx. The combined treatment with the antimycotic medications exhibiting both the general systemic and local activities during 3 weeks appears to be the optimal therapeutic modality for the management of laryngomycosis. Of special importance is the dynamic follow-up of the treated patients including the control examinations in the course of the treatment (days 7, 14, and 21) to be followed by the mycological study after the termination of therapy and its repetition every 3 months during the subsequent period.

The present study was designed to carry out the comprehensive clinical examination of 120 patients presenting with paresthesia of the upper respiratory tract (42 men (35%) and 78 women (65%P) aged 56 to 90 years). The most frequent complaints included cough (72%), globus sensation (46%), itching (43%), dry throat (38%), and difficulty of swallowing (28%). The duration of the clinical symptoms ranged from 1 month to 3 years (m±M: 1+to 1.46). The etiological factors behind paresthesias in the patients of the older age groups in comparison with the patients below 55 years of age included gastroenterological and cardiovascular diseases, pathology of the broncho-pulmonary system, and neurological pathology. ENT pathology was diagnosed equally often in the patients of both groups. Endocrine pathology and stress-associated conditions occurred more frequently in the patients below the age of 55 years. The intolerance of drugs was more commonly encountered in the patients of the older age group (amounting up to 35%). It is concluded that the ultimate etiological factor of paresthesia of the upper respiratory tract can be deduced based on the detection of a particular disease and the analysis of the dynamics of the patients' complaints after the completion of the adequate treatment.