Yu.L. Soldatskiy

Currently, biological therapy is an innovative and highly effective approach in the treatment of severe, non-controlled chronic rhinosinusitis with nasal polyps (CRSwNP) associated with T2-inflammation by standard treatment methods. The article presents a long-term follow-up of a patient who, 1 year after the start of targeted biological therapy with dupilumab, stopped treatment on his own because of complete relief of symptoms of CRSwNP. Within 2 years after the abandonment of biological therapy, the patient had a persistent clinical remission in relation to the symptoms of CRSwNP, confirmed by the results of a video endoscopy of the nasal cavity and data of computed tomography of the paranasal sinuses. The trigger for the polyp recurrence more than 2 years later was presumably an acute respiratory viral infection. Subsequently, because of the lack of response to basic therapy, dupilumab treatment was resumed. This clinical observation shows that even prolonged remission after discontinuation of genetically engineered biological therapy (GEBT) does not eliminate the risk of late recurrence, and viral infections can trigger the resumption of T2-mediated inflammation. The hypothesis of «tissue immunological memory,» previously proposed in studies of dupilumab in patients with atopic dermatitis, may be of particular importance in triggering polyp recurrence. These findings highlight the need for personalized approaches to the initiation and discontinuation of GEBT in CRSwNP, an in-depth study of the criteria for a super response to treatment, and the importance of long-term patient monitoring even after achieving sustained remission.

Objective. To study the frequency of occurrence, peculiarities of course and treatment of orbital complications of sinusitis in children of the first year of life with rhinogenic orbital complications Material and methods. A retrospective analysis of treatment of 74 patients of the first year of life (mean age 8.9±3.0 months) hospitalized in the department of otorhinolaryngology of the Morozovskaya Children’s City Clinical Hospital with rhinogenic orbital complications For the period from 01.01.2019 to 31.06.2024 was carried out. Results. Non purulent orbital complications of sinusitis(I and II stages according to Chandler classification) were diagnosed in 48 patients, purulent (II and III according to J. Chandler classification) in 26 patients. The main complaints on admission to the hospital were: hyperemia and eyelid edema (100%), fever (78.3%), nasal congestion only in 58.1%. The peculiarities of the clinical picture, when nasal symptoms may be absent or appear later than orbital symptoms, are the main reason why children are initially observed on an outpatient basis by other specialists (pediatrician, allergist, ophthalmologist) and were seen by a specialized specialist later. Conclusion. Orbital complications of acute sinusitis in children continue to remain high and account for up to 13.1% of hospitalized children with acute sinusitis. Considering the advantages of endoscopic rhinosurgery, we perform endoscopic endonasal sinusotomy and orbitotomy for purulent complications of acute sinusitis, taking into account the age-specific features of ONP in children. The effectiveness of conservative therapy in non-purulent orbital complications is 75%.

Some patients with bronchopulmonary dysplasia (BPD) whose status requires long-term mechanical ventilation (MV), undergo tracheostomy (TS), however, the characteristics of such patients are not presented in domestic studies as yet. The purpose of this research was to calculate the frequency of TS in children with BPD, to assess the clinical features of such patients’ status, the comorbidity and the outcomes in these patients. Materials and methods used: 73 children in their first year of life - aged 2.0 [1.0; 5.0] months old, 45 (62%) boys/28 (38%) girls, with diagnosed BPD participated in a single-center cohort retrospective study and were divided into two groups (with BPD and TS; 14, and with BPD but without TS; 59), who were admitted at the Morozov Children’s City Clinical Hospital (Moscow, Russia) in 2020-2023. The demographic characteristics of patients, their comorbidity and mortality as well as the reasons for TS were assessed. Results: the frequency of TS in infants with BPD was 4.3% [95% CI 2.4%; 7.2%]. In the structure of infant patients with TS, children with BPD accounted for 18.7% [95% CI 10.6%; 29.3%]. In 14 children with BPD, TS was performed at median age of 3.5 [2.0; 6.0] months old with an average age of 4.4±2.7 months old. These patients had severe comorbidities, such as: perinatal CNS damage (all of them), congenital heart defects (6), Edwards syndrome (2), Down syndrome (2) and CHARGE syndrome (2). Patients with BPD and TS, compared with patients with BPD but without TS, had statistically significantly greater gestational age (p=0.005) and birth weight (p=0.046), rather frequently needed the MV (p=0.007) and ware assigned with the palliative patient status (p<0.001). Of the 8 children with BPD with TS with known follow-up, 5 (63%) had died. Conclusion: the need for TS and long-term MV in children with BPD is determined by severe comorbidity.

Juvenile recurrent laryngeal papillomatosis, or juvenile onset recurrent respiratory papillomatosis (JoRRP), is a rare disease of viral etiology developing in children under 12 years of age and characterized by a high recurrence rate, the need for multiple surgical interventions, and the lack of effective drug treatment. JoRRP occurs worldwide, but data on the prevalence of the pathology have been published only in a few countries. Today, there are no consolidated epidemiologic data on JoRRP in the Russian Federation, so it is impossible to assess the general situation of the prevalence of the disease and develop a unified treatment strategy and possible directions of prevention. The issues of routing of patients with JoRRP remain not completely solved to provide timely and adequate medical care in the Russian Federation. The geographical peculiarities of the Russian Federation and the absence of a unique disease code in ICD-10 cause unreliability of data on laryngeal papillomatosis in the Russian Federation. Thus, it is necessary to estimate the prevalence of laryngeal papillomatosis in children and the volume of therapeutic care provided to patients in the regions of the Russian Federation. Objective. To determine the frequency of JoRRP, the predominant types of human papillomavirus, and the volume of therapeutic care provided to patients with JoRRP in the regions of the Russian Federation. Materials and methods. 629 patients aged from 1 year to 17 years 11 months from all eight federal districts of the Russian Federation with previously diagnosed JoRRP, code D14.1 according to the International Classification of Diseases, 10th revision, were included in the study. The level of prevalence of juvenile recurrent laryngeal papillomatosis of the larynx, the volume of treatment assistance in the federal districts and regions of the Russian Federation, and the composition of HPV types in intraoperative material from patients with laryngeal papillomatosis were assessed. Results. The prevalence of juvenile recurrent laryngeal papillomatosis in the regions of the Russian Federation in 2022 and 2024 was 1.26 and 0.92 cases per 100,000 children aged 0–17 years. The main medical care provided to patients in 100% of cases was surgical. Human papillomavirus (HPV) typing by polymerase chain reaction from intraoperative papilloma tissue was performed only in 6 regions of the Russian Federation in 2022 and in 19 regions of the Russian Federation in 2024. The predominant HPV types were types 6 and 11. The average number of surgical interventions performed in 1 patient during the disease period was 6.6 in 2022 and 5 surgical interventions in 2024. Conclusions. The register of patients with JoRRP in the Russian Federation was formed for the first time, including epidemiological data on patients, treatment options, and data on predominant HPV types. Staff shortage of otolaryngologists in the regions, insufficient awareness of physicians about the disease and tactics of management of patients with JoRRP contribute to late detection of the pathology and inability to provide adequate and timely care to patients with JoRRP. Surgical excision of papillomas remains the main type of treatment for patients with JoRRP in the Russian Federation for today. HPV typing in the intraoperative material is performed extremely rarely, so modern methods of treatment and prevention of JoRRP are not applied. The presence of genital condylomas in mothers is an important factor in the development of JoRRP, which requires adequate therapy that should be carried out in preparation for pregnancy.

Introduction. The differential diagnosis of orbital complications of rhinosinusitis with diseases of the lacrimal sac in childhood remains unresolved both due to the similarity of the symptoms of the diseases and due to certain diagnostic difficulties requiring computed tomography. Objective. To develop an algorithm for routing a patient to the emergency department of a multidisciplinary emergency hospital based on clinical and diagnostic distinctive features of sinusitis with orbital complications and diseases of the lacrimal sac with reactive edema of the eyelids. Materials and methods. A retrospective cohort analysis of children’s medical histories, who were treated in the otorhinolaryngological and ophthalmological departments of the Morozovskaya Children’s City Clinical Hospital during 2022 was performed for orbital complications of rhinosinusitis or dacryocystitis with reactive edema of the eyelids. The patients were divided into two groups, according to the main diagnosis: group I included children with intraorbital complications of sinusitis, and group II included patients with diseases of the lacrimal sac. Results. The study included 275 patients (170 children with intraorbital complications of sinusitis and 105 patients with diseases of the lacrimal sac). The median age of patients was 10 years (Q1-Q3 7-13 years) for patients in group I and 8 months (Q1-Q3 6-11 months) for group II. In children with intraorbital complications of sinusitis, pain in the sinus projection area (96.4%), nasal congestion (94.1%) and discharge in the nasal cavity (90.6%) were most often noted. The highest prognostic significance for this disease was pain in the sinus projection (positive prognostic value 92.1%, negative prognostic value 93.8%) and nasal congestion (positive prognostic value 94.1%, negative prognostic value 90.5%). CT markers with a high level of specificity for intraorbital complications of sinusitis are: thickening of the ocular muscles, thickening or destruction of the medial orbital wall, fat infiltration or orbital abscess. For dacryocystitis, computed tomography (CT) markers are: infiltrative changes in the lacrimal sac, phlegmon and abscess of the lacrimal sac. Conclusion. The greatest diagnostic value for orbital complications of sinusitis is pain in the sinus projection, as well as the presence of swelling and nasal discharge. CT scan of the paranasal sinuses has greater specificity in determining infiltrative changes in the lacrimal sac, intraorbital tissue and musculoskeletal structures of the orbit and is indicated for all patients with suspected orbital complication of rhinosinusitis.

Rehabilitation of children with fractures of the upper wall of the maxillary sinus remains relevant due to the need for a balanced approach to treatment, which would take into account both the features of traumatic injuries in children and the specifics of their age development. The article describes a technique for combined (endoscopic transnasal and transconjunctival) surgical treatment of children with fractures of the upper wall of the maxillary sinus using a sinus balloon catheter. Objective. To study the effectiveness and safety of the functional method of treating fractures of the upper wall of the maxillary sinus using endoscopic sinus surgery and a sinus balloon catheter. Material and methods. The study included 106 children aged 5 to 17 years with fractures of the upper wall of the maxillary sinus who underwent surgical treatment at the Morozovskaya Children’s City Clinical Hospital from 2018 to 2023. Treatment was administered to children with pronounced bone defects, combined injuries, and ophthalmological symptoms. Results. As a result of the treatment, all 106 children showed no hernial protrusions in the lumen of the maxillary sinus on control tomograms. There were no cases of decreased visual acuity or impaired eye movement function during follow-up by an ophthalmologist. Complete consolidation of bone fragments with restoration of the integrity of the sinus wall was achieved in 91.5% of patients; in the remaining 8.5% of cases, a bone defect in the upper wall of the maxillary sinus up to 1-2 mm in diameter was preserved according to CT data, which clinically did not manifest itself. Conclusion. The proposed technique using a sinus balloon catheter is preferable for children with fractures of the upper wall of the maxillary sinus. Due to the functionality of access, absence of the need for endoprosthetics of the bone walls of the sinus and orbit, minimization of disruptions to the growth zones of the facial skeleton, and achieving good functional and cosmetic results.

Objective. To study the efficacy and safety of balloon dilation as the first choice method in the treatment of children of the first year of life with acquired subglottic stenosis. Material and methods. A retrospective analysis of the treatment of 25 patients aged 27 days to 11 months of life (average age 5.3±3.76 months) with subglottic stenosis caused by prolonged intubation, in whom balloon dilation was the first method of treatment. Grade III Cotton-Myer stenosis was preoperatively detected in 22 children, the remaining 3 had grade II stenosis. Results. The success rate of balloon dilation was 100%; tracheotomy was not required in any case, the absence of stenosis during a follow-up examination in the catamnesis was recorded in 14 (56%) children, the remaining 11 (44%) had grade 0-I stenosis and did not cause respiratory disorders. In 1 child (1.5 years old), a subglottic cyst was removed after balloon dilation. One dilation was required in 18 (72%) children, two — in 5 (20%), three and four — respectively for 1 patient. If additional intervention was necessary, the operation was repeated 10 days — 3 months after the previous one. There were no postoperative complications. Conclusion. Balloon dilation is a highly effective and safe alternative to traditional surgical interventions for acquired subglottic stenosis in children of the first year of life and can be recommended as a method of first choice.

ЦЕЛЬ ИССЛЕДОВАНИЯ Изучить современный спектр бактериальных патогенов, встречающихся при обострении хронического гнойного среднего отита (ХГСО) у детей — жителей Московского региона, исследовать чувствительность выделенных штаммов к различным антибактериальным химиопрепаратам. МАТЕРИАЛ И МЕТОДЫ Проведен анализ результатов бактериологического исследования микробиоты гнойного отделяемого из полостей среднего уха, полученного у 269 детей с ХГСО в возрасте от 1,5 до 18 лет в период с 2017 по 2021 г. У большинства обследованных (70,6% из 190 детей) выявлен ХГСО с холестеатомой. РЕЗУЛЬТАТЫ Монокультура высеяна у 62,5% обследованных, бактериальные ассоциации — у 25,7%, бактериально-грибковые ассоциации — у 2,6%, посевы не дали роста у 9,2%. Среди возбудителей преобладал Staphylococcus aureus, который обнаружен у 36,1% детей. Второй по частоте диагностированный микроорганизм — Pseudomonas aeruginosa, она обнаружена у 12,3% пациентов. В бактериально-грибковых ассоциациях преобладали Candida spp. (7,1%). В работе также приведены результаты чувствительности к антибактериальным препаратам выделенных штаммов. Среди штаммов, выделенных у детей с ХГСО с холестеатомой, отмечена большая устойчивость к оксациллину, цефокситину и антисинегнойным препаратам. ЗАКЛЮЧЕНИЕ Наиболее частыми возбудителями при обострении хронического гнойного среднего отита у детей остаются S. aureus (36,1%) и P. aeruginosa (12,3%). Патогенные грибы изолированно не встречаются, а в бактериально-грибковых ассоциациях преобладают Candida spp. (6,7%). Наиболее эффективными средствами лечения обострений хронического гнойного среднего отита, общепризнанно и по данным нашего исследования, являются топические фторхинолоны (ципрофлоксацин). Системные антибиотики, из которых наиболее эффективны фторхинолоны (ципрофлоксацин), показаны при выраженном обострении, тяжелых и деструктивных формах хронического гнойного среднего отита.

The first observation in the world literature of the development of subglottic cysts in the larynx in monochorionic monoamniotic twins is presented. The girls were born prematurely at 34 weeks of gestation, from the first day of life for 7 and 8 days, respectively, were transferred to mechanical ventilation. At the fourth month of life, symptoms of laryngeal stenosis appeared and began to gradually progress, conservative therapy had no effect. The diagnosis of subglottic cysts was established on the basis of fibrolaryngoscopy; after endolaryngeal surgery, breathing returned to normal. This case demonstrates the importance of timely endoscopic examination of the respiratory tract in children with stridor.