Eduard O. Vyazmenov

Background. Chronic tonsillitis is a significant issue in otorhinolaryngology and often co-occurs with chronic pharyngitis. This condition accounts for a significant proportion of inflammatory airway diseases. Existing treatment methods do not always ensure sustained remission, necessitating the search for new approaches. Laser technologies appear promising due to their high efficacy. Aim. Improving treatment outcomes for chronic tonsillitis using a pulsed-periodic CO2 laser. Materials and methods. A total of 36 patients were enrolled and divided into two groups of 18. The study group comprised 13 children (72.3%) aged 8–18 years and 5 adults (27.7%) aged 20–40 years. The control group consisted of 10 children (55.6%) aged 8–18 years and 8 adults (44.4%) aged 20–40 years. All patients underwent a comprehensive assessment (including microbiological analysis of tonsillar crypt secretions) and received treatment. Patients in the study group underwent partial laser ablation of the palatine tonsils using a specialized pulsed CO2 laser (pulse power 2 kW, pulse duration 20 μs, pulse energy 20, 30, and 40 mJ, and pulse repetition rate 15, 25, 30, and 50 Hz). Statistical analysis was performed. Results. A positive effect (no complaints, exacerbations, reduction, disappearance of local signs) was observed in 14 main group patients (77.8%) versus 10 control group patients (55.6%). In 16 main group patients (88.9%), pathogenic flora growth inhibition was documented after laser treatment: before the procedure, 11 (68.75%) – Staphylococcus aureus and 5 (31.25%) – Streptococcus pyogenes, after – no growth was detected in any of these 16 patients. Conclusion. Laser ablation with a pulsed-periodic CO2 laser is an effective, gentle method for treating chronic tonsillitis, with a positive effect in 77.8% and bactericidal action in 88.9% of cases. The method is suitable for outpatient use, broadening its clinical application.

Aim. To assess the potential use of a combined topical preparation in the form of ear drops containing chloramphenicol, clotrimazole, beclomethasone dipropionate, and lidocaine in the treatment of patients with acute otitis externa, based on the clinical presentation and characteristics of the microbiological profile. Materials and methods. A retrospective analysis of medical records of 168 patients with acute otitis externa over a 5-year period was performed. The study included children older than 6 years and adult patients. All patients underwent otorhinolaryngological examination, culture-based microbiological testing of discharge from the external auditory canal with species identification, CFU/mL counts and analysis of antimicrobial susceptibility data for clinically significant bacterial isolates according to laboratory reports, as well as local therapy with a combined topical preparation in the form of ear drops containing chloramphenicol, clotrimazole, beclomethasone dipropionate, and lidocaine. In cases where inflammation spread to the skin of the auricle, a combined ointment containing chloramphenicol and methyluracil was additionally used. Treatment efficacy was assessed based on the dynamics of subjective symptoms and objective signs of inflammation; tolerability was evaluated according to the presence of adverse events. Statistical analysis included calculation of mean values and proportions. Results. Positive clinical dynamics were observed with the use of the combined topical ear drop preparation in patients with acute otitis externa: therapy resulted in regression of the main symptoms in 96.4% of patients, including reduction of otalgia, edema, hyperemia of the external auditory canal skin, and pathological discharge. Conclusions. Combined topical therapy with an ear drop preparation demonstrated high efficacy and a favorable safety profile in the treatment of acute otitis externa in children older than 6 years and adult patients, providing positive clinical dynamics in 96.4% of patients.

Introduction. Inflammatory ear, nose, and throat (ENT) diseases account for a significant proportion in the respiratory disease profile. The causative agents of these diseases may include atypical infections along with other viral and bacterial agents.Aim. To determine the seasonal incidence of Chlamidia pneumoniae and Mycoplasma pneumoniae infections in acute respiratory infection (ARI) outpatients with otolaryngological manifestations; to evaluate the most common symptoms to establish a relationship between clinical symptoms and laboratory findings of patients.Materials and methods. 284 acute respiratory infection (ARI) patients aged 3 to 17 years underwent routine examination of ENT and lower airways, PCR assay for the detection of C. pneumoniae and M. pneumoniae in epithelial cell scrapings obtained from the nasopharynx and oropharynx, chlamydia and mycoplasma IgA/IgG/IgM ELISA, bacteriological analysis. Statistical data processing was conducted.Results. Acute sinusitis (82.4%) and pharyngitis (21.8%) were the most common clinical manifestations of respiratory mycoplasmosis and chlamydia in patients. M. pneumoniae IgM positivity was found in 53.3% of patients aged 3 to 6 years, similar data were obtained regarding C. pneumoniae. The frequency of positivity rates for C. pneumoniae IgM, IgG and IgA and M. pneumoniae IgM was found to be significantly higher in autumn as compared to other seasons (p < 0.05).Conclusions. Respiratory mycoplasmosis is common in preschool and primary school children in the autumn-winter period. ENT atypical microflora manifests itself as acute rhinosinusitis, in which mycoplasma-chlamydial infection is detected in 31.7% of cases. The classic clinical presentations of respiratory mycoplasmosis include productive cough along with nasal breathing difficulty and discharge from the nasal cavity.

In ENT clinical practice, there are cases of a disease similar to those ones of chronic adenotonsillitis, but insensitive to the designated conservative therapy. This disease was first described in 1987 and is called PFAPA syndrome. Its symptoms periodicity and its regression when corticosteroids are prescribed were established. Adenotomy/adenotonsillectomy can eliminate the symptoms of the disease or significantly reduce the frequency of relapses. The histological features of the structure of the palatine and pharyngeal tonsils, as well as the characteristics of the PFAPA-syndrome, were revealed. Clinical Case Description: patient K., 3 years old, repeated cases of fever were recorded in the child from the age of 1 year 3 months. They were initially regarded as manifestations of acute respiratory viral infections, complicated by adenoiditis, pharyngitis, aphthous stomatitis and cervical lymphadenitis, with a frequency of 1.5–2 months, 6–7 episodes per year. The antiviral therapy was prescribed without any effect. A prednisolone test (1.5 mg/kg) was positive; it led to a rapid normalization of body temperature and condition improvement. The adenotonsillectomy was done. Surgical intervention and the postoperative period were uneventful. The follow-up period was without any recurrence of the disease for more than 1 year. Patient F., 6 years old, had, the recurrent (each 1.5–2 months), acute respiratory viral infections, adenotonsillitis, accompanied by lymphadenitis and febrile fever. A prednisolone test was positive. The patient was diagnosed with PFAPA syndrome by the age of 6. The adenotonsillectomy was done. No disease relapses were noted in the follow-up.

Benign and malignant formations of the nose and paranasal sinuses in the early stages of development are asymptomatic or manifest minor nonspecific signs, and therefore often remain unrecognized. Hamartoma is a tumor-like formation of a dysembriological nature, consisting of excessive tissues peculiar to the affected organ. Due to the rarity of the occurrence of hamartomas of the sinonasal region, especially in pediatric practice, their diagnosis may present certain difficulties, since they can mimic other formations, such as nasal polyps or inverted papilloma, may occur as an isolated formation in the nasal cavity, or in combination with chronic rhinosinusitis, nasal polyposis, allergic rhinosinusitis. Aim – to report a rare clinical case in pediatric practice of respiratory epithelial adenomatoid hamartoma associated with allergic rhinosinusitis and polyposis, display the relationship between the occurrence of respiratory epithelial adenomatoid hamartoma and chronic inflammation of the nasal cavity and paranasal sinuses, to carry out differential diagnosis with other exophytic aggressive lesions of the nasal cavity, combine and summarize available data on sinonasal hamartomas. The article describes a clinical case of respiratory epithelial adenomatoid hamartoma in a 17-year-old child with a previous 4-year follow-up with nasal cavity polyposis and a history of repeated polypotomy. The results of endoscopy and computed tomography of the nasal cavity and paranasal sinuses, the results of surgical intervention, as well as the conclusions of a histological examination of the tumor removed from the patient are presented. The authors analyzed the domestic and foreign literature, on the basis of which they presented a differential series of sinonasal hamartomas. Respiratory epithelial adenomatoid hamartoma is a rare pathological formation of the sinonasal region, which manifests itself as an isolated polypoid mass in the nasal cavity or as an accidental surgical finding in patients with chronic sinusitis. The association with nasal polyps supports the hypothesis that inflammation may be one of the inducing factors. Respiratory epithelial adenomatoid hamartoma, although rare, should be considered in the differential diagnosis of exophytic lesions of the nasal cavity. The tactics of treatment involves endoscopic removal of the formation within healthy tissues, which provides good long-term results, relapses are extremely rare.

Background. The main complaint of patients with inflammatory diseases of the pharynx is a sore throat; rhino-orbital pathology, in turn, is manifested by symptoms associated with impaired nasal breathing, lacrimal drainage and other ophthalmological disorders. With pathology of the larynx, dysphonia is often present. As a rule, such patients initially fall into the hands of general practitioners, therapists and pediatricians, less often otolaryngologists, however, periodically the clinical situation requires the involvement of other specialists and additional laboratory and instrumental studies. The article presents a number of clinical observations of patients with combined pathology of the pharynx, larynx and rhino-orbital zone, who initially turned to an otolaryngologist, who subsequently required a team approach from various specialists. Aim. Demonstration of a differentiated approach to the diagnosis and treatment of combined pathology of the pharynx, larynx and rhino-orbital zone within the framework of interdisciplinary interaction of specialists based on clinical observations of patients. Materials and methods. We observed 5 patients who initially sought consultation with an otorhinolaryngologist with complaints of pain or discomfort in the throat, impaired nasal breathing, lacrimal drainage, itching in the eye area, and dysphonia. Results. The article presents clinical cases of syphilis, leptotrichosis of the oropharynx, herpesvirus infection type VI, infectious mononucleosis, infectious-toxic paresis of the larynx, the diagnosis and treatment of which was carried out through interdisciplinary interaction of otorhinolaryngologists with doctors of other specialties. The presented observations demonstrate that, despite the reason for treatment, patients with combined pathology of the pharynx, larynx and rhino-orbital zone require the help of not only otolaryngologists, but also other specialists, primarily infectious disease specialists. Conclusion. In order to improve the quality of diagnosis, routing and treatment of patients with combined pathology of the pharynx and rhino-orbital zone, it is necessary to develop interdisciplinary interaction and create conditions for expanding the professional erudition of doctors dealing with the problems of pathology of the same anatomical areas.

BACKGROUND: Thyroid cancer is the most common endocrine malignancy, accounting for 3.4% of all cancers diagnosed annually. Differentiated thyroid cancer (DTC) is primarily treated with surgery, which can often involve complications such as postoperative pareses or reversible laryngeal nerve (RLN) paralysis. Currently, rehabilitation possibilities for patients with postoperative RLN pairs are relevant. In this study, we used neuromuscular electrostimulation with vocaSTIM in combination with drug therapy and evaluated the effectiveness of the rehabilitation. AIMS: To determine the possibility of using neuromuscular electrophonopathic laryngeal stimulation (NMELS) in restoring laryngeal function after surgical treatment of DTC complicated by pareses/paralysis of thr RLN. MATERIALS AND METHODS: Seventy-six patients with DTC who have undergone surgical treatment, complicated by paresis of RLN, were enrolled in this study. RESULTS: The study analyzed the treatment results of these 76 patients. The age of the patients ranged from 6 to 78 (average age, 47) years, the female-to-male ratio was 59 to 17 (women, 77.6%; men, 22.4%). Postoperative unilateral laryngeal paresis was present in 56 patients (73.68%) and bilateral lesions in 20 (26.32%). Phonation violation was found in all patients: dysphonia, 76 (100%); dysphagia, 28 (36.84%); and respiratory failure, 11 (14.47%), and 2 patients (2.63%) were tracheotomized postoperatively. All patients underwent neuro-phonic rehabilitation with mandatory assessment and video fixation of laryngeal function. As a result of neuromuscular electrophonopathic stimulation of the larynx, 69 out of 76 patients (90.79%) had improved larynx function. CONCLUSIONS: Based on our experience, NMELS with vocaSTIM can be used for restoring the functions of the larynx in patients with RLN paresis of varying severities, after surgical treatment for DTC.

Background. Nasopharyngeal cysts are mostly congenital malformations. However, their clinical manifestation can also occur in adolescence, depending on their severity, size and location. Nasopharyngeal cysts are rare in the practice of an otolaryngologist, but can be found in nasal obstruction. The article presents the literature data on the theories of the origin, clinical manifestations, peculiarities of the diagnostics and surgical treatment of the nasopharyngeal cysts. Aim. To increase the efficiency of diagnostics and treatment of nasopharyngeal cysts in children on the basis of a differentiated approach to the manifestation of the disease symptoms. Materials and methods. 29 patients aged from 1 to 8 years (mean age 4.210.39 years) with nasopharyngeal cysts and cyst-like neoplasms were treated at the clinical sites of the Department of Otorhinolaryngology and Pediatric Department of Pirogov Russian National Research Medical University (Moscow) from 2009 to 2022. Results. On admission all 29 (100%) children complained of an increasing nasal obstruction, anterior and posterior purulent rhinorrhea, snoring, decreased hearing, and epiphora. 18 patients (62.1%) had a history of recurrent otitis media and were diagnosed with bilateral exudative otitis media on examination. Transnasal or transoroepipharyngeal endoscopic marsupialization and cyst coagulation with an electrosurgical complex were performed in 28 (96.5%) children. In 19 (65.5%) cases the operation was performed with a single-stage adenotomy and in 8 (27.6%) cases with tubal valvular plasty, partial destruction of the tubal tonsils. Conclusion. Improvement of diagnostics quality due to modern imaging technologies leads to detection of a greater number of accidental findings of nasopharyngeal cysts and requires systematization and detailed elaboration of the accumulated knowledge in the work of the pediatric otorhinolaryngologist.

BACKGROUND: The frequency of ectopia of thyroid gland among all types of dysgenesis varies from 30 to 70%, its most common localization is the root of the tongue. Otorhinolaryngologists, oncologists, pediatricians can take lingual ectopia for hypertrophy of the lingual tonsil or fibroma of the tongue root, which leads to unreasonable surgical treatment. Thyroid scintigraphy plays a key role in the diagnosis of ectopia.AIM: To assess the etiological structure of congenital hypothyroidism (CH) and demonstrate the clinical course in patients with ectopic thyroid tissue in the root of the tongue.MATERIALS AND METHODS: A group of patients with CH was examined. All patients underwent neck ultrasound and radionuclide imaging. The examination was carried out against the background of the abolition of hormone replacement therapy for 14 days or before its initiation. Patients with ectopia in the root of the tongue underwent videofibrolaryngoscopy. Some patients underwent a genetic study with using genes panel of a panel of candidate genes responsible for the development of CH using the NGS method. The molecular genetic study was conducted to some patients, next-generation sequencing with the genes panel.RESULTS: The study included 73 patients with primary CH aged from 2 weeks to 17.3 years: 69 children were diagnosed based on the results of neonatal screening, 4 children with thyroid ectopia were first examined older than 6 years. The median age of patients at the time of the examination was 6.9 years [4.8; 10.0]. By data of ultrasound aplasia was diagnosed in 47.9% of patients, one child had hemiagenesis and ectopic thyroid tissue of various localization was detected in 26.0% of children. In 24.7% of children thyroid tissue was found in a typical location. Scintigraphy confirmed thyroid aplasia in 65.7% of children. Examination revealed various variants of ectopically located thyroid tissue in 31 children (42.4%): thyroid ectopia in the root of the tongue in 25 children (80.6%), ectopia in the sublingual region in 5 children (16.2%), double ectopia was detected in 1 child. The median level of TSH in newborns with ectopic thyroid gland was 124 IU/ml and was significantly lower than in children with aplasia — 219 IU/ml, p<0.05. On the other side the level of TG in children with ectopia was significantly higher than in children with aplasia — 37.12 ng/ml versus 0.82 ng/ml, p< 0.05.CONCLUSION: Combination of two methods is the best diagnostic approach to determine the etiology of CH — ultrasound and scintigraphy studies compensates deficiencies of each other. Our study demonstrates the importance of scintigraphy in children with CH and patients with the formation of the root of the tongue and the anterior surface of the neck in order to avoid unnecessary removal of the thyroid gland. In case of confirmation of thyroid ectopia in the root of the tongue and in the absence of symptoms of obstruction or bleeding, it is recommended to refer the patient to an endocrinologist for conservative treatment.