Vol 5, No 1 (2020)


Current aspects of treatment of patients with bilateral laryngeal paralysis

Kirasirova E.A., Lafutkina N.V., Mamedov R.F., Rezakov R.A., Usova M.I., Kulabukhov E.V.


Objectives - to improve the effectiveness of treatment of patients with bilateral laryngeal paralysis by developing a treatment algorithm, justifying the surgical methods and the criteria for the effectiveness evaluation. Material and methods. 52 patients (including 49 women and 3 men) with bilateral larynx paralysis were examined and operated in 2017-2019. The age of the patients ranged from 27 to 71 years. 20 patients underwent the laryngoplasty, including the right-side myoaritenoidchordectomy with laterofixing of the opposite vocal fold with external access. 32 patients received the laryngoplasty with microsurgical technique under the direct support laryngoscopy. Results. The differentiated approach to the surgical treatment of patients with bilateral larynx paralysis allowed to decannulate 97% of patients in early postoperative period with restoration of the respiratory function and preservation of the voice function. In 2 patients it was impossible to form a physiological glottic chink due to a rough scar-dystrophic process in the surgery area. Conclusion. The preliminary use of tracheostomy tube is a factor that impairs the effectiveness of reconstructive surgical interventions in patients with bilateral laryngeal paralysis, if compared to patients with single-step tracheostomy and laryngoplasty. The long course of the bilateral laryngeal paralysis (more than 1 year) leads to persistent and irreversible pathological changes in the arytenoid cartilage and vocal folds. Minimally invasive techniques for the bilateral laryngeal paralysis treatment under the direct support laryngoscopy are the "gold standard" of global laryngology, if the indications for surgery are strictly observed. In all other cases, the patients are subject to a one-step reconstructive surgery with an open approach to the paralyzed voice fold.
Science and Innovations in Medicine. 2020;5(1):4-8
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Diagnosis of anxiety-depression disorders in patients with laryngeal granuloma

Kryukov A.I., Veltischev D.Y., Zeltyn A.E., Seravina O.F., Romanenko S.G., Teplykh E.A.


Objectives - to determine the variants of psychiatric disorders in patients with laryngeal granuloma using the affectivity-stress model, based on the complex psychopathological and clinical-psychological diagnostics of anxiety-depression disorders (ADD). Material and methods. We examined 80 patients, aged from 33 to 65 years. Postintubation granuloma was diagnosed in 7 patients. GERD was diagnosed in 56 patients. 49 patients had a relapse granulomas after surgery. Results and Conclusion. The correlation of laryngeal granuloma with the disorders of the anxiety-depression spectrum (ADD) was established. In most patients, the development of granuloma occurred with underlying psychiatric disorder. The role of anxiety in the structure of ADDs and the significance of their diagnosis for the choice of therapeutic tactics is proved. It is necessary to examine the patients with laryngeal granuloma for the presence of ADDs, and to consult a psychiatrist to determine an individual therapeutic tactics.
Science and Innovations in Medicine. 2020;5(1):9-13
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A new method of endonasal dacryocystorhinostomy

Volov N.V.


Objectives - to improve the quality of surgical treatment of patients with chronic dacryocystitis. Material and methods. Six people participated in the study. All the examined and operated patients were diagnosed with chronic dacryocystitis. The patients' examination included the consultation of an ophthalmologists, an otolaryngologist, and an internist, a CT scan of nose, paranasal sinuses, nasolacrimal canal, a video endoscopic study of the nasal cavity. Each patient had indications for surgery. An endonasal dacryocystorhinostomy was performed under the control of video endoscopic technique using the N.V. Volov's Elevator. The surgical approach - via the inferior nasal meatus, under the inferior nasal concha. The surgical method - breaking out of the bone window is performed by turning the elevator medially from the side of the lachrymal sac into the nasal cavity. Results. There were no intraoperative complications. The operation time was less than five minutes. The treatment was carried out on an outpatient basis. During the follow-up period (2-6 months) no relapses were registered. These facts can be regarded as the advantages of this method of surgical treatment of dacryocystitis. Conclusion. The method of endonasal dacryocystorhinostomy, performed through the inferior nasal meatus using an elevator, significantly reduces the time of formation of the bone window and the imposition of the anastomosis between the lachrymal sac and the nasal cavity. The process of intraoperative search for the projection of the nasolacrimal canal simplifies. It also reduces the wound surface and shortens the rehabilitation period.
Science and Innovations in Medicine. 2020;5(1):14-16
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Isolated lesions of the sphenoid sinus: features of diagnosis and treatment

Larin R.A., Krasilnikova S.V., Shakhov A.V., Suzaeva P.V., Pisarev E.N.


Objectives - to analyze the cases of isolated lesions of the sphenoid sinuses and to identify the main errors in the differential diagnosis in the prehospital and treatment periods. Material and methods. The study includes the data on the treatment of 58 patients with an isolated lesion of the sphenoid sinus in the period 2015-2018. The patients' age varied from 18 to 68 years. Gender distribution: men - 21 (30.7%), women - 37 (69.3%). Results. The following surgical approaches were used: transnasal access, extended transnasal access, transetmoid access, access according to the Bolger Box technique. In one case, the transpterygoid approach was used. When performing extended access, it was possible to achieve the formation of persistent, epithelized anastomosis in all the cases. In polypous-purulent forms of sphenoiditis, the relapses of the disease were most often observed, however, only anti-inflammatory therapy was required, including a sinus irrigation through the formed anastomosis. Conclusion. Further studies are required, to examine the features/ safety and clinical efficacy of the various endosurgical approaches.
Science and Innovations in Medicine. 2020;5(1):17-22
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Evaluation of mucociliary clearance in the postoperative period after a maxillary sinus surgery

Mareev O.V., Mareev G.O., Fedosov I.V., Ermakov I.Y.


Objectives - evaluation of the local function of the mucociliary clearance (MCC) in the postoperative period in patients with foreign bodies in the maxillary sinuses, who have undergone various surgical treatment. Material and methods. Using an original analysis technique for highspeed digital video recording of a microscopic picture of a specimen, obtained by brush biopsy from specific regions of the nasal cavity and paranasal sinus under endoscopic control, the MCC of the nasal mucosa was evaluated in the control group (n=60) and in the group of patients, who received various surgery (n=60) of maxillary sinuses. Results. We obtained the data on persistent and apparent local MCC disorders in the field of the surgical intervention in the postoperative period. Conclusion. Surgical interventions with access not in the area of the natural ostium of the maxillary sinus are more gentle, since they do not injure the mucociliary clearance in the key region - the ostium.
Science and Innovations in Medicine. 2020;5(1):23-27
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Morphological and functional state of the nasal cavity after surgical interventions in the vertical section of the lacrimal ducts

Fileva L.V., Ovchinnikov A.Y.


Objectives - to compare the condition of the nasal cavity after a dacryocystorhinostomy of external and endonasal access. Material and methods. Comparative assessment of the results of the study of 96 patients with chronic dacryocystitis was done. The patients were divided into 2 groups: group 1 included persons who underwent the videoendoscopic endonasal dacryocystorhinostomy; group 2 - patients with external dacryocystorhinostomy. For all the participants, there were registered the complaints and anamnesis, the data of video-endoscopy of the nasal cavity, anterior active rhinomanometry, transport and olfactory functions. The information on the state of the nasal cavity after surgery in the vertical section of the lacrimal ducts was also obtained. Results. In both groups we revealed the changes in the mucous membrane, in the anatomical structures of the nasal cavity, in the mobility of the ciliated epithelium, respiratory functions and olfaction. When comparing the results in both groups, the statistically significant differences were found in the questionnaire data - a complaint of lacrimation, and the data on the mucociliary clearance disorders (p<0.05). Conclusion. According to the questionnaire data, in group 2, after external dacryocystorhinostomy, lacrimation was more often observed -in 63.63% of patients. An increase in the time of mucus advancement up to 35.0 minutes (normal to 15.0 minutes) in group 2 is most likely due to the more common thickening of the lower nasal concha, if compared to patients in group 1.
Science and Innovations in Medicine. 2020;5(1):28-31
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Current principles of management of massive cholesteatoma and temporal bone pyramid defect

Baryshevskaya L.A., Zelter P.M., Chernyshenko I.O., Zelyova O.V., Koldova E.V.


Objectives - to present a modern approach to the diagnosis and treatment of chronic suppurative otitis media with cholesteatoma, which led to a defect in the upper wall of the temporal bone pyramid. The case presented emphasizes the importance of timely diagnosis and treatment of this disease. Material and methods. Complaints, anamnesis, data from objective examination, additional methods of examination (high-frequency tone threshold audiometry multispiral computed tomography of temporal bones, diffusion-weighted magnetic resonance imaging of the brain). Conclusion. An innovative integrated approach, using radiological methods for studying the temporal bone (temporal bone multispiral CT, diffusion-weighted MRI of the brain), allows to diagnose cholesteatoma, the presence of bone-destructive changes in the structures of the middle and inner ear, as well as to determine the boundaries of the formed structure, which is important for planning modern surgical intervention.
Science and Innovations in Medicine. 2020;5(1):32-35
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The use of speech sentence audiometry in a free sound field

Boboshko M.Y., Berdnikova I.P., Maltzeva N.V.


Objectives -to determine the normative data of sentence speech intelligibility in a free sound field and to estimate the applicability of the Russian Matrix Sentence test (RuMatrix) for assessment of the hearing aid fitting benefit. Material and methods. 10 people with normal hearing and 28 users of hearing aids with moderate to severe sensorineural hearing loss were involved in the study. RuMatrix test both in quiet and in noise was performed in a free sound field. All patients filled in the COSI questionnaire. Results. The hearing impaired patients were divided into two subgroups: the 1st with high and the 2nd with low hearing aid benefit, according to the COSI questionnaire. In the 1st subgroup, the threshold for the sentence intelligibility in quiet was 34.9 ± 6.4 dB SPL, and in noise -3.3 ± 1.4 dB SNR, in the 2nd subgroup 41.7 ± 11.5 dB SPL and 0.15 ± 3.45 dB SNR, respectively. The significant difference between the data of both subgroups and the norm was registered (p <0.05). Conclusion. High informative value of sentence speech audiometry in a free sound field for assessment of the hearing aid fitting benefit is shown. The higher sensitivity of testing in the noise condition compared with the studies in quiet was revealed.
Science and Innovations in Medicine. 2020;5(1):36-39
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Review of integrated solutions for rehabilitation of sensorineural hearing loss in adults

Vladimirova T.Y., Kurenkov A.V., Aizenshtadt L.V., Galieva K.R.


Objectives - to analyse the complex solutions for rehabilitation of sensorineural hearing loss in adults and elderly people. Material and methods. We reviewed 27 articles on the problem, published in the recent 5 years, presented in the international databases PubMed, Scopus and E-library. Conclusion. The rehabilitation procedure for chronic SNHL is quite clearly regulated and defined at the state level only for the person with hearing disabilities. While determining the needs of the disabled person in rehabilitation, the recommended rehabilitation approaches are described. However, in the normative documents, there is no clearly defined rehabilitation algorithm, taking into account the patient's individual characteristics. A high index of multimorbidity in adults with SNHL, including anxiety-depressive disorders and cognitive deficit, determines the need for inclusion of the auditory training in the rehabilitation process. The use of various options for auditory training along with electro-acoustic correction of hearing or cochlear implantation is an essential component of an individual rehabilitation program.
Science and Innovations in Medicine. 2020;5(1):40-43
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Middle ear functional state in case of pathological changes of nose and throat

Kalesnikava S.M., Merkulava E.P.


Objectives -to compare the functional state of middle ear in adults in case of various pathology of nasal cavity, paranasal sinuses and throat. Material and methods. In 2018-2019 period, 151 patient, aged from 16 to 70 years, was examined by acoustic impedancemetry. The patients reported the subjective satisfactory state of the acoustic organ, but had a pathology of the upper respiratory tract. Results. In the groups, there were no significant differences associated with gender. Most of the patients were of working age. In all study groups, the impaired function of the auditory tube, with various intensity, was registered, although the patients had no hearing complaints. At the same time, the acumetry and tonal threshold audiometry data indicated the normal acuity of hearing. Conclusion. Acute and chronic sinusitis was the most frequent risk factor for middle ear ventilation disorder. A quarter of patients with acute sinusitis, without otological complaints, had type B and C tympanograms. 93.7% of patients, who had undergone the surgical correction of the deviated nasal septum, did not have a middle ear ventilation disorder. Surgical intervention in the nasal cavity and oropharynx leads to a transient dysfunction of the auditory tube, but does not require special treatment due to self-recovery.
Science and Innovations in Medicine. 2020;5(1):44-48
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Diagnostic significance of subjective techniques for the study of the acoustic organ in patients with primary arterial hypertension

Lisotskaya V.V., Merkulova E.P., Greben N.I., Eremenko Y.E.


Objectives - to evaluate the diagnostic significance of subjective techniques for the study of the acoustic organ in patients with primary arterial hypertension (HT) Material and methods. 40 patients (n = 40) were divided into 2 groups: Group 1 included patients with HT, group 2 - conditionally healthy patients, examined at the Republican Center for Research and Practice in Otorhinolaryngology, in 2018-2019. The mathematical statistics, Student t-test were used. Results. The patients in the group 1 presented the following complaints: the decrease in speech intelligibility 80% (n=16), difficulty in recognizing the speech in polyphony 70% (n=14), tinnitus 60% (n=12), hearing loss 15% (n=3). Otoscopy in both groups was within normal. Whisper test result was 6 m in the conditionally healthy patients. In patients with HT, the whisper test with familiar multi-syllable words resulted as 6±0.5 m. However, the mono-syllable word hearing in all patients was reduced to 4±0.5 m. Type A tympanogram was registered in patients of both groups (n=40) with bilateral acoustic reflex. High-frequency audiometry showed changes in 1/3 of the patients in HT group (n=6). Monoaural speech intelligibility (multi-syllable words) at the comfortable hearing threshold was not significantly different in both study groups. The binaural speech intelligibility tested by alternating binaural speech at the comfortable auditory threshold reached 80±5% (t>0,95), along with extremely low pass percentage (35%) in digital dichotic tests in patients with HT, that can suggest the feasible central mechanism of the auditory analyzer lesion. Conclusion. HT is a systemic disease that causes an impairment of the acoustic organ at the central and peripheral levels. In addition to the standard batch of hearing tests, it is recommended to use the superthreshold speech intelligibility tests in patients with arterial hypertension.
Science and Innovations in Medicine. 2020;5(1):49-52
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The results of hearing impairment diagnostics in schoolchildren of 1-11 forms

Machalov A.S., Sapognikov Y.M., Kreisman M.V., Balakina A.V., Karpov V.L.


Objectives - to analyze the results of the screening of hearing impairment (audiological screening) in schoolchildren of grades 1-11, and to identify the need to expand the stages of audiological screening. Material and methods. The study included 216 pupils from the 1st up to the 11th forms. During the study, in all the children, the following procedures were carried out: otoscopy, acoustic impedancemetry, registration of delayed evoked otoacoustic emission, assessment of speech intelligibility, questioning the parents about the presence and frequency of ENT diseases and signs of hearing loss. Results. The positive results in the registration of delayed evoked otoacoustic emission correlated with the number of episodes of ENT diseases. In most cases, when detecting instrumental deviations from the normal state of the auditory analyzer, the parents noted the child's difficulties in learning and communication, but did not seek medical help. Conclusion. The hearing impairment screening allows for the timely detection of the initial manifestations of hearing impairment of any etiology in children of different age groups. It is advisable to conduct screening examination of hearing impairment in pupils of 1-11 forms, in order to prevent the persistent hearing loss. In case of the detection of the initial signs of the auditory system pathology, the timely rehabilitation of such patients is recommended.
Science and Innovations in Medicine. 2020;5(1):53-57
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Step-by-step algorithm for diagnosis, examination and assessment of professional suitability in noise-induced hearing loss

Pankova V.B., Fedina I.N., Serebpyakov P.V., Volokhov L.L., Bomshteyn N.G.


Objectives - to present a step-by-step algorithm for diagnosis, examination and assessment of professional suitability in noise-induced hearing loss. Material and methods. A group of experts analysed the evidence base, consisting of more than 200 cases of primary diagnosed occupational sensorineural hearing loss (OHL), registered by various institutes for occupational safety and health. Also, the methodological instructions on the main issues of occupational hearing loss examination were regarded. Results. The methodological and regulatory documents were developed and put in practice, allowing the hygienic and clinical specialists to follow the step-by-step diagnostic and examination algorithms for OHL. Conclusion. All specialists, involved in the diagnosis, in the expertise of the occupational impact, the assessment of professional suitability, the OHL prophylaxis, should use the unified step-by-step algorithms, presented in the regulatory and methodological documents of federal and professional significance.
Science and Innovations in Medicine. 2020;5(1):58-61
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Diagnostic methods for determining auditory function in infants

Savelyev E.S., Savelyeva E.E., Tufatulin G.S.


Objectives - ал overview of the subjective and objective methods of hearing testing in infants that can be used in clinical practice. Results. Both subjective and objective methods of hearing function testing can be used in infants. The most well-known and common in practice tests are: behavioral audiometry, visual reinforcement audiometry, impedancemetry, recording of otoacoustic emissions (OAE) and various classes of auditory evoked potentials. Conclusion. It is necessary to conduct a comprehensive hearing examination, using both subjective and objective research methods, for the accurate detection of the hearing thresholds in infants.
Science and Innovations in Medicine. 2020;5(1):62-69
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Use of continuous medical and pharmaceutical education system for cancer alertness formation in practice of otorhinolaryngologists of the Orenburg region

Lutsay E.D., Anikin M.I., Murtazina N.I.


Objectives - to present practical application issues of distance education technologies in the training of health workers for the additional professional development program "Cancer alertness issues in practice of otorhinolaryngologists". The relevance of the program development and implementation in the Orenburg region is of particular importance, due to the fact that the regional cancer morbidity rate exceeds the average value in Russia. Results. The professional development program was prepared by the teaching staff of the Otorhinolaryngology Department of the Orenburg State Medical University and is meant for specialists certificated in "Otorhinolaryngology", "General Medical Practice (Family Medicine)". The program includes training materials, entry level tests that allow determining the specialists' initial knowledge level in the issues of early detection of ENT-organs malignant neoplasms, and the final progress check. Conclusion. The program allows doctors-otorhinolaryngologists to increase the professional competencies level in the field of malignant neoplasms cancer alertness; it was implemented in the education and information environment of the university on the basis of the "1C: Educational Organization" platform at the beginning of this year.
Science and Innovations in Medicine. 2020;5(1):70-72
pages 70-72 views

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