Sergey Anatolyevich Artyushkin

Objective. Study of a clinical case of chronic mucormycosis of the paranasal sinuses in the Perm region, analysis of publications on the topic. Material and methods. This article describes a clinical case of chronic mucormycosis of the paranasal sinuses, diagnosed in the otolaryngology department of the Perm Regional Clinical Hospital in 2021. An analysis of scientific papers on the topic of “chronic mucormycosis of the paranasal sinuses” was performed in the electronic search databases eLibrary and PubMed as of September 2025, using the keywords: chronic mucormycosis of the paranasal sinuses, chronic rhino-orbital mucormycosis, chronic rhino-orbito-cerebral mucormycosis (we used Russian and English languages). Results. Chronic mucormycosis of the paranasal sinuses developed in a 68-year-old patient with insulin-dependent type 2 diabetes mellitus. The diagnosis of mycosis was established in the Department of otorhinolaryngology of the Perm Regional Clinical Hospital 6.5 months after the onset of complaints and was verified by pathohistological examination of intraoperative material from the left maxillary sinus. Treatment included left extranasal maxillary sinusotomy, antifungal therapy with posaconazole, and correction of glycemic levels. A search query in the eLibrary gave a negative result. Two reviews from 1996 and 2016, as well as case reports, were found in the PubMed database. Publications lack a classification of mucormycosis that identifies uniform time criteria for the chronic form; some indicate a duration of more than 4 weeks. The average disease duration worldwide is approximately 7 months. The causes of this chronic, sluggish course of the disease are not fully understood.

Osteomas of the paranasal sinuses are benign lesions of the skull, accounting for 0.7 % of all paranasal sinus tumors (PNS). They are typically asymptomatic and are primarily diagnosed incidentally on CT scans. The most common symptoms are headache, nasal discharge, and signs of PNS inflammation. Osteomas are often associated with nasal polyposis or mucopyocele, which are generally considered secondary lesions. We also consider osteoma secondary to inflammation associated with nasal polyposis and mucopyocele [1]. We conducted a retrospective analysis in our ENT department from January 2021 to December 2023. In our cohort of 876 patients with nasal polyposis, we found 13 cases of osteoma, with an incidence of 7.21 %. The mean age was 47.23 years, the male to female ratio was 3.1:1.1. In 9 cases, the osteoma was located in the frontal sinus, 3 were located on the lateral part of the ethmoid roof (35 %), and 2 extended from the ethmoid bone to the frontal sinus. The mean tumor size was 10.02 ± 4.54 mm. The collected data may indicate that chronic mucosal inflammation can cause bone changes and ultimately lead to osteomas [2]. We can assume that osteomas of the paranasal sinuses may be a complication of nasal polyposis. We present a complex clinical case of nasal osteoma removed using a bicoronal approach to the paranasal sinus in a single stage with the creation of a Draf 3 rhinostomy.

Tinnitus is a serious medical and social problem of our time for many people, leading to significant psycho-emotional shock in some cases, disruption of social and professional adaptation. To date, there are several methods of treating tinnitus, the principle of which is based on pathogenetic concepts of brain neuroplasticity. The purpose of this work is to review existing tinnitus treatment methods from the point of view of modern neurophysiological concepts. Materials and methods: A keyword search and analysis of the works found in Russian and foreign databases (elibrary, CyberLeninka, PubMed, Scopus, Google Academic) over the past 5 years was carried out. A total of 387 keyword publications were found, and after eliminating duplicates and those that did not match the subject of the article, 21 papers were selected. Results. The use of non-medicinal tinnitus therapies such as sound therapy, transcranial magnetic stimulation, bimodal stimulation, and psychotherapeutic methods has shown statistically significant effectiveness in a number of systematic reviews and meta-analyses, both as part of monotherapy and as part of complex therapy aimed at retraining in tinnitus, which has shown the best results. The effectiveness of these methods has a neurophysiological explanation based on the neuroplasticity of the brain and the fact that changes occurring during the development of tinnitus can regress with certain measures. Thus, these options can be considered effective pathogenetic methods of treating tinnitus from the point of view of the principles of evidence-based medicine.

The Tinnitus Catastrophizing Scale (TCS) is designed for the quantitative assessment of cognitive–emotional reactions to chronic tinnitus and is widely used internationally as a reliable psychometric instrument. The aim of the present study was to perform the linguistic and cultural adaptation and validation of the Russian version of the questionnaire for use in Russian clinical practice. Following translation and cultural adaptation, a validation study was conducted in 130 participants, including patients with tinnitus and normal hearing, tinnitus with sensorineural hearing loss (SNHL) from mild to profound degree, and a control group without tinnitus (for evaluation of face validity). Testing was carried out in two visits, with a 7-day interval to evaluate test–retest reliability. The results confirmed the strong psychometric properties of the Russian version of the TCS: internal consistency (Cronbach’s α=0.93), test–retest reliability (ICC=0.99), and high face validity (82—96% agreement, mean ≈89.5%). The average completion time was 6—7 minutes. The obtained data are consistent with those from international validation studies and confirm the equivalence of the Russian and original versions of the instrument. The adapted Russian version of the TCS can be used in clinical audiology, otorhinolaryngology, neurology and psychiatry to assess the degree of tinnitus-related catastrophizing, to stratify patients, and to monitor treatment effectiveness over time.

The article presents three clinical cases of an unusual audiological profile in children, not previously described in the literature. The cases are of interest due to the atypical symptomatology featuring preserved otoacoustic emissions (OAEs) concurrent with elevated thresholds of auditory brainstem responses (ABRs). Notably, wave V exhibited normal morphology and latency; in some instances, the ABR thresholds correlated with the behavioral thresholds. This clinical presentation cannot be classified as either conventional peripheral sensorineural hearing loss or an auditory neuropathy spectrum disorder. It is hypothesized that the morphological substrate of this condition is a lesion at the level of the inner hair cell or the synapse. The underlying pathogenesis is suggested to involve mild impairments in neural synchronization, which are sufficient to allow for the recording of ABRs with thresholds that, in some cases, correlate with behavioral responses.

BACKGROUND: It has been shown that the novel coronavirus infection (COVID-19), in addition to pulmonary involvement, is frequently accompanied by psychoneurological symptoms. However, rehabilitation of patients after COVID-19, as well as after other viral infections, remains a substantial challenge in clinical practice. AIM: To analyze the effects of mushroom β-glucans on the mental and physical status of patients with moderate COVID-19 during the acute phase and early post-COVID period. METHODS: The study included 60 patients (22 men and 38 women aged 26–74 years) with COVID-19 confirmed by polymerase chain reaction and chest computed tomography. Patients were randomized into two groups of 30 individuals each. The control group received standard treatment according to national clinical guidelines (version 11, May 7, 2021) in combination with placebo. In the intervention group, standard therapy was supplemented with mushroom β-glucans (dietary supplement Glucaferon®). The patients’ psychoemotional and physical status was assessed using validated questionnaires: anxiety (GAD-7), depression (PHQ-9), general health status and working capacity (EQ-VAS), and fatigue (VAFS) during 10 days of hospitalization and for 28 days after discharge. RESULTS: During the first days of hospitalization, symptoms of depression and anxiety predominated over fatigue severity. After discharge, patients reported a gradual increase in fatigue, whereas anxiety and depressive symptoms demonstrated an opposite trend. Comparative analysis showed that patients receiving Glucaferon® experienced faster recovery of psychoemotional status compared with the placebo group. Daily administration of the supplement was associated with an approximately 1.5-fold reduction in fatigue severity by the end of the follow-up period. CONCLUSION: Mushroom β-glucans may be considered a promising class of agents potentially capable of reducing chronic neuroinflammation and psychoneurological complications associated with COVID-19, as well as preventing neurodegenerative processes. However, further studies are required to confirm these findings.

The review is devoted to the problem of balance disorders combined with hearing loss in pediatric population. The balance function is implemented by three systems: visual, somatosensory and vestibular and plays an important role in the child’s development. The critical period for vestibular system development occurs prior to a child taking their first independent steps and the balance system continues to mature until approximately 4-6 years of age. According to various sources, vestibular disorders may occur in children with sensorineural hearing loss with a frequency ranging from 8% to 85% without any correlation to the degree of hearing impairment. These balance disorders, in combination with hearing loss, have been shown to limit various aspects of a child’s development such as motor and cognitive skill acquisition, learning, sports participation, physical activity, written expression, reading ability, communication, and social interaction. In modern clinical practice, a framework for an algorithm has been developed to diagnose balance disorders in children of different ages. These methods should be tailored to each child’s developmental level and be highly informative, while also complementing each other in terms of results. Approaches are currently being explored to screen for vestibular issues in children with confirmed hearing loss. Data on changes in balance in children underwent cochlear implantation is conflicting. In the immediate postoperative period, some patients may experience transient vestibular dysfunction, but over time, there is a general trend towards improved balance. Discussions are underway regarding the potential of vestibular rehabilitation as part of a comprehensive approach for children with hearing impairment. This includes enhancing neuroplasticity through adaptation, habituation, and substitution. It is essential to investigate the efficacy of various methods of rehabilitation for children with hearing loss who experience balance issues.

Surgical interventions in the oropharyngeal zone and on the anatomical structures of the laryngeal entrance, especially its posterior sections, still present significant difficulties due to the difficult surgical access for performing the required volume of surgical manipulations. A large number of surgical approaches proposed for operating in this zone — transoral, various types of pharyngotomies, lateral and median mandibulotomy, resection of both jaws (bimaxillary resection) indicate the absence of a definitive solution to this surgical problem. Therefore, intraoperative physiological changes in the position of the patient’s head can contribute to improving the key parameters of surgical approaches to the oropharyngeal zone and the structures of the laryngeal entrance by increasing the working space when performing manipulations in the area of interest, and new information on the intravital positional anatomy of the larynx will become a source of development of surgery for diseases of this complex anatomical zone. Purpose of the study — to obtain information on lifetime changes in the position of the larynx relative to the external base of the skull during some physiological movements of the head and neck. Materials and methods. The material for the work was the data obtained as a result of anthropometric measurements and magnetic resonance imaging of the neck of 100 healthy, randomly selected individuals (55 women and 45 men) who agreed to participate in the research project. The lifetime topography of the larynx was studied in the standard anatomical position of the body, with a fully flexed (extended) neck and with head turns depending on the gender and constitutional characteristics of the subject. Results. When measuring in different positions the distances from the most lateral points of the upper edge of the thyroid cartilage on the right and left and from the center of the most medial point of the posterior surface of the cricoid arch to the reference point on the base of the skull (the most medial point of the foramen magnum), the following changes were revealed. During neck flexion, the distances from the most medial point of the foramen magnum edge to the most lateral points of the thyroid cartilage (on the right and left) decrease. The greatest changes were found in the group of dolichomorph males — by 26%. At the same time, during neck flexion, the distance from the reference point on the base of the skull to the center of the most medial point of the posterior surface of the cricoid cartilage arch increases in almost all examined groups. A more significant increase is observed in males with a mesomorphic body type — by 18.9%. Neck extension has different effects on the transformation of the distances from the base of the skull to the reference points on the main cartilages of the larynx. In most of our observations, the above intervals increase. The greatest increase in the length of the segment from the reference point to the center of the most medial point of the posterior surface of the cricoid cartilage arch was observed in women with a brachymorphic body type — by 10.6%. At the same time, the distance to the lateral part of the thyroid cartilage on the right in brachymorph males, on the contrary, decreases, by a maximum of 21.3%. Turning the head to the left and to the right in most of the examined groups leads to a decrease in all measured distances. When turning the head to the left, the greatest changes in the form of a decrease in the studied distances in relation to the left half of the thyroid cartilage were recorded in men with a brachymorphic body type — by 17.8%. When turning the head to the right in relation to the right half of the thyroid cartilage in the group of examined dolichomorph males, the decrease in the length of the studied distance was 25%. Conclusion. The intravital positional anatomy of the larynx was studied relative to the reference point on the outer surface of the base of the skull, depending on the gender and constitutional characteristics of the examined person, which significantly expands the information on the topographic anatomy of this organ and the anterior neck as a whole.

Introduction. Chronic tonsillitis does not always lend itself well to standard treatment, so it requires interdisciplinary cooperation with the search for new methods of diagnosis and treatment, one such method may be osteopathic correction. Changes in the structure of connective tissue in chronic inflammation contribute to the development of biomechanical disorders in the form of limitation of tissue mobility and increase in their density, which, in turn, may be prerequisites for the formation of somatic dysfunctions (SDs). There are no data on the peculiarities of osteopathic status in patients with chronic tonsillitis in the available literature, which predetermined the purpose of this study.The aim of the study: to study the features of osteopathic status in patients with chronic tonsillitis and its dynamics after a course of complex therapy including osteopathic correction.Materials and methods. The prospective randomized controlled study, conducted on the basis of the Department of Osteopathy with a course of functional and integrative medicine and the Department of Otorhinolaryngology of I.I. Mechnikov NWSMU in the period from 06.2022 to 04.2024, included 93 patients with the diagnosis of «Chronic tonsillitis» who visited a doctor about the recurrence of the disease. All patients were divided into two groups, main (n=44) and control (n=49), depending on the treatment performed, using the randomisation envelope method. All patients were examined by osteopathic examination with the formation of an osteopathic report before treatment, as well as 30 and 90 days after the start of treatment. Patients of both groups received otorhinolaryngological treatment in the form of washing of the palatine tonsils (five washing procedures with antiseptic solution, the interval between the procedures was 2 days). Patients of the main group additionally received osteopathic correction of the identified somatic dysfunctions, which included five procedures: three procedures with an interval of 14 days. The total duration of the course was 1 month. Osteopathic correction was performed to each patient individually, based on the results of osteopathic diagnostics and a completed osteopathic report.Results. Regional (neck region, visceral and structural components; thoracic region, structural and visceral components; head region) level dysfunctions were the most characteristic for patients with chronic tonsillitis. Global SDs were dominant in 23 % of patients and regional SDs in 77 %. After the complex (including otorhinolaryngological treatment and osteopathic correction) treatment in the patients of the main group, the frequency of detection of regional and local SDs statistically significantly decreased, global level SDs were not detected (p0,05 by the McNemar criterion).Conclusion. According to the results of the study, the peculiarities of osteopathic status in chronic tonsillitis were shown. The inclusion of osteopathic correction in the complex treatment of patients contributes to a statistically significant decrease in the frequency of detection of somatic dysfunctions of different levels compared to conventional conservative treatment. It is necessary to continue the study and analyse the relationship between the identified somatic dysfunctions and the presence of objective and subjective symptoms of the disease.

The leading factors in the pathogenesis of chronic polyposis rhinosinusitis (CRSwNP) are dysfunction of the epithelial barrier of the nasal and sinus mucosa and dysregulation of the immune system, both at the systemic and local levels. A Th2-mediated immune response plays a central role in the development of disease in patients with CRSwNP CRPS, and CRSwNP is often associated with bronchial asthma (BA). At the present time, for the conservative treatment of patients with CRSwNP+BA, preference is given to drug therapy aimed at the correction of mucosal immunity. The use of interferon α2β (IFN α2β) and the dipeptide γ-D-glutamyl-L-tryptophan may reduce the severity of the long-term local inflammatory process. However, the clinical efficacy of these drugs in the context of chronic polyposis has not been studied. The aim of this study was to compare the efficacy of topical application of recombinant IFN α2β, recombinant IFN α2β in combination with γ-D-glutamyl-L-tryptophan and IL-4Rα receptor inhibitor in the treatment of patients with CRSwNP+BA. The patients were divided into three groups. In the first group (31 people), 1 million units of interferon alpha2b were injected into the polyposis tissue for five days. In the second group (31 people), interferon alpha2b at a dose of 1 million units and gamma-D-glutamyl-L-tryptophan at a dose of 0.1 mg were injected into the polypous tissue for five days. To assess the dynamics of clinical symptoms in the reference group (31 people), a drug with a known mechanism of action and efficacy — a genetically engineered IL-4Rα receptor inhibitor — was used. This drug was used 300 mg once every 2 weeks subcutaneously for 1 year. The obtained results showed that recombinant IFN α2β in combination with γ-D-glutamyl-L-tryptophan are pathogenetically appropriate preparations for conservative treatment of patients with the following initial indicators: severity of the polyposis process — 2.2+0.2 points, swelling — 2.8+0.4 points, and amount of discharge — 2.9+0.3 points. A single 5-day course of the above-mentioned preparations had a positive therapeutic effect, which was accompanied by a pronounced reduction in the clinical symptoms of the disease: the volume of polyposis tissue, nasal breathing difficulties and swelling of the nasal mucosa after one month and was maintained for one year. At the same time, the results of our study indicate the necessity of a longer period of application of recombinant IFN α2β in combination with γ-D-glutamyl-L-tryptophan in patients with CRSwNP+BA. The data obtained were comparable to the corresponding indicators when using the IL-4Ra inhibitor. In our opinion, the mechanism of action of the preparations is associated with a decrease in the activity of inflammatory and proliferative processes in the nasal and sinus mucosa.