Lipomas are the most common benign tumors of mesenchymal origin, very rarely found in the upper respiratory tract. Laryngeal lipomas are so rare that, to date, just over 100 cases have been described in the literature. This tumor has a slow growth and can manifest various symptoms due to the mass effect with compression of neighboring structures, causing dysphagia, hoarseness and life-threatening symptoms due to airway obstruction. For preoperative diagnosis, indirect laryngoscopy using flexible and rigid endoscopes, computer and magnetic resonance imaging can be used. These methods provide a volume of useful information sufficient for adequate treatment planning. Surgery is the method of choice and includes endoscopic and/or external surgical access. It is very important to completely remove the lipoma to avoid local recurrence. A clinical case. A 45-year-old patient came to our clinic with complaints of hoarseness of voice, a feeling of lack of air, which increases with physical exertion, the presence of a “swelling” on the front surface of the neck. For the first time, I noticed a change in voice about 22 years ago, the presence of a “swelling” on the neck – about 10 years ago. I did not seek medical help. Four years ago, he was examined by an ENT doctor, diagnosed with a neoplasm of the larynx, refused surgical treatment. Due to the increasing difficulty of breathing, in 2022 he entered our clinic for examination and surgical treatment. After the examination, a neoplasm of the larynx was revealed with its spread through the cricothyroid ligament to the anterior surface of the neck. The formation was removed using a combined approach: external and endoscopic (transoral laser microsurgery using CO2-laser). Histological examination revealed mature adipocytes without cellular atypia, which corresponded to a lipoma. It can be assumed that the tumor originated primarily in the larynx (as indicated by the anamnesis data, the presence of feeding vessels in the laryngeal component of the tumor) for a long time, and, having reached a certain size and experiencing pressure from surrounding tissues in the larynx, it began to spread along the inner surface of the thyroid cartilage plate downwards, pushing the thyroarytenoid muscle medially, and having reached the cricothyroid ligament and gradually stratified it, it continued to grow outward, into the area of the anterior surface of the neck. This access was necessary for the complete removal of a large lipoma, preventing the possibility of relapse and rapid rehabilitation of the patient. Conclusion. Patient R. underwent successful surgical treatment – removal of laryngeal lipoma spreading through a defect in the cricothyroid ligament to the anterior surface of the neck. In our opinion, the choice of combined access made it possible to radically remove the formation and preserve the anatomical structures of the larynx as much as possible, which made it possible to quickly restore vocal and respiratory functions. Липомы являются наиболее распространенными доброкачественными опухолями мезенхимального происхождения, очень редко встречающимися в верхних отделах дыхательных путей. Липомы гортани настолько редки, что на сегодняшний день описано в литературе чуть более 100 случаев. Данная опухоль имеет медленный рост и может проявляться различными симптомами за счет масс-эффекта со сдавлением соседних структур, вызывая дисфагию, охриплость и опасные для жизни симптомы из-за обструкции дыхательных путей. Для предоперационной диагностики можно использовать непрямую ларингоскопию с использованием гибких и жестких эндоскопов, компьютерную и магнитно-резонансную томографию. Данные методы дают объем полезной информации, достаточный для адекватного планирования лечения. Хирургия является методом выбора и включает эндоскопический и/или наружный хирургический доступ. Очень важно полностью удалить липому во избежание местного рецидива. Клинический случай. В нашу клинику обратился пациент 45 лет с жалобами на осиплость голоса, чувство нехватки воздуха, усиливающееся при физической нагрузке, наличие «припухлости» на передней поверхности шеи. Впервые изменение голоса заметил около 22 лет назад, наличие «припухлости» на шее – около 10 лет назад, за медицинской помощью не обращался. Четыре года назад осмотрен ЛОР-врачом, установлен диагноз «Новообразование гортани», от оперативного лечения отказался. В связи с нарастанием затруднения дыхания в 2022 г. поступил в нашу клинику для обследования и оперативного лечения. После проведенного обследования выявлено новообразование гортани с распространением его через перстнещитовидную связку на переднюю поверхность шеи. Образование было удалено с помощью комбинированного доступа: наружного и эндоскопического (трансоральной лазерной микрохирургии с применением СО2-лазера). По данным гистологического исследования выявлены зрелые адипоциты без клеточной атипии, что соответствовало липоме. Можно предположить, что опухоль первично возникла в гортани (на что указывают данные анамнеза, наличие питающих сосудов в гортанном компоненте опухоли) достаточно давно, и, достигнув определенного размера и оказывая давление окружающие ткани в области гортани, начала распространяться по внутренней поверхности пластинки щитовидного хряща вниз, отодвигая щиточерпаловидную мышцу медиально, и дойдя до перстнещитовидной связки и, постепенно расслоив ее, продолжила рост наружу в область передней поверхности шеи. Данный доступ был необходим для полного удаления большой липомы, предотвращения возможности рецидива и быстрой реабилитации пациента. Заключение. Пациенту P. было проведено успешное хирургическое лечение – удаление липомы гортани, распространяющейся через дефект в перстнещитовидной связке на переднюю поверхность шеи. По нашему мнению, выбор комбинированного доступа позволил радикально убрать образование и максимально сохранить анатомические структуры гортани, что позволило быстро восстановить голосовую и дыхательную функции.

The blast shock wave is the main damaging factor in conditions of modern armed conflict. The effect on the body of a loud sound and a sharp increase in air pressure in the environment leads to the development of acubarotrauma. The value of sanitary losses of the otorhinolaryngological profile amounted to 6.5% of the total number of requests for medical care at the advanced stage of providing specialized care. Damage to the ENT organs by a blast wave with the development of acubarotrauma out of the total number of sanitary losses of the otorhinolaryngological profile was 38%. The development of protective equipment has changed the nature of damage to the head and neck area toward a significant decrease in the number of isolated damages of the auditory system. A combination of acubarotrauma with shrapnel wounds of the head was observed in 17% of cases; with closed-head injury, in 43%; with shrapnel wounds of the upper and lower extremities, in 26%; with mechanical injuries, in 13%. Depending on the location of the victim relative to the shelter, the remoteness of the damaging factor, distinctive complaints, the nature of damage to the tympanic membrane, and acumetry data, 4 types of acubarotrauma were identified that can be used to determine the medical and evacuation characteristics of the victims. Timely provision of medical care, depending on the nature of the acubarotrauma, will allow the most effective use of the rehabilitation potential of a particular victim at the following stages of treatment.

According to statistics, the most common complaint to an ENT doctor is difficulty in nasal breathing. The leading cause of such complaints is the curvature of the nasal septum, vasomotor and hypertrophic rhinitis. These conditions cause changes in the quality of life in the human body, and most importantly, the development of chronic diseases. The purpose of the study: to identify general patterns in patients with nasal obstruction, to develop recommendations for managing patients in the postoperative period. Patients and methods. In the period from 2018 to 2020, we examined 96 people aged 20 to 40 years: 72 of them were men, 24 were women with varying severity of nasal obstruction syndrome. The control group consisted of 16 people who did not complain of difficulty in nasal breathing. The patients were divided into two groups: those who received conservative treatment, and the group that was planned to undergo a surgical intervention aimed at eliminating nasal obstruction. Further, in patients of both groups, indicators of the acid-base state of venous blood were evaluated. Results. Indicators of the acid-base state of venous blood in patients of the group treated with a course of nasal decongestants and intranasal glucocorticosteroids remained practically unchanged after the treatment. Recovery of indicators of the acid-base state of venous blood in patients who underwent surgery is fully determined by the third month after the surgical treatment. Conclusions: The prevalence of diseases, including the hypoxic component, determines the need to study and understand the mechanisms of hypoxia, as well as the issues of eliminating oxygen deficiency, the process of adaptation to it.

The condition of blood supply and microcirculation in the mucous membrane is considered to be the main factor determining the consistency of local flaps of the nasal mucous membrane.OBJECTIVETo assess the possibility of using autofluorescence endoscopy to control the condition of flaps of the nasal mucous membrane after surgical interventions.MATERIAL AND METHODSThe assessment of the processes of biological destruction of 15 fragments of the mucous membrane of the inferior nasal concha, obtained during intranasal interventions with endoscopic technique in autofluorescence mode, followed by histological examination at different periods of observation, has been conducted. The results of the proposed method were tested in 84 patients with chronic and intraoperative defects of the nasal septum after the surgical intervention.RESULTSIt has been shown that autofluorescence endoscopy can be used to assess the viability of flaps of the nasal cavity's mucous membrane. A change of the autofluorescence signal to a whitish and orange shades indicates the presence of ischemia and necrosis. Method sensitivity was 92.3%, specificity was 95.8% and total accuracy was 95.4%.CONCLUSIONThis method is promising for predicting the long-term outcomes of surgical treatment of the nasal septum's perforation in relation to the risk of reperforation forming, as well as for assessment of the functional viability of local flaps in plastic reconstruction of defects of the anterior skull base.

Increased vestibulo-vegetative sensitivity can occur when the vestibular analyzer is damaged (in particular, its peripheral part), it can also be congenital and manifest itself in the form of a condition such as motion sickness. In the first case, a person actively goes to the doctor with certain complaints, some pathology is identified, and appropriate treatment is prescribed. In the second case, problems arise only under certain external conditions – increased vestibular load, usually with the presence of Coriolis accelerations. When examining such persons, it is often only about the asymmetry of excitability between the right and left labyrinths. However, the issues of intralabyrinthine interaction both in pathology and in vestibular rehabilitation measures may be of interest to researchers as a direction for improving diagnostic methods and compensating for the pathology of the peripheral part of the vestibular analyzer. It was suggested that during regular vestibular loads in the form of vestibular training there is a change in the relationship between intralabyrinthine and interlabyrinthine excitability. Objective of the study. To determine whether the relationship between intralabyrinthine and interlabyrinthine excitability changes under the influence of nonexercise vestibular training in persons prone to motion sickness. Materials and methods. Preselected individuals with increased vestibulo-vegetative sensitivity underwent a course of vestibular training on a stabilometric platform according to the Rectis with optical stimulation program. Also, before and after the training course, each of them underwent video oculometry according to the algorithm we developed, when the rotation is performed alternately in the plane of each of the six semicircular canals. The analysis of changes in the indicators of video oculometry, which arose as a result of training, was carried out. Results. A relative change in both interlabyrinthine and intralabyrinthine excitability was revealed.

A survey of 48 victims aged 19-36 years with explosive trauma and combined damage to the auditory system was conducted to assess the level of damage to nerve structures by analyzing the bioelectric activity of the cerebral cortex. All patients underwent electroencephalography (EEG). It is established that akubarotrauma of explosive genesis almost always leads to lesions of the function of the cortical part of the auditory analyzer. Desynchronized activity on the EEG after acubarotrauma is a favorable prognostic sign, indicating only functional disorders of the cortical part of the auditory analyzer. On the contrary, EEG changes of an organic type of cortical or stem nature are an unfavorable prognostic factor, usually accompanied by sensorineural hearing loss with prolonged and incomplete hearing recovery. Promising drugs for the treatment of otoneurological disorders are antihypoxants, in particular, derivatives of triazine indole, which affect the molecular mechanisms of hypoxia development.

In recent decades, among diseases of the nose and paranasal sinuses, an increase in the number of people with perforations of the nasal septum has been noticeable. To date, the most effective method of treating perforations is operational. Currently, surgeons’ work on closing defects of the nasal septum does not always end with a positive result due to the fact that the transplant materials used in plastic surgery of perforations are often rejected some time after surgery and the perforations reappear. In our study, we treated 80 patients with septum defects in the age range from 18 to 63, for whom septum perforation was closed using transplant materials: fascia treated with Alloplant technology and allogeneic cartilage treated with Alloplant technology and without application. The septum defect closure performance was determined after 1 month and 1 year after surgery. The study revealed that plastic surgery of nasal septum perforations using transplant materials processed using Alloplant technology using the anatomical, clinical, and functional results of treatment one month and one year after surgery has a more effective method than the classical treatment method and leads to fast and full return of all functions of the mucous membrane of the nasal cavity.

The obstruction of nasal breathing due to vasomotor rhinitis is quite a common cause of visits to the ENT doctor. Today, it is believed that therapeutic measures should begin with the identification of possible causes that result in the formation of nasal hyperreactivity, and the treatment of the underlying disease. Medical treatment of vasomotor rhinitis can begin with the prescription of topical corticosteroids and antihistamines. The long-term observations have shown that the use of decongestants and topical steroids in the preoperative period reduces reactive phenomena in the nasal cavity after surgical treatment. To objectify the empirical observations, the authors have examined 20 patients after surgical intervention for vasomotor rhinitis in the scope of submucosal vasotomy. In the postoperative period, the patients were recommended regiminal and restrictive measures, and prescribed antihistamines and local irrigation therapy with warm saline. The authors assessed the transport function of the nasal cavity mucous membrane by the study of mucociliary transport rate in the test with coal dust and the respiratory function of the nasal cavity by the volumetric flow rate using anterior active rhinomanometry. The study revealed that the use of decongestants and topical steroids in the preoperative period reduces the reactive events in the postoperative period and shortens the patient’s rehabilitation period.

Surgical treatment of patients suffering from chronic suppurative otitis media is an important issue of otiatry. The high frequency of unsatisfactory results of surgical treatment of patients with chronic suppurative otitis media, the lack of optimal (generally accepted) approach to their surgical treatment, the persistent hearing loss after sanitizing operations determines the relevance of this problem: the need to identify the causes of unsatisfactory results, develop an algorithm and new methods of surgical treatment. ENT physicians generally believe that the obliteration of the mastoid cavity, applied after modified radical mastoidectomy, is sufficient to prevent such problems as otorrhea, infection, the proliferation of granulation tissue and hearing loss. Obliteration can be performed using various methods and materials, including autologous bone chips and dust, hydroxyapatite, cartilage, and periosteal-pericranial flaps. Obliteration of the mastoid cavity was proposed to facilitate healing and epithelialization and can be performed during the initial procedure of the canal plasty or during the secondary delayed procedure. Obliteration reduces the volume of the mastoid process cavity, thereby reducing the size of the lumen, which is necessary for effective control of the disease. Reduction of depth and the total volume of the mastoid cavity also provides the elimination of the areas with permanent accumulation of moisture, theoretically reducing the frequency of the necessary cleaning.

Improvement of statokinetic stability is a pressing problem of aviation medicine in view of progress in aviation engineering. As the speed and maneuver capability of aircrafts grew, the conflict between a continuous increase in available power and constant psychophysiological abilities of the human body becomes inevitably harder. Statistics evidences that 49.0% of aviation accidents are due to erroneous actions of pilots. Today, tough mental activity is involved in an aviator’s labor, while the body is affected by a broad variety of flight-related factors. Information flow analysis, instant decision making, and control of aircraft strain the psychophysiological human abilities to their limit. All aircrew members must keep being professionally effective throughout the mission. This circumstance warrants the development of appropriate means and methods to improve the statokinetic stability in air and space crews. The objective of this work was to study the psychophysiological dynamics during statokinetic perturbations prior to and after a course of electrical tranquilization of the central nervous system (CNS) in combination with modified Yarotsky’s test (MYT). Statokinetic perturbations were modeled using a continuous Coriolis acceleration accumulation test (CAAT) in a rotating chair. The indices under study included the maximum CAAT tolerance time and the strengths of vestibular sensory, vestibular vegetative, and vestibular somatic reactions. Functional characteristics were tested using complex functional computer stabilography (CFCS). An analysis of the results led to the conclusion that a course of CNS electrical tranquilization in combination with MYT is highly efficient.

The objective of the study of specific features of microstructural changes of the central part of auditory system in 17 patients with chronic ear diseases before and after ear surgery by means of MR-morphometry and diffusion tensor tractography. The obtained data of the volume of the grey matter and the thickness of cortex of definite structures related to auditory information processing have been compared with the results of 20 healthy persons. Besides, the study of the functional state of the airways in terms of fractional anisotropy index has been performed. The obtained changes in the grey and white matter of brain prove the microstructural reorganization in the central part of auditory system in hearing-impaired patients. It has been found out that the main changes concerned the increase of the volume of the grey matter and the thickness of cortex in the areas of hearing fields of the right hemisphere (superior temporal sulcus and gyrus). The revealed structural transformation phenomena might result from the long-term sensory deprivation related to hearing loss. The follow-up comparison made in 12 months after the ear surgery revealed the signs of restoration of morphometric values in a number of structures of the central part of auditory system.

The objective of the research is to evaluate the efficacy of rehabilitation in 73 patients with hearing and vestibulation impairment after ear surgery. Rehabilitation had the form of a set of auditory and vestibular training in conditions of non­invasive neuromodulation. Vestibular training had the form of an exercise on equilibrium control with the eyes closed performed with the help of Brain Port device during a week after surgery. Audial training was a 10-days acoustic stimulation on the expiry of 1 month after surgery. In both cases non­invasive neuromodulation was provided by electrotactile stimulation of tongue using Brain Port device. The data of tone threshold audiometry, speech intelligibility in conditions of speech interference, computerized posturography and gate examination were evaluated. The results confirm effectiveness of the used rehabilitation activities for speech intelligibility and gait improvement in majority of the patients.