Vol 5, No 1 (2020)

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.

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.

Aim – 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 high-speed 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.

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.

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.

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.

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.

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.