[Residency is a fundamental stage of professional training of an otorhinolaryngologist]

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.

[Control of hormonal rhinitis symptoms in patients with hypothyrosis: pathogenetic and clinical aspects]

BACKGROUND

One of the poorly studied sections of the pathology of ENT organs is chronic rhinitis in patients with hypothyroidism, the pathogenesis of which has not been fully understood, the diagnosis causes significant difficulties, and there are no recommendations for treatment. Despite receiving replacement therapy with levothyroxine, the symptoms of rhinitis persist.

OBJECTIVE

To study the effectiveness of the use of intranasal glucocorticosteroids in patients with chronic rhinitis and hypothyroidism.

MATERIAL AND METHODS

Patients with chronic rhinitis and hypothyroidism used mometasone nasal spray 100 mcg 1 time per day for a course of treatment of 2 months (n=60). To assess the symptoms of rhinitis, a visual analog scale (0-10 points), endoscopic examination of ENT organs, anterior active rhinomanometry were used. Evaluation of mucociliary transport was used a saccharin test. The concentration of transforming growth factor (TGF-β1) in nasal secretion and blood serum was studied by ELISA (Enzyme-Linked Immunosorbent Assay), the number of metabolites of NO - nitrites+nitrates (NOx) was recorded by colorimetric method.

RESULTS

The use of mometasone nasal spray in patients with hypothyroidism helped to reduce complaints on a visual-analog scale (difficulty in nasal breathing, rhinorrhea) and improve nasal breathing according to anterior active rhinomanometry. The concentrations of TGF-β1 and NOx in nasal secretions before mometasone treatment were higher than after treatment, which probably indicates the contribution of these substances to the formation of edematous hypertrophic changes from the nose in patients with hypothyroidism.

[Epidemiology and modern methods of treatment of non-traumatic nosebleeds]

Data on the detection incidence of nosebleeds (NBs) of non-traumatic origin in the population show considerable variability in statistical indicators, and NBs treatment and consequences depend on the localization of hemorrhage source, the volume of blood loss, patient's general condition, the presence and nature of comorbid pathology and a number of other factors. There are some differences in the choice of NBs treatment options, evaluation of their clinical and economic efficiency, which indicates the need to analyze and systematize the results of such studies.

OBJECTIVE

To analyze data on prevalence and current treatment approaches of non-traumatic nosebleeds.

MATERIAL AND METHODS

The search for publications (articles and related abstracts) on the subject of the study, presented in the PubMed database, has been conducted. The choice of material was made according to the following key words: non-traumatic nosebleeds, causes, incidence, methods of stopping nosebleeds.

RESULTS

The literature data show a significant prevalence of NBs in the population, their potential hazard to the life of patient and the importance of clinical and demographic characteristics of persons for determining treatment tactics in each case. In practical terms, primary and secondary NBs should be distinguished. In case of primary NB, the use of coagulation and nasal packing is recommended after determining the place of bleeding. In secondary NB it is necessary to establish its cause in order to assess risk factors and apply appropriate topical or systemic drug therapy. The so-called difficult (difficult-to-treat) NBs deserve special attention. As a rule, these cases involve bleeding from the posterior parts of nose. The analysis of publications shows a high (90%) efficacy of surgical interventions, used as first-line treatment. Effectiveness of embolization in such cases was 75% and of anterior/posterior nasal packing was 62%.

CONCLUSION

The literature data show a significant prevalence of nosebleeds in the population and their potential hazard to the life of patient. The existing differences in the assessments of treatment options for this pathology, their clinical and economic efficiency are the basis for further research, in particular, to clarify the causes of nosebleeds' occurrence and recurrence, the impact of treatment methods on quality of patients' life.

[Features of adherence to treatment of patients with chronic rhinosinusitis with nasal polyps]

Chronic polypous rhinosinusitis (CPR) is characterized by refractory to drug therapy and a high potential for recurrence after surgical treatment. One of the important factors limiting the effectiveness of drug therapy of CPR, in particular intranasal glucocorticosteroids (inGCSs), is the insufficient level of adherence to treatment of patients with CPR.

OBJECTIVE

Generalization of data on the significance and ways to increase adherence to treatment of patients with CPR.

MATERIAL AND METHODS

Materials of scientific publications included in the Cochrane Library, Russian Science Citation Index, MEDLINE, PubMed information bases were used as a data source. The material was selected based on the following keywords: "chronic rhinosinusitis", "nasal polyps", "intranasal glucocorticosteroids", "adherence to treatment".

RESULTS

Despite the fact that inGCSs are one of the main pathogenetically justified methods of treating CPR, their use is limited by many factors, one of which is the level of patient compliance with the treatment regimen.

CONCLUSION

Improving adherence to treatment is one of the important reserves for increasing the effectiveness of drug therapy for chronic polypous rhinosinusitis.

[Hereditary hemorrhagic telangiectasia (Rendu-Osler syndrome)]

The analysis of publications is carried out and current data concerning the etiology, pathogenesis, diagnosis, and principles of treatment of hereditary hemorrhagic telangiectasia are presented.

[The effectiveness of complex drugs in the treatment of acute rhinitis]

Purpose of the study. Generalization of data on the value of alternative and additional treatment of acute infectious rhinitis with Korizalia.

MATERIAL AND METHODS

The material of scientific publications included in the Cochrane Library, information bases of the RSCI, MEDLINE, PubMed was used as a data source. The choice of material was carried out using the key words: colds, acute rhinitis, herbal medicine, homeopathic remedies.

RESULTS

Analysis of published clinical trial descriptions suggests the potential value of homeopathic medicines, in particular Korizalia, in improving the effectiveness of the treatment of acute rhinitis. The use of Korizalia in acute infectious rhinitis was more effective in relation to the main symptoms of ARI compared with placebo.

CONCLUSION

The lack of optimal drugs for the etiotropic treatment of viral acute respiratory infections determines the relevance of alternative and complementary methods of treatment using drugs of natural origin. The drug Korizalia can be used for acute respiratory infections (acute infectious rhinitis) as an alternative drug or in combination with other drugs.

[External otitis: clinical diagnostics and treatment tactics]

OBJECTIVE

To summarize modern data about the epidemiology, etiology, clinical course and diagnosis of otitis externa.

MATERIAL AND METHODS

Materials of scientific publications included in the Cochrane Library, information bases of the RSCI, MEDLINE, PubMed were used as a data source. The choice of material was carried out according to the keywords: otitis externa, etiology, diagnosis, treatment, local treatment.

RESULTS

The role of combined drugs in the main etiopathogenetic mechanisms of the external ear inflammatory process is shown.

CONCLUSION

Analysis of published data from clinical trials indicates the importance of a fixed antibacterial agents and anesthetic combination in increasing the effectiveness of topical therapy for otitis externa.

[Acute sinusitis: topical issues of terminology and diagnosis]

OBJECTIVE

To analyze and summarize data on terminology, etiology, diagnostic criteria for acute sinusitis.

DATA SOURCES

Publications (articles and related abstracts) submitted to the PubMed database. The choice of material was carried out, according to the keywords: cold, acute viral sinusitis, acute bacterial sinusitis, post-viral sinusitis, acute respiratory viral infection, diagnosis of acute sinusitis.

RESULTS

The published research results indicate the existence of certain disagreements regarding the terminology, diagnostic criteria, indications for diagnostic studies in acute sinusitis. The data on the etiology, pathogenesis, and diagnostic features of acute sinusitis are presented in the current guidelines, reviews and publications of the results of clinical trials.

[Herbal medicine for acute sinusitis - current trends]

THE AIM OF THE STUDY

Was to summarize data on the role and place of herbal remedies, in particular, the extract from the roots of Pelargonium sidoides (EPs 7630) in the treatment of acute sinusitis.

MATERIAL AND METHODS

Materials of scientific publications included in the Cochrane Library, information bases of the RSCI, MEDLINE, PubMed were used as a data source. The choice of material was carried out according to the keywords: epidemiology of acute sinusitis, modern treatment of acute sinusitis, colds, herbal remedies, Pelargonium sidoides.

RESULTS

Analysis of published clinical trial data demonstrates evidence that EPs 7630 is significantly superior to placebo in reducing the duration and severity of symptoms of acute respiratory infection and indicates the advisability of including an extract from Pelargonium sidoides (EPs 7630) roots in OS treatment protocols. The high safety profile and clinically significant efficacy of this drug make EPs 7630 an important component of drug therapy for acute sinusitis.

[Systemic and local antibiotic therapy for acute sinusitis]

The purpose of the study was to summarize data on modern antibiotic therapy for acute sinusitis, the role and place of topical antibacterial drugs, in particular Fluimucil-Antibiotic, in modern treatment strategies for this disease.

METHODS

Search in the PUBMED electronic database (articles and related abstracts) for the keywords «acute sinusitis", «antibiotics», «thiamphenicol glycinate acetylcysteine» «biofilm», «respiratory tract infection», «N-acetylcysteine».

RESULTS

The published research results indicate the high antibacterial activity of the Fluimucil-Antibiotic, in particular, for the topical drug use in the form of inhalations, applications, irrigation, and instillations. The published research results indicate a wide spectrum of antimicrobial action of Fluimucil-Antibiotic, its ability to destroy biofilms and prevent their formation, good pharmacokinetics, safety, which makes it possible to consider it as a potential treatment option for acute sinusitis in everyday practice.

[ENT care in the context of the new coronavirus infection COVID-19]

The spread of the pandemic of the new coronavirus infection COVID-19 inevitably makes adjustments to the medical care. Given that the main route of transmission is airborne, otorhinolaryngologists are at increased risk of infection. Based on the literature data of leading otorhinolaryngologists, as well as their own experience working with patients with the new coronavirus infection COVID-19, the authors present relevant recommendations on the organization of specialized otorhinolaryngological care in the context of the COVID-19 pandemic. The authors consider the etiology, pathogenesis, and clinical manifestations of COVID-19. The features of the examination of ENT, diagnostic and therapeutic procedures, including the use of silicone hydrotamps to stop the front and rear nose bleeds, developed in L.I. Sverzhevskiy OHRIM, and indications for hospitalization in the ENT hospital. Features of operations on the otorhinolaryngological profile during a COVID pandemic are also described. Summing up, the authors indicate that during the pandemic of the new coronavirus infection COVID-19, otorhinolaryngologists need to adhere to two fundamental principles aimed at preventing the spread of infection: the use of modern effective personal protective equipment and the use of examination methods (surgical treatment methods) that prevent the formation of biological aerosols.

[The state of regional lymph nodes in chronic tonsillitis according to ultrasound]

Despite the variety of chronic tonsillitis clinical symptoms, none of the known signs of this disease is typical for it.

PURPOSE OF STUDY

Is development of a method for differential diagnosis of complicated (toxic-allergic) and uncomplicated (simple) forms of chronic tonsillitis.

METHODS

147 patients were divided into 2 groups: 1) 61 (42%) - with a simple form and 2) 86 (58%) - with a toxic-allergic form of chronic tonsillitis of the II degree. Patients underwent ultrasound examination of regional lymph nodes, to determine their localization, quantity (single, multiple), shape, size and structure.

RESULTS

According to ultrasound data, it was revealed that for the simple form of chronic tonsillitis the following characteristics of the lymph nodes were typical - bean-like form, single, clear contours, homogeneous central parts and reduced vascularization; for the toxic-allergic form of chronic tonsillitis, the following characteristics of lymph nodes were revealed - oval shape, lymph nodes conglomerates, hypoechoic central parts, increased vascularization and irregular shape of the gates.

CONCLUSION

The proposed method allows to quickly and efficiently conduct differential diagnosis of chronic tonsillitis. This technique is easily reproducible in the conditions of any (outpatient, inpatient) medical facility using standard equipment for ultrasound examination, does not require the use of any drugs.

[Peculiarities of the ENT-organ condition in hypothyroidism]

BACKGROUND

The interrelationship of thyroid pathology and ENT organs is one of the least studied aspects of iodine deficiency diseases. Diseases of this localization are distinguished by a variety of their causes, high prevalence, a tendency to prolonged and chronic process, resistance to drug therapy and a negative effect on the quality of life of patients.

AIM

To study the state of ENT organs in hypothyroidism in the iodine-deficient region of Eastern Siberia (Irkutsk Region).

MATERIAL AND METHODS

The main group consisted of 302 patients with hypothyroidism, and the control group - 116 people without thyroid pathology. All patients who participated in the study were on replacement therapy (Levothyroxin). An objective study of the ENT organs was performed using an endoscope and a microscope. The SF-36 questionnaire was used to study the indicators of quality of life. A questionnaire was used to assess the symptoms of rhinitis, which provided clarification of the severity of symptoms on a visual analogue scale.

RESULTS

Among patients with thyroid dysfunction, various changes characteristic of chronic pathology of the pharynx, larynx, and ear were found with almost the same frequency as among those examined without thyroid pathology. Chronic rhinitis in hypothyroidism is characterized by manifest edematous-hypertrophic changes in the turbinate, intense hyperemia of the nasal mucosa, the presence in the nasal passages of viscous, thick mucous discharge. The most important integral indicators of health components are physical (PH) and psychological (MH) patients with chronic rhinitis were reduced (50.6±1.96 and 53.0±2.08 respectively).

CONCLUSION

The symptoms of rhinitis are leading in the structure of the pathology of the upper respiratory tract in hypothyroidism and have a significant negative impact on the patient's quality of life indicators.

[Presbyacusis]

In the world, the spread of hearing loss due to age is an important socio-medical problem. Age-related hearing loss is the result of the biological process of aging of the tissue elements of the auditory analyzer. Changes in hearing develops by a complex of factors associated with both genetic, environmental and social aspects. Presbycusis is one of the causes of human cognitive disorders. Recent studies on hearing impairment prove a correlation with cognitive processes that increase the risk of dementia in the elderly. Timely rehabilitation of hearing with the use of hearing aids allows you to delay the processes of inhibition of cognitive function, and allows older people to prolong active longevity. Patients require consistent auditory and cognitive training for better socialization.

[Nasal irrigation: opportunities and disadvantages]

RELEVANCE

Despite the widespread use of nasal irrigation in routine medical practice and a significant list of salt solution for nasal irrigation on the pharmaceutical market, contradictions remain in understanding of process essence, when salt solution acts on the mucous membrane of nasal cavity and evaluation of their effectiveness.

AIM

analysis of current data of frequency, methods and efficiency of systematic nasal irrigation and effect of salt solution at the mucous membrane of nasal cavity.

RESULTS

In review the authors generalized and analyzed recent information about meaning of nasal irrigation for upper respiratory tract disease, about role of nasal mucus at maintaining homeostasis in nasal cavity and initial respiratory tract in general. Describes the data about effect of nasal irrigation on antinfectious protect of mucous membrane of nasal cavity.

[Medically-induced rhinitis]

This paper summarizes the currently accepted concepts of the pathogenetic mechanisms underlying the morphological and functional changes in intranasal mucosa of the patients having a long history of the application of the long-acting topical vasoconstrictor agents. The author presents the data illustrating the effectiveness of various methods for the pharmacotherapeutic treatment of medically-induced rhinitis.

[The use of modern topical medications for the stepwise treatment of allergic rhinitis: the effectiveness and prospects for the further extension of their application]

The objective of the present work was to summarize the results of clinical studies designed to evaluate the effectiveness of 'Momate Rhino Advance' in the form of the nasal spray (based on the fixed combination of mometasone furoate and azelastine) that finds an increasingly wide application for the treatment of allergic rhinitis. The available data give evidence that this medication can be prescribed to the patients presenting with the severe and moderate form of allergic rhinitis. The treatment should be started with the use of the combined preparation and continued, after the adequate control of the clinical symptoms of allergic rhinitis is achieved, using 'Momate Rhino' during the next 2-4 weeks for the reliable management of the disease. It is concluded that the proposed strategy makes it possible to avoid the simultaneous application of multiple medications (polypragmasy) and thereby reduce the intake of medicines by the patients suffering from allergic rhinitis.

[The modern strategies for the treatment of allergic rhinitis]

The present literature review had the objective to analyze the published data concerning the effectiveness of intranasal administration of antihistamine preparations and intranasal glucocorticoids for the treatment of allergic rhinitis. Special emphasis is placed on the clinical significance and the further prospects for the application of a fixed combination of these medications including azelastineplusmometasonefuroateas the first choice therapy of moderately severe and severe manifestations of allergic rhinitis.

[A coughing patients makes a visit to the otorhinolaryngologist's office: the practical aspects of diagnostics and treatment]

This article summarizes the modern concepts of the most common causes and mechanism underlying the development of cough. The significance of pathogenetic cough-suppressant therapy is emphasized with special reference to the following aspects: the importance of reducing the thickness or bronchial secretions, its more efficient removal from the lumen of the respiratory passages, creation of the prerequisites for regression of the inflammatory process, lowering the intensity of cough, improvement of subjective feelings and the quality of life of a given patient. The advantages of the application of the compounded preparations containing synergic components responsible for the high therapeutic effectiveness of these medicines is demonstrated as exemplified by the ingredients of the ascoril expectorant. It is concluded that this medication should be recommended for the treatment of patients suffering from cough of the known nature.

[The remote post-graduate education in otorhinolaryngology: the first results and further prospects]

The objective of the present work was the retrospective analysis of the efficiency of two courses of remote education of otorhinolaryngologists in the real-time mode based on the results of the on-line questionnaire study. We analyzed the data obtained during the implementation of the pilot project of the remote post-graduate education at the Department of Otorhinolaryngology,Russian Medical Academy of Post-Graduate Education making use of the independent Internet resource for the professional training of otorhinolaryngologists. The two programs of remote education realized in 2012 and 2013 involved 7.9% of all otorhinolaryngologists practicing in the Russian Federation. The fraction of those who passed through all stages of the learning process increased almost two-fold, that is from 10% in 2012 up to 19% in 2013. About 14% of the participants made themselves familiar with all program modules; this result is in agreement with the data obtained in mass on-line remote teaching of the non-medical audience. It is concluded that the results of the present study provide a basis for the elaboration of the remote education programs for the training of specialists not only in otorhinolaryngology but also in other fields of medicine.

[Prospects for the application of bacteriophages in otorhinolaryngology]

The objective of the present work was to summarize the available literature data concerning the importance of and prospects for for the application of bacteriophages for the treatment of the most common diseases of the upper respiratory tract and the ear.

[Acute tonsillopharyngitis: the effectiveness of topical therapy]

The objective of the present study was to evaluate the clinical effectiveness of a furasol sore throat gargle solution for the treatment of acute tonsillopharyngitis. Forty patients presenting with acute tonsillopharyngitis were allocated to two groups, 20 subjects in each, by means of independent sequential randomization. Prior to the onset of the treatment, all the patients were examined for determining the species composition of pharyngeal microflora with the use of an «AutoScan4 System» analyzer («Siemens», USA) and estimating the resistance to antibacterial preparations (by the disk diffusion method). All the participants of the study were prescribed antibacterial therapy. In the patients of group 1 (study group), the antibacterial treatment of acute tonsillopharyngitis was supplemented by a furasol sore throat gargle solution whereas those of group 2 (controls) were treated without topical therapy. The quantitative evaluation of the severity of manifestations of the disease before and after the treatment was based on a 5-point visual-analog scale. It was shown that systemic antibacterial therapy resulted in the consistent decrease of the frequency of occurrence of pathogenic and potentially pathogenic microflora in the patients comprising both groups. Treatment with a furasol sore throat gargle solution did not lead to the appearance of bacterial species alien to the oropharynx, nor was it accompanied by the impairment of resistance of its mucous membrane to the colonization by microorganisms. The results of the study give evidence of the well apparent regression of the subjective signs of tonsillopharyngitis and the inflammatory changes in the mucous membrane of the pharynx in the patients given the topical treatment in the form of a furasol sore throat gargle solution in addition to antibacterial therapy. It is concluded that a furasol sore throat gargle solution can be recommended for the introduction into the combined treatment of the patients presenting with acute tonsillopharyngitis.