I. S. Elizbaryan

Study of the function of the nasal cavity and its comparison with the reactions of the autonomic nervous system under stressful conditions can improve the effectiveness of diagnostic and therapeutic measures and detail the processes of pathogenesis in pathology of the nose and paranasal sinuses. Objective. To evaluate the reactivity of the respiratory function of the nasal cavity under the influence of the regulation of the sympathetic nervous system (SNS) and parasympathetic nervous system (PNS) using standard physiological tests and active anterior rhinomanometry. Patients and methods. The study involved 97 healthy subjects divided into 3 groups according to their vegetative status — sympathotonics, normotonics, vagotonics using the Kerdo index and Vein scale. All participants underwent a number of tests using active anterior rhinomanometry (AAR): cold pressor test, Martinet test and Valsalva test. Correlation and regression analysis (Pearson’s coefficient) and multivariate analysis of variance (MANOVA) were used for statistical analysis and evaluation of intra-group relationships and ratios. Results. Cold pressor test showed a strong correlation between the initial values of rhinomanometry and indicators 1 and 3 minutes after the test. Martinet test revealed less pronounced relationships between heart rate (HR), systolic and diastolic blood pressure (BP) and rhinomanometry indicators. A strong correlation between the initial value of AAR and indicator 1 minute after the test was established when evaluating vagosympathetic activity by means of Valsalva test. The results showed different dynamics of AAR depending on the patient’s vegetative status. The revealed correlations between rhinomanometry, BP and HR were combined with the vegetative status of the subjects. Conclusion. AAR can be used in a comprehensive assessment of the ANS function and demonstrates that vagotonia can be the cause of the development of vasomotor rhinitis; dysfunction of the SNS can be the basis for the formation of atrophic changes in the nasal cavity and sinuses.

Introduction. The polymorphism of clinical manifestations of chronic polypous rhinosinusitis determines the need for a detailed scientific approach in the study of pathogenetic mechanisms.Aim. To study the morphological manifestations of disorders of the neuroepithelium of the olfactory zone of the nasal cavity in patients with chronic polypous rhinosinusitis.Materials and methods. We conducted a prospective analysis of biopsic specimens as well as clinical and functional parameters of 16 patients with chronic polypous rhinosinusitis, who were divided into two groups: treatment group (A) and comparison group (B), aged 25 to 65 years (average age 53 ± 14.3 years). The study subset included 7 men and 9 women. We assessed the main clinical manifestations: radiologic abnormalities in the nasal cavity and paranasal sinuses evaluated according to the Lund-Mackay score, olfactometry and MoCA test in addition to a pathomorphological examination of olfactory neuroepithelium biopsied from the nasal cavity and determination of the chronic inflammation activity index using a histological activity score.Results. In all patients with chronic polypous rhinosinusitis in the symptom complex, there was a violation of the sense of smell in the variants of hyposmia (50%) and anosmia (50%). The presence of neurocognitive disorders according to the MOS test was detected in 70% of patients. During morphological examination, pathological disorders in the olfactory zone of the nasal cavity were caused by atrophy of nerve fibers and lympho-macrophage infiltration involving mixed glands (variable range – mild/moderate/severe). All the analyzed signs were directly dependent on the duration of the disease and the severity of the lesion.Discussion. Analysis of radiologic findings according to the Lund-MacKay score combined with the age of the patients and duration of the disease confirms the rationale of conducted study and its topicality.Conclusion. The revealed pathological changes in the neuroepithelium of the nasal cavity in the olfactory zone were observed only in patients with chronic polypous rhinosinusitis and were directly dependent on the duration of the disease and the form of the inflammatory process.

A pathological process in the nasal cavity and paranasal sinuses in chronic rhinosinusitis with nasal polyps (CRSwNP) is not limited by nasal obstruction and has a complex impact on the patient’s central regulatory mechanisms manifesting in cognitive and mnestic functions impairment. Objective. To conduct a comprehensive comparative analysis of clinical and functional indicators characterizing nasal manifestations in patients with CRSwNP, as well as the results of cognitive tests in the pre- and postoperative periods. Patients and methods. A number of patients equal 45 with a long medical history of CRSwNP (M=117 months) without concomitant chronic pathology were examined. The age of patients was between 22 and 65 years (M=48.964 years). Clinical testing was carried out using the Sinonasal Outcome Test (SNOT-22), Lund—Mackey tests and active anterior rhinomanometry (ml/s). The changes in the X-ray examination (computed tomography of paranasal sinuses) were evaluated on the Lund—Kennedy scale. Cognitive abilities were assessed based on the MoCA test (in scores) with subsequent interpretation by a psychiatrist. The evaluation of indicators was carried out before the surgical treatment, after 1 and 6 months. Results. There has been a decrease in sinonasal symptoms on the SNOT-22 scale (from M=31.42 scores before surgery and to M=4.04 scores after 6 months); the Lund—Kennedy scales (from M=7.87 to M=0.38 respectively); the Lund—Mackey scales (from M=15.49 to M=0.47 scores respectively). The active anterior rhinomanometry indicators had a tendency to mean values increase from 399.04 ml/s to 856.60 ml/s after 6 months. Assessment of neurocognitive disorders on MoCA in patients preoperatively demonstrated mean values of 21.49 scores, which indicated the presence of disorders of mild severity. Mean values of 25.38 scores were obtained at further testing after 1 month, which were fixed after 6 months. Conclusion. An interdisciplinary approach to the evaluation of clinical manifestations in patients with CRSwNP, based on the inclusion of neurocognitive disorders testing in the study, allows to more fully evaluate the impact of the pathological process on the patient’s body. The inclusion of the MoCA test in the complex of intra- and postoperative researches allows to form an individualized approach in the implementation of therapeutic and rehabilitation activities in this category of patients.

The purpose of the study: to review the results of scientific research on combined etiopathogenetic, clinical, and functional manifestations of chronic rhinosinusitis and a number of neurological diseases classified as neurocognitive disorders (NCDs). The interdisciplinary approach in the analysis was based on the modern understanding of neurocognitive disorders and induced neuroinflammatory reactions, the commonality between the infectious agents in the pathogenesis of chronic rhinosinusitis and diseases characterized by NCDs, and the validity of the involvement of central brain structures in the process of chronic inflammation of the nasal cavity and paranasal sinuses. The analogy of the formation of such manifestations as nasal obstruction, changes in the olfactory tract and visual function, and disorders of the microbiota of the upper respiratory tract, and their impact on brain structures with impaired neurocognitive functions was drawn. The systematization of scientific research data characterizing various chronic forms of rhinosinusitis and NCDs was a confirmation of the regulatory role of the autonomic nervous system and the hypothalamic-limbic-reticular complex in understanding the common pathophysiological mechanisms occurring in these nosologies.

The sinonasal symptoms inherent in chronic polypositis rhinosinusitis have a complex effect on the central structures of the patient's nervous system. The study of impaired cognitive and mnestic functions in this category of patients allows us to form a comprehensive understanding of the symptom complex of clinical manifestations and affect therapeutic tactics. Objective: to conduct a comprehensive comparative analysis of clinical and functional indicators characterizing nasal symptoms in patients with chronic polypous rhinosinusitis and cognitive tests in the pre- and postoperative period. Materials and methods: testing was performed in 45 patients with polypous rhinosinusitis (PRS) with a long history of the disease (M= 117 months). The age of the study group was from 22 to 65 years (M=48.964 years), without concomitant chronic pathology. The scope of clinical testing included the SNOT-22 sinonasal symptoms scale, Lund-Mackey tests and active anterior rhinomanometry (ml/sec). Changes in X-ray examinations (CT ONP) were evaluated on the Lund-Kennedy scale. Cognitive abilities were tested on the basis of the MoCA test in points with subsequent interpretation by a psychiatrist. The evaluation of the indicators was carried out before the surgical treatment of PRS, after 1 and 6 months. Results: The results were obtained to reduce the indicators of sinonasal symptoms on the SNOT-22 scale from M=31.42 before surgery and up to 4.04 points after 6 months; the Lund-Kennedy scale from M=7.87 to M=0.38 points; the Lund-Mackey scale from M=15.49 to M =0.47 points at the final stage. The indicators of active anterior rhinomanometry tended to increase from M=399.04 ml/sec before surgery and M=856.60 ml/sec after six months. Testing of neurocognitive disorders according to MoHS in patients preoperatively demonstrated average values of 21.49 points, which indicated the presence of mild variants of disorders. Further testing made it possible to obtain indicators of 25.38 points after 1 month, which were fixed during the study after 6 months. Conclusion. An interdisciplinary approach to the assessment of clinical manifestations in patients with polypous rhinosinusitis, based on the inclusion of testing of neurocognitive disorders in the study, allows for a more complete assessment of the impact of the pathological process on the patient's body. The inclusion of the MOS test in the complex of pre- and postoperative studies allows us to form an individualized approach to the implementation of therapeutic and rehabilitation measures in this category of patients.

Removal of osteomas of the paranasal sinuses can be performed in various ways: with a chisel, a drill, a piezotome. Each method carries certain advantages and disadvantages as well as risks of complications. One of the most modern and safe methods for separating the tumor and the normal sinus wall is a piezotome. Purpose of the study. Rationale for the use of a piezosurgery for the purpose of improving the surgical technique of removing osteomas of the paranasal sinuses and preventing postoperative complications. Patients and methods. A prospective analysis of 59 clinical cases using various methods of separation of osteoma and sinus wall was carried out to substantiate the advantages of using a piezotome. The following parameters were evaluated: technical difficulties when fragmentation of large osteomas is necessary, the possibility of precision movement of the working part of the instrument, the surgeon’s subjective feelings regarding the possibility of technical errors during the operation, as well as the time spent on removing tumors of approximately the same size and localization. Conclusion. As a result of the study, the advantages of using a piezotome for tissue separation according to the presented characteristics were revealed.

Physicians of different specialties accumulate the clinical material about the atypical course of different diseases during the pandemics of the new coronavirus infection (COVID-19). Mucormycosis is one of such diseases, which was earlier observed in immunocompromised patients with the uncontrollable diabetes mellitus, transplant recipients, patients with hematological diseases, neoplasias (especially after chemotherapy), or the HIV-infection. Aim of the study. Advancing the treatment tactics in patients with necrotic fungal rhinoorbital lesions in the COVID-19 infection based on the analysis of clinical and pathomorphological disease features. Material and methods. A prospective analysis of 13 clinical cases was conducted along with the pathomorphological study of the biopsy material. Results. Vascular and perineural changes were detected in affected tissues, which may confirm the specific pathogenesis of fungal lesions of the rhinofacial region in the post-COVID syndrome.

A rare case of recurrent residual cholesteatoma formed in a patient after undergoing open mastoid surgeries on the right ear in childhood.

Архив медицинского научно-практического журнала «Российская оториноларингология»