Mikhail M. Polunin

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 analyze incidence, clinical manifestations, diagnostic features, and treatment tactics of otogenic cerebral sinovenous thrombosis caused by acute otitis media in children. METHODS: retrospective analysis of medical histories of patients hospitalized in an otolaryngologic division of a multidisciplinary children’s hospital between January 2020 and May 2026 was preformed. The study included children with diagnosis of cerebral sinovenous thrombosis developed due to various forms of acute otitis media confirmed by neuroimaging. all patients underwent clinical, laboratory examination including computer tomography and magnetic resonance imaging of the brain. Treatment was comprehensive and included extended antrostomia with irrigation of the infectious lesion and, if necessary, sinus decompression and resection of perisinuous purulent lesions, as well as antibacterial and anticoagulant therapy. RESULTS: In the studied period, 6765 children were hospitalized with acute otitis media, among them 205 (3.0 %) had disease complications. Cerebral sinovenous thrombosis was diagnosed in 51 patients: 0.75 % of all otitis cases and 24.5 % of all complicated forms. Patient age varied between 4 and 17 years (median 10.5 years), school-aged children predominated (76 %). The most common clinical manifestations were intracranial hypertension syndrome (90 %), polymorphic clinical symptoms (82 %), lesional neurologic abnormalities (40 %), seizures (30 %), and ophthalmologic disorders (23 %). The most common was thrombosis of the sigmoid sinus (70 %), thromboses of the cavernous (17 %), sagittal (12 %) sinuses and internal jugular vein (5.9 %) were rarer. Control neuroimaging in patients with thromboses of the sigmoid, cavernous and sagittal sinuses showed partial recanalization at the time of discharge. In patients with thrombosis of the internal jugular vein, recanalization was observed at later time (after 6–9 months) after completion of anticoagulant therapy. CONCLUSION: Otogenic cerebral sinovenous thrombosis is a rare but severe complication of acute otitis media in children. the disease is characterized by non-specific clinical picture and predominance of symptoms of intracranial hypertension which requires high clinical vigilance and obligatory use of modern neuroimaging techniques. Comprehensive treatment including surgical irrigation and anticoagulant therapy allows to achieve positive dynamics with restoration of venous blood flow in the majority of patients. Further studies are necessary for optimization of diagnostic criteria and standardization of treatment tactics in children with this pathology.

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.

The process of hearing impairment in children suffering from cystic fibrosis remains one of the pressing problems for the scientific medical community today. The article examines the effect of systemic antibacterial therapy with aminoglycoside antibiotics on the auditory function of children with cystic fibrosis. Objective. To analyze the causes of hearing loss and the causes of hearing impairment in children with cystic fibrosis from antibacterial therapy with aminoglycoside antibiotics. Material and methods. Search for literature sources using the search engines PubMed, Web of Science and eLibrary. Results. A review of the literature shows that the acute problem of sensorineural hearing loss is associated with frequent use of aminoglycosides, and predictors of conductive hearing loss are inflammatory processes in the middle ear and eustachian tube. It has been demonstrated that not in all cases, antibacterial therapy with aminoglycoside antibiotics leads to hearing impairment, which demonstrates the urgent need to study the auditory function of children with cystic fibrosis and identify the characteristics of hearing impairment.

The literature review presents an analysis of data on the state of the auditory analyzer and the level of speech development in premature infants and toddlers.

To identify the influence of the stapedius muscle acoustic reflex on the cochlear response amplitude and their mean values (response power) in premature infants. Patients and methods. A total of 355 data sets from 99 infants, divided into 4 gestational age groups, were analyzed. The studies were conducted at 3, 6, 9, and 12 months and included high-frequency impedance measurements, including acoustic reflexometry, and the recording of otoacoustic emissions at the frequency of the distortion product. Results. A moderate correlation was found between the reflex amplitude and the power of the cochlea response in full-term infants (37-40 weeks), primarily at frequencies of 1000 and 2000 Hz, as well as a moderate relationship in the group of infants born at 33-36 weeks of gestation (r = –0.38). The strength of the relationship increased with an increase in the intensity of the applied sound signal from 80 to 100 dB. Conclusion. The obtained data indicate possible disturbances in sound conduction in premature infants, as well as the synchronous spectral development of the nervous system, middle and inner ear, which must be considered when interpreting the results of examinations in children in the first year of life, and especially in premature infants.

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.

Complaints about olfactory disorders in children are extremely rare. This article describes a case of a 9-year-old girl who visited an otorhinolaryngologist due to the absence of smell perception. The examination results revealed congenital isolated anosmia caused by the absence of olfactory bulbs. The causes of congenital anosmia (both syndromic and isolated) are discuss.

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%.

Recording the latency of the stapedial muscle acoustic reflex is one of the methods for detecting retrocochlear pathology in adults. There is insufficient literature on the characteristics of recording the latency of the stapedial muscle acoustic reflex in infants. Objective. To study the features of recording the latency of the stapedial muscle acoustic reflex, as well as its indicators in children of the first year of life. Material and methods. 3130 measurements and their combinations obtained during the examination of 416 children were analyzed. Dynamic indicators were taken into account: initial and final latency, initial and final recovery time, and the time of increase and decrease in the latency of the acoustic reflex. The obtained data were subjected to covariance and correlation analysis. Results. Covariance and correlation relationships of some dynamic indicators of the latency of the acoustic reflex, as well as their dependence on the gestational age, age, and intensity of the presented tone, were revealed. Conclusion. Reflexometry in children born before 32 weeks of gestation should be performed after 9 months of life, and after 33 weeks, starting from 6 months of life.