Chronic ENT Research Articles

Vaccination of Children with recurrent and chronic inflammatory ENT pathology

Recommendations highlighted features vaccination of children with with recurrent and chronic inflammatory ENT pathology. It is shown how the immunization scheme may be changed according to the pathology and the age of the child.

Persistent infections in the children presenting with chronic ENT diseases: the potential of etiotropic therapy

The objective of the present study that involved 176 children at the age varying from 2 to 12 years presenting with chronic ENT diseases was etiological diagnostics and etiotropic therapy of these pathologies taking into consideration the duration of the disease of less than one year (n=72), from 1 to 2 years (n=54), and over 2 years (n=50). The bacteriological method was employed to identify microflora from the upper respiratory tract and the molecular-biological methods for the detection of Epstein-Barr virus DNA, cytomegalovirus, and 6 types of human herpes virus in the blood and saliva. All the children were treated with the recombinant interferon preparations given for 1-1.5 months. For 41% of the children this treatment was combined with antibacterial therapy followed by immunocorrective therapy with interferon inducers (in 79.4% of the patients) or bacterial lysates (20.6%). The study revealed the predominant role of types 4, 5, and 6 type herpes viruses in the development of chronic ENT pathologies in the children with the gradual lowering of activity of these infections over 2 years. Staphylococcus aureus and Streptococcus pyogenes as well as fungi of the genus Candida were the commonest bacterial and fungal pathogenic agents isolated from the naso- and oropharynx of the children suffering from chronic ENT pathology.The effectiveness of etiotropic therapy was shown to decrease with time, from 78% during 1 year after the onset of the disease to 30% within the next 2 years.

New Arguments in favor of the Release Active Antiviral Drug to Prepare Children for Vaccination

Release-active drug with a dual mechanism of action used for preimmunization against pneumococcal vaccination in children with chronic nasopharyngeal infection A prospective, randomized comparative study involving 994 children of 2 to 5 years of age was conducted (from December 2011 to April 2015) to assess the efficacy of Anaferon for Children for pre-immunization and an aid to pneumococcal vaccine treatment in children with chronic nasopharyngeal diseases. Patients in the test group (507 children) started to receive Anaferon for Children (AnC, release-active antiviral and immunomodulatory drug) 10 days prior to vaccination with a pneumococcal conjugate vaccine (PCV13) and continued the treatment for 40 days. 487 children were randomized into the comparator group receiving the PCV13 vaccine alone, without Anaferon for Children. The efficacy of Anaferon for Children was assessed by measuring the incidence of acute respiratory infections (ARI) and exacerbations of chronic ENT disease developed by study patients. In addition, total cell counts and subset ratios were obtained and activity of lysozyme and secretory immunoglobulin A was analyzed in nasal fluids. Between days 3 to 10 of study, ARI signs were reported in 58 children (11.9%) in the comparator group, thus making vaccination impossible in these subjects. In AnC group, no ARI cases were observed within the same period and all the children received the vaccine as scheduled. During the first month post vaccination, 15 cases of illness were recorded (4.9%) in the group of test treatment and 37 (7.6%) (p = 0.001) in the comparator group. The incidence rates of ARI recorded in study patients for a period of 12 months was 1686.4 per 1000 (855 infection episodes) in the test group vs. 2086.2 per 1000 (1016 ARI cases) in the comparator group (p = 0.02). Based on the data obtained over the follow-up period, patients in the test group demonstrated a 25% decrease in the incidence of ARI exacerbations or exacerbations of chronic ENT pathology (e.g., acute otitis, acute bronchitis, pneumonia, chronic maxillary sinusitis) as compared to the comparator group (p = 0.061); the percentage of children developing no respiratory infections was increased in this group by 3 times (p = 0.001) and the number of recurrent ARI episodes was reduced by 1.2 times (p = 0.001), including a decrease of 1.6 times in the number of children with two recurrent ARI episodes (p = 0.001). AnC was noted to have a beneficial effect on lysozyme activity, sIgA level and cell count distribution in nasal fluids (normalized more rapidly compared to the comparator group). The study showed good tolerability and safety of the combination of AnC and PCV13 vaccine for the children with chronic nasopharyngeal diseases and advisability of Anaferon for children application for preparation to immunization and vaccination against pneumococcal infection.

The structure of childhood diseases in the patients presenting with hospital-acquired ENT pathology estimated based on the results of monitoring children's hospitals in Moscow

The objective of the present work was to study the structure of childhood diseases in the patients presenting with hospital-acquired ENT pathology based at the results of analysis of the annual reports presented by the heads of departments of otorhinolaryngology of Moscow children's hospitals for the period from 2011 till 2013. It was shown that pharyngeal pathologies predominate among the children amounting to 43.9% of the total ENT morbidity. These conditions are followed by nose and paranasal sinus pathologies (29.2%), ear diseases (22.5%), laryngeal, bronchial and tracheal pathologies (4.4%). The analysis of the internal structure of different classes of diseases was made separately for the ear, throat, and nose (ICD-10). The results of the study give evidence of the tendency toward the higher incidence of selected forms of acute inflammatory diseases and chronic ENT pathologies in the childhood.

The system of prophylaxis in otorhinolaryngology

This publication is focused on the modern basis behind the system for the prevention of acute and chronic ENT diseases with special reference to the compliance with the principles of primary, secondary, and tertiary prophylaxis. The special emphasis is laid on the role of the otorhinolaryngologist in the formation of the healthy lifestyle, organization of regular medical examination and rehabilitative treatment of the population. A detailed description of the activities of an otorhinolaryngologist in the framework of mass prophylaxis programs is presented. The main drawbacks of the current normative-regulatory documentation are discussed. It is concluded, based on the analysis of ENT morbidity among the Russian population, that the participation of otorhinolaryngologists is indispensable at the first, second, and third stages of regular medical examination. The modern regulations for the prophylaxis of occupational ENT diseases are considered.

Evaluation of Allergies in Children with Recurrent Ear and Sinus Infections

In children, environmental allergy is one of the factors that may contribute to the development of recurrent or chronic sinusitis and otitis. We aimed to determine the frequency and characteristics of allergies in children with recurrent and/or chronic ENT infections. We reviewed medical records of children who were referred to pediatric allergy and immunology clinic between July 2009 and July 2012 with the diagnosis of chronic rhinosinusitis, recurrent sinusitis, recurrent otitis, and chronic otitis. Patients with cystic fibrosis and anatomic defects were excluded. Allergic evaluation included allergy skin prick test or ImmunoCAP assay for environmental allergens (dust mites, cat, dog, cockroach, pollens, and mold spores) and if indicated for food allergens. Demographic data, including age and sex, and concomitant disorders, including asthma, atopic dermatitis, food allergy and drug allergy, were recorded. To date, 67 charts were reviewed. Mean age was 6.3 years. Sixty-four patients underwent allergy evaluation by either skin test or blood test. Fifteen patients (23.5%) had positive test: 7 patients for indoor allergens only, 1 patient for outdoor allergens only, and 7 for both indoor and outdoor allergens. Atopic dermatitis and food allergy were more common in allergen-sensitized children and asthma was more common in non allergic children. Allergy evaluation should be considered in children with recurrent or chronic sinus and ear infections.

Extremely high frequency therapy for the prevention of acute respiratory diseases in children with chronic ENT and allergic diseases

Extremely high frequency (EHF) therapy (42.19 +/- 0.10 GHz; 5.6 mm) is an efficacious method for the prevention of acute respiratory diseases (ARD) in frequently ill children presenting with chronic ENT diseases (chronic tonsillitis, chronic sinusitis) and allergic reactions (allergic rhinitis, atopic dermatitis). It helped to reduce ARD morbidity, duration of a single ARD episode, and frequency of bacterial complications per one child during the 6 and 12 month-long observation periods in comparison with the patients of the placebo group. It is believed that prophylactic effect of EHF therapy in frequently ill children is due to positive effect of extremely high frequency electromagnetic radiation on the adaptive capacity of the organism, improvement of both cellular and humoral immunity, correction of the initial vegetative tone and vegetative dysfunction.

Chronic inflammation and microflora in ENT organs in patients with multiple sclerosis

The paper presents the results of the analysis of nasal cavity and stomatopharynx condition in the group of patients with multiple sclerosis. Microflora, immunological status and inflammatory changes of mucous membranes are studied. In the group of patients with multiple sclerosis the frequency of dysbiotical changes and chronic ENT diseases is higher than in the group of comparison. The correlation between frequency of dysbiosis and immunological status disturbances is shown.

Medical supervision of young female athletes training in complex coordinational sports

This article proposes simple medical criteria that can be used by trainers and others for effective medical supervision of young female athletes. The cross-sectional, age-stratified study compared girls 10-17 years of age involved in intensive training in gymnastic floor exercises, trampoline, or badminton. Each sport and/or control group was represented by 40-45 girls. Data included medical history, morphometric variables and observation of biological development. Gymnasts started training earliest (approximately 5-years-old) and trained most intensely (18-20 h/wk), followed by trampolinists and then badmintonists. Height, weight, body mass index, and % body fat were reduced in athletes, with gymnasts showing the greatest reduction. Athletes showed higher ratios of leg length to height and shoulder width/hip width, and smaller pelvic size compared to height. The average age of menarche of gymnasts was 13.8 (1.6 year later than controls). Delays of biological development of more than 2 years were common in athletes, and some gymnasts showed more than a 4-year delay. These delays were related to morphometric indicators of hormonal imbalance and to low body fat. Gymnasts had more childhood diseases, with an infection index of 2.8 compared to 1.1 for the control group, and had a higher level of chronic ENT problems. Trainers need to protect the health of athletes. During the course of training, anamneses, delayed menarche and other signs of delayed biological development must be monitored. Morphometric measures and indicators of biological development are proposed to provide simple criteria important in protecting the athletes' health.

Immunologic evaluation of patients with recurrent ear, nose, and throat infections

Purpose In this study, we aimed to study the frequency of possible underlying immunodeficiency responsible for susceptibility to ear, nose, and throat (ENT) infection. Materials and methods One hundred three (72 males and 31 females) consecutive children and adult patients with history of recurrent or chronic ENT infections, referred by otolaryngologists to the Department of Allergy and Clinical Immunology, Children's Medical Center, Tehran University of Medical Sciences (Tehran, Iran), were enrolled to the study from March 2003 to March 2006. For each patient, demographic information and medical histories of any ENT infections were collected by reviewing the patient's records. We measured immunoglobulin isotype concentrations and immunoglobulin (Ig) G subclasses by nephelometry and enzyme-linked immunosorbent assay methods, respectively. Of 103 patients, 75 received unconjugated pneumococcus polyvalent vaccine, and blood samples were taken before and 21 days after vaccination. Specific antibodies against whole pneumococcal antigens were measured using enzyme-linked immunosorbent assay method. Existence of bronchiectasis was confirmed in each patient using high resolution computed tomography scan. Results Among 103 patients, 17 (16.5%) patients were diagnosed to have defects in antibody-mediated immunity including 6 patients with immunoglobulin class deficiency (2 common variable deficiency and 4 IgA deficiency), 3 with IgG subclass deficiency (2 IgG2 and 1 IgG3), and 8 with specific antibody deficiency against polysaccharide antigens. In our series, bronchiectasis was detected in 5 cases associated with primary immunodeficiency. Conclusions Long-standing history of ENT infections could be an alarm for ENT infections associated with primary antibody deficiency.

The yield of upper gastrointestinal endoscopy in patients with suspected reflux-related chronic ear, nose, and throat symptoms.

It is well established that various ENT disorders and symptoms may be a manifestation of gastroesophageal reflux disease (GERD). Erosive esophagitis is considered a rare finding in ENT patients and therefore upper gastrointestinal (GI) endoscopy is not recommended in the diagnostic work-up. However, large prospective studies underscoring this policy are lacking. The aim of the present study was to investigate the prevalence and severity of esophagitis in patients with suspected GERD-related chronic ENT symptoms. Endoscopy was performed in 405 ENT patients with suspected GERD and 545 typical GERD patients. The presence of erosive esophagitis, Barrett's esophagus, hiatal hernia, peptic ulcer, and Helicobacter pylori infection on biopsies was determined and compared with the results of a symptom questionnaire. The prevalence of erosive esophagitis (52.3% vs 38.4%; p < 0.05), mainly grade 1 (31.9% vs 22.7%; p < 0.05), and of peptic ulcer (8.4% vs 4.3%; p < 0.05) was significantly higher in patients with GERD-related ENT symptoms compared to typical GERD. Barrett's mucosa occurred in, respectively, 4.9% and 4.5% of the patients (NS). Esophagitis prevalence was highest in patients with predominant cough and lowest in globus pharyngeus and throat symptoms. The presence of esophagitis was associated with significantly higher rates of symptom relief during the first 8 wk of proton pump inhibitor (PPI) therapy. Patients with suspected GERD-related ENT symptoms have a high prevalence of esophagitis and this is associated with better response to antisecretory therapy.

Ambulatory Esophageal pH Monitoring

Extraesophageal manifestations of gastroesophageal reflux may be best diagnosed using ambulatory esophageal pH monitoring. This test involves the placemenmt of a thin pH probe in the esophagus, which is connected to a small box on a waistbelt. Studies are done in an ambulatory state in the patient’s home and work environment. Data collected assesses acid exposure time over the circadian cycle and the relationship of symptoms to pH drops. Studies in adult asthmatics demonstrate abnormal amounts of acid reflux by 24-hour esophageal pH monitoring in >50% of patients. Likewise, large studies in patients with chronic ENT complaints find abnormal acid reflux values in 50–80% of patients. Several problems and issues with ambulatory pH monitoring still need addressing, including (1) the need for dual pH monitoring, (2) artifact and reproducibility, (3) normal values, (4) role in the initial diagnosis, and (5) role in the follow-up of poorly responding patients.

離島診療所で経験した耳鼻咽喉科疾患症例の検討

One hundred and sixty four ENT patients were observed at the Kashima village hospital located on the remote, isolated islands (Islands of Koshiki), Kagoshima prefecture, during two years of April 1987 to March 1989. They were composed of the following conditions; 1. Of the 164 individuals, 46 cases, showing 28.1% were admitted from the other inconvenient districts. 2. About a half of all the patients with acute infectious diseases might be treated by their home doctors. 3. The patients required operative care were contained in the individuals with chronic inflammatory diseases. 4. Most of the cases with acute otitis in summer were caused by naked diving to catch the fishes in these islands. 5. The incidence of the chronic ENT diseases such as perceptive hearing disturbances including the presbyacusis, chronic otitis media, chronic sinusitis, and laryngopharyngeal paresthesia in order, were the same as one of the previous reports in the other remote isolated islands. All the general practitioners worked in the remote isolated islands should be necessary to have a special training of fundamental knowledges and clinical skills in otolaryngology.

Dizziness and perceptual style.

This study tested the hypothesis that patients suffering from non-organic ('psychogenic') dizziness would score higher on Witkins' frame dependence test than a group of dizzy patients with peripheral organic damage. A computerized version of the portable rod and frame test was administered to a group of 10 chronic ENT patients with peripheral vestibular disease, 10 ENT patients with no detectable organic problems and 10 non-dizzy controls. Contrary to the hypothesis, the psychogenic group had less frame-dependent error than the peripheral group and less (though not significantly so) than the normal group. Four of the psychogenic group had very low frame dependence scores. The experience of dizziness may not be necessarily related to anxiety proneness and may be a function of an inhibitory autonomous perceptual style as well as one overly dependent on external cues.