Difficulty In Nasal Breathing Research Articles

The effectiveness of using a homeopathic preparation containing calendula, witch hazel, aesculus, menthol and zinc oxide in patients with nasal obstruction in vasomotor and chronic subatrophic rhinitis

Introduction. In recent years, the world has seen an increase in the number of patients with difficulty in nasal breathing due to nasal obstruction, one of the causes of which are functional disorders of the nasal mucosa in various forms of rhinitis. Frequent use of intranasal decongestants among the population further contributes to the lack of effectiveness of conservative treatment and the need for surgical correction to restore free nasal breathing. This article discusses the possibility of using a homeopathic preparation containing calendula, witch hazel, aesculus, menthol and zinc oxide in patients with nasal obstruction in vasomotor and chronic subatrophic rhinitis to stop the clinical manifestations of the disease and improve the quality of life of patients. Аim. Тo evaluate the effectiveness of a drug containing calendula, witch hazel, aesculus, menthol and zinc oxide in patients with vasomotor and chronic subatrophic rhinitis in the complex treatment of nasal obstruction. Мaterials and methods. The study involved 48 adult patients of both sexes, aged 20 to 50 years, diagnosed with vasomotor (idiopathic) rhinitis in 24 and chronic subatrophic rhinitis in 24 patients. The studied preparation containing calendula, witch hazel, esculus, menthol and zinc oxide was smeared on the mucous membrane of the nasal cavity by laying gauze turundas for 5 minutes, 3 times a day, while the course of treatment was 10 days. The efficacy and safety of the drug was assessed by the dynamics of the severity of subjective symptoms, objective clinical data during control examinations by an otorhinolaryngologist in points, as well as by the presence of side effects in the treatment of the disease. Results. Results of the study showed a pronounced positive trend in the form of relief of subjective complaints and the main clinical manifestations of the disease, accompanied by an improvement in the quality of life in patients in both groups examined during treatment. Side effects were not observed in patients in both study groups. Conclusions. Based on the results of the study, conclusions were drawn about the efficacy and safety of using a complex homeopathic preparation containing calendula, witch hazel, esculus, menthol and zinc oxide in an adult group of patients with nasal obstruction, which makes it possible to recommend it for widespread use for the complex treatment of nasal syndrome. obstruction in vasomotor and chronic subatrophic rhinitis, as well as other forms of rhinitis accompanied by nasal obstruction syndrome.

Features of the course of influenza and its co-infection in children at the present stage

Influenza is an acute respiratory infection, mainly affecting the respiratory tract (often the trachea), with a tendency to develop symptoms rapidly and in most cases not requiring hospitalization. All acute respiratory infections are non-specific, with symptoms of intoxication, catarrhal symptoms (nasal congestion, rhinorrhoea, sore throat or pharyngeal discomfort), fever and cough. Improvement and widespread implementation of molecular methods to identify respiratory pathogens has led to the establishment of a higher frequency of co-infections. A literature review of the frequency of influenza co-infections is presented. Clinical cases of monoinfluenza and co-infections of influenza and respiratory syncytial infection are described, demonstrating the antagonistic effect of the two viruses on the course of the disease. In the first case, the patient, 1 year 1 month old, was hospitalised with a fever of 39 ºC in a moderate condition. A nasopharyngeal swab showed RNA of influenza A virus by PCR and was diagnosed with influenza. In the second case, the patient, 2 years old, at the beginning of the disease complained of an increase in body temperature to 38.7 ºC, cough, and difficulty in nasal breathing. On admission, the patient was in moderate condition with a body temperature of 36.6 ºC, clear consciousness and well-being. On auscultation, breathing in the lungs was rigid, single moist rales, scattered on both sides. A nasopharyngeal swab showed RNA of influenza A virus and respiratory syncytial virus by PCR. A viral acute respiratory infection of combined etiology and acute bronchitis was diagnosed. In the third case, a 14-year-old patient presented with complaints of fever up to 39 ºC, headache, weakness, muscle pain, dry cough. The condition was of moderate severity. The diagnosis of influenza A was confirmed by a rapid test for influenza A/B/C. In the treatment and prevention of both monoinfection and co-infections of influenza and other viruses, these clinical examples demonstrate the effectiveness of oseltamivir. These clinical examples highlight some key parameters: respiratory co-infections change the typical clinical picture of the disease, making it difficult to clinically diagnose the infection, highlighting laboratory diagnosis, which in turn facilitates rapid verification of the diagnosis and timely prescription of adequate therapy.

Результати аналізу епідеміологічного дослідження медичних даних щодо ефективності Назірус Синус сироп у комплексній терапії гострого вірусного та поствірусного риносинуситу в дітей

In pediatric practice, the prevalence of rhinosinusitis (RS) depends on age: so, in the age category of 6-7 years old, acute RS at least 1 time per year old affects 8.5% of children, and at the age of 13-14 years old - 14.6%. Acute RS is one of the most common reasons for prescribing antibiotics, so correct treatment is extremely important, given the global crisis of antibiotic resistance. The tactics of treatment of acute RS depends on the form, nature of the inflammatory process and the presence of complications. Purpose - to study the effectiveness of the plant-based dietary supplement Nasirus Sinus syrup in the complex therapy of children 3-11 years old with acute viral and postviral RS. Materials and methods. Were analyzed medical data of 1176 children 3-11 years old who received outpatient therapy with a clinical diagnosis of “Acute viral RS” and “Acute postviral RS” (ICD-10: J01.9). The difference between these patients was only the duration of the disease. Results. It has been established that the use of a plant-based dietary supplement Nasirus Sinus syrup in the complex therapy of children 3-11 years with acute RS helps to reduce subjective (nasal congestion, difficulty in nasal breathing, cough, snoring) and objective (mucous membrane hyperemia, postnasal drainage, rhinorrhea, wheezing, goopiness) manifestations of acute RS in a shorter time compared to the control group. The assessment of the severity of acute viral and postviral RS by Major Sinusitis Severity in absolute numbers in the main group was significantly different from the control group. Conclusions. When using the complex therapy of acute viral and postviral RS in children 3-11 years with the inclusion of a plant-based dietary supplement Nasirus Sinus syrup, the results indicate a decrease in the manifestation of symptoms already on the 3rd day of therapy, reliably demonstrates positive dynamics on the 5th and 7th days. Nasirus Sinus syrup should be recommended for use in children in the complex therapy of RS. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Smoke-related interstitial fibrosis – a case report

Smoking-related interstitial fibrosis (SRIF) is a recently described disease which is common finding in a long-term cigarette smokers.Aim. To acquaint readers with relatively unknown interstitial disease. We describe a case of a smoking patient with a long smoking history and squamous cell carcinomas of the larynx and lung who complained of an unproductive cough, sore throat, hoarseness, difficulty in nasal breathing, and shortness of breath during exercise. Obstructive disorders, lung hyperinflation, and a severe decrease in diffusion capacity reflected the signs of severe emphysema in combination with fibrotic changes found by high resolution computed tomography (CT). X-ray picture and characteristic histological changes made it possible to diagnose SRIF.Conclusion. Diagnostics of the disease should be based on CT-signs, histologic picture and functional data. The prognosis is relatively favorable.

State of cerebral hemodynamics in patients with deviation of the nasal septum

Violation of the ecological state of the environment has led to the fact that the center of gravity in otorhinolaryngology has shifted towards rhinology. The curvature of the nasal septum is the most common cause of persistent and severe obstruction of nasal breathing, as well as violations of all the numerous functions of the nose, the development of inflammatory and degenerative processes in the upper respiratory tract. In the case of trouble-free functioning of the nasal cavity of a person, first of all, he is worried (or not worried) by the existing cosmetic function, its preservation or correction. However, the situation changes dramatically when there are disorders of the respiratory, olfactory, protective functions of the nasal cavity. Violation of these functions can cause a person to have complaints and symptoms that are understandable to him, such as difficulty in nasal breathing, one or two sides, excessive secretion of nasal secretions, postnasal rhinorrhea, frequent acute sinusitis or exacerbation of chronic sinusitis, and it is not clear how headache pain, otitis media, dysfunction of the auditory tube, manifestations of rhinocardinal, rhinocerebral and rhinopulmonary reflexes. And not the last place in the occurrence of these complaints and conditions belongs to the nasal septum.

COVID-19 Outbreak at Sports Club: Conditions of Occurrence and Causes of the Spread of Infection

Relevance. The new coronavirus infection (COVID-19), which appeared in late 2019 in China, has spread to almost all countries of the world in just a few months. The explosive nature of its spread was accompanied by the formation of large epidemic foci in organizations of various profiles, including leisure and sports. Aims. To establish the conditions and causes of the spread of SARS-CoV-2 among the members of one of the sports clubs based on an in-depth epidemiological analysis. Materials and methods. To study the features of the spread of the SARS-CoV-2 virus in a sports organization, the following documents were used previously developed by the authors and successfully tested in practice: «Act of epidemiological investigation of group and outbreak morbidity of new coronavirus infection (COVID-19) at an enterprise/organization/institution» and «Individual card of a patient with a new coronavirus infection (COVID-19) at the enterprise / organization/institution». In the process of epidemiological investigation, in order to detect SARS-CoV-2 RNA in PCR, a laboratory examination of sports club participants (sick and contact) was conducted, followed by genome-wide sequencing of isolated SARS-CoV-2 viruses on the basis of the Laboratory of Molecular Virology of the A. A. Smorodintsev Influenza Research Institute, which performs these types of studies. Results. Within 17 days, 26 cases of COVID- 19 were registered among the sports team members and staff from the support group (coaching staff, medical staff, administrators), which was 74.3% of their actual number. The majority of patients (76.9%) had mild acute respiratory infection, two (7.7%) had no symptoms, and four (15.4%) had interstitial pneumonia. Of the clinical manifestations of the disease, the most frequent were weakness, fever, headache, muscle and joint pain, difficulty in nasal breathing and serous-mucous discharge from the nose, sore throat, cough, shortness of breath, anosmia and dyspeptic manifestations in the form of diarrhea, nausea or vomiting. The occurrence of the outbreak was the result of the introduction of infection from the opposing team at the tournament. The leading factors that contributed to the spread of COVID-19 among sports club members were the admission to games and training of athletes with acute respiratory infections, prolonged close contact between players during training and competitions, violations in the use of personal protective equipment, compliance with hygiene and hand antiseptics, disinfection measures in the premises of sports institutions and defects in the implementation of the regulations for the examination of teams for SARS-CoV-2 during tournaments. Conclusion. Based on the results of the study, data were obtained on the features of the spread of SARS-CoV-2 in sports organizations, which can be used in conducting preventive and anti-epidemic measures in sports and leisure institutions.

А case of combination of dacryocystocele with a nasolacrymal cyst in infant child

INTRODUCTION: Dacryocystocele (hydrops of the lacrimal sac) is a rare variant of a congenital pathology caused by the obstruction of proximal and distal lacrimal ducts, followed by progressive distension of the lacrimal sac [1]. Given the accumulation of abundant contents in the lacrimal sac and nasolacrimal duct, the membrane that closes their outlet under the inferior turbinate can be stretched, and the prominence of such a membrane into the inferior nasal passage is in the form of the so-called nasolacrimal cyst [3].
 Description of the clinical case. A 1.5-month-old girl was hospitalized in the ophthalmology department of the University. Below are the history data. At the 30th week of pregnancy, the fetus had a bilateral space-occupying lesion in the area of the inner canthus of the eye. At birth, the child had a dense swelling in the region of the left lacrimal sac but without discharge. From birth, he had difficulty in nasal breathing.
 RESULTS: According to the results of multislice computed tomography of the lacrimal ducts with contrast (Ultravist), cavity formations were found under the inferior turbinate on both sides with a contrast level. At the age of two months, the child, accompanied by an otolaryngologist, underwent surgery for the removal of nasolacrimal cysts on both sides and reconstruction of the lacrimal ducts and their intubation with a silicone thread on the left. After surgical treatment, the outflow of tears and nasal breathing were restored, and no signs of dacryocystocele were detected. The silicone thread was removed after 1 month, and no tear production was observed.
 DISCUSSION: Treatment of children with dacryocystocele involves the simultaneous reconstruction of lacrimal ducts by an ophthalmologist and excision of the nasolacrimal cyst by an otolaryngologist.
 CONCLUSION: When examining a child with dacryocystocele, the possible presence of a nasolacrimal cyst should be considered. The interaction of an ophthalmologist and an otolaryngologist at all stages of the treatment and diagnostic process enables the prevention of disease complications and unnecessary surgical procedures.

Modern approach for complex treatment of odontogenic maxillary sinusitis

Introduction: Odontogenic maxillary sinusitis is associated with diseases of the maxillary teeth. The close anatomical relationship of these teeth with the floor of the maxillary sinus leads to violation of the integrity of its mucosa and creates prerequisites for the infection to pass into the sinus cavity. Odontogenic maxillary sinusitis is characterized by dental complaints and the typical symptoms of all rhinosinusitis. There is lack of consensus in the literature on the algorithm of behaviour in these cases. Aim: To recommend a contemporary algorythm of management in patients with odontogenic maxillary sinuitis, which is consistent with both the established rules for the treatment of rhinosinusitis and the individual characteristics of each clinical case. Materials and methods: For the period 2001-2021, 157 patients were treated at St. George University Hospital, after extraction of an upper tooth (4-6) or with symptoms of nasal breathing difficulties and unilateral whitish secretion with an unpleasant odour. All of them had a history of dental intervention and CT data for changes in the osteomeatal complex or „foreign bodies“ in the maxillary sinus. Results: All patients were discharged on the third day after admission in improved general condition without complaints. No late postoperative complications were observed. In 8 of the patients with sinuscopy, after the control CT examination, performed a month later, a second intervention was necessary for the extraction of residual fungal material. Conclusion: The treatment of odontogenic maxillary sinusitis involves interdisciplinary approach of otorhinolaryngologists and dental specialists. However, modern understanding of the functioning of the nasal cavities and the development of pathological processes in them help us to build and present an adequate concept for diagnosis and therapeutic behavior.

ENT symptoms of mask-wearing in the coronavirus disease 2019 era.

Analysis of the otorhinolaryngological problems caused by mask-wearing in the coronavirus disease 2019 era. A survey with 26 questions was sent by e-mail to 576 individuals. The most frequently worn masks were three-layer surgical ear loop masks (n = 434, 80.1 per cent), followed by N95 or filtering facepiece code 2 masks (n = 58, 10.7 per cent), and cloth masks (n = 50, 9.2 per cent). The most bothersome symptoms caused by mask-wearing were difficulty in nasal breathing (n = 227, 41.8 per cent), nasal itching and pain (n = 93, 17.2 per cent), earache (n = 88, 16.2 per cent), difficulty in expressing oneself (n = 73, 13.5 per cent), difficulty in understanding speech (n = 56, 10.3 per cent), and ear itching (n = 5, 0.9 per cent). The problems associated with mask-wearing may result in avoidance of wearing them. Thus, there is a need for new methods that will reduce the problems related to mask-wearing, to increase their use in the community.

Complex Approach to Diagnosis of Nasal Cavity and Nasopharyngeal Pathologies in Children. Initial Results

Background. Nasal cavity and nasopharyngeal pathology are crucial and common issue in pediatric otorhinolaryngology. One of the major reasons for the nasal breathing difficulties are adenoids, allergic rhinitis, acute rhinitis, rhinosinusitis, nasal septum deviation. All these diseases can occur individually and in combination with each other, while clinical signs can be similar.Objective. The aim of the study is study and estimate the condition of nasal breathing and sense of smell in children with different nasal and nasopharyngeal pathology.Methods. The study included 128 children, all children were divided into 3 groups comparable by gender and age. Children with confirmed acute ENT organ disease were included in the 1st group, children with allergic disease exacerbation were included in the 2nd group, and clinically healthy children (control group) were included in the 3rd group. Survey methodology: rhinomanometry (RMM), rhinoresistometry (RRM), olfactometry.Results. It was revealed that nasal resistance in children with allergic diseases exacerbation is significantly higher both before and after anemisation of nasal mucosa with a solution of nasal decongestants than in children of the control group (according to the RRM). The air flow rate increases by average of 25% in children with various ENT organs diseases, and in children with allergic diseases — by average of 43% after anemisation of the nasal mucosa. The obtained data shows the role of nasal mucosal edema in patients with allergic diseases during exacerbation. Analysis of our RMM and RRM data suggests the importance of further use of these methods in children.Conclusion. The obtained results will allow us to optimize the diagnosis approach and personalize the management of patients with various nasal cavity and nasopharynx pathologies. Nowadays, the study is ongoing.

Breastfeeding challenges in infants with nasal breathing difficulties: alternative supplemental feeding methods

This review article highlights the features of breastfeeding in case of obstructed nasal breathing in infants, special attention is paid to non-sucking or alternative methods of bottle feeding with expressed breast milk for the period when breastfeeding is not possible or formula supplementation is necessary as an addition to breastfeeding.Breathing through the mouth is considered a pathological adaptation due to difficulty in nasal breathing and is associated with the development of many pathological conditions. There is an evidence base that prolonged breastfeeding is associated with nasal breathing at an older age, as well as the correct formation of the bite. The anatomical and physiological features of the structure of the upper respiratory tract in infants predispose to a more frequent occurrence of difficult nasal breathing compared to adults, which causes difficulties in breastfeeding, up to the refusal of the child’s breast. Therefore, knowledge of modern methods of supplementary feeding with expressed breast milk for this period, as well as ways to effectively and safely deal with nasal congestion in infants, will help doctors and parents to overcome the difficult period of the disease, accompanied by nasal congestion without loss and maintain breastfeeding for as long as possible, in the light of modern data on influence of breast milk on the subsequent life of mother and child.The main method of treatment for nasal congestion of various etiologies is irrigation-elimination therapy. According to the literature, good tolerability and no side effects were found when using a nasal aspirator used in conjunction with isotonic saline.

ВОЗМОЖНОСТИ РАННЕЙ ДИАГНОСТИКИ ПЕРВИЧНОЙ ЦИЛИАРНОЙ ДИСКИНЕЗИИ

Despite the manifestations of primary ciliary dyskinesia (PCD) in the neonatal period or in the first year of life, the diagnosis of this rare disease is usually established at the age of 4–7 years. The aim of the study was to search for reserves for early diagnosis of PCD. Materials and methods of research: 17 patients were observed with PCD, confirmed on the basis of the PICADAR scale, highspeed light video microscopy (all patients) and transmission electron microscopy (in 3 patients) of the mucous biopsy of the respiratory membrane using a genetic study (in one patient). Results: all patients were born full-term; neonatal respiratory distress syndrome (RDS) was observed in 71% of patients; the median duration of mechanical ventilation/oxygen therapy was 14 [7; 21] days; lateralization abnormalities were found in 35% of patients; all patients had persistent nasal congestion and/or rhinorrhea, 94% had chronic or recurrent sinusitis, otitis, recurrent pneumonia, chest x-ray and computed tomography (CT) scans in 71% had atelectasis with constant localization in the middle lobe, 12 of 15 patients, traced in the follow-up, – bronchiectasis (BE), also mainly in the middle lobe (in 9 patients). The average age at diagnosis was 5 [1.75; 7] years, patients with an established diagnosis over the age of 3 years were more often diagnosed with BE. The median of PICADAR scores was 7 [6; 8] points. Conclusions: to establish early diagnosis of PCD, it is important to consider neonatal RDS, lateralization of organs, difficulty in nasal breathing, starting from the first half of life.

Клініко-сонографічні показники як діагностичні критерії інфекційного мононуклеозу в дітей

Актуальність. Значний поліморфізм клінічних проявів інфекційного мононуклеозу, поліорганність ураження, часта відсутність чітких клініко-параклічних критеріїв та відстроченість результатів доступних лабораторних тестів, а іноді і неможливість їх проведення утруднюють діагностику захворювання на догоспітальному етапі та при надходженні до стаціонару. Мета дослідження: оптимізувати діагностику та лікування інфекційного мононуклеозу в дітей шляхом вивчення сучасних особливостей перебігу та аналізу діагностичної цінності клінічних та інструментальних показників у верифікації захворювання. Матеріали та методи. На базі інфекційного боксованого відділення крапельних інфекцій КМУ «Обласна дитяча клінічна лікарня» (м. Чернівці) обстежені 65 дітей, хворих на інфекційний мононуклеоз, які знаходилися на стаціонарному лікуванні в період 2014–2015 рр., першу клінічну групу (І) сформували 42 дитини, заключний клінічний діагноз захворювання у яких верифіковано на підставі комплексу клініко-гематологічних критеріїв, до другої (ІІ) клінічної групи порівняння увійшли 23 дитини, хворі на серологічно підтверджений інфекційний мононуклеоз. За основними клінічними ознаками групи спостереження вірогідно не відрізнялися. Результати. Установлено, що для хворих на інфекційний мононуклеоз дітей характерні клінічні особливості, зокрема раптовий початок захворювання (у 93,8 %) із лихоманки, вищої за 37,5 °С (у 80 %), наявність ексудативного тонзиліту (у 81,6 %), підщелепної та шийної лімфаденопатії (у 90,7 %), утрудненого носового дихання (у 78,4 %) та гугнявості голосу (у 73,8 %). У підтвердженні інфекційного мононуклеозу Епштейна — Барр-вірусної етіології явища ексудативного тонзиліту та лімфаденопатії виявилися високочутливими (90 та 95 % відповідно), проте із значною часткою хибнопозитивних результатів. Висновок. Таким чином, з урахуванням недостатньої діагностичної цінності клініко-анамнестичних та сонографічних показників у виявленні інфекційного мононуклеозу Епштейна — Барр-вірусної етіології в дітей, що підтверджувалося низькими значеннями відношення правдоподібності та показників ризику, використання їх доцільне лише в комплексі.

Position and orientation of hyoid bone in mouth breathing children: a cephalometric study

Introduction: The importance of the hyoid bone is associated with its unique anatomical position. The hyoid bone is the only bone in the facial skeleton that attaches to other bones only with the help of muscles. Aim: The aim of this article is to make a cephalometric analysis of the craniofacial anatomy and position of the hyoid bone in children with mixed dentition who have difficult nasal breathing, habitual mouth breathing and a control group of nasal breathing children. Materials and methods: A total of 120 lateral cephalograms of children with mixed dentition were analyzed. The examined X-rays were divided into three groups: 50 lateral cephalograms of children with difficult nasal breathing; 18 lateral cephalograms of children with a habitual mouth breathing and 52 lateral cephalograms of nasal breathing children. To determine the position of the hyoid bone we used the method of Bibby and Preston.1 Results: When comparing the type of the hyoid triangle we found the presence of a statistically significant difference (χ2 = 24.97; p <0.001). In 84% of the children with nasal breathing difficulties there is a negative hyoid triangle and in only 16.00% a positive hyoid triangle. In the nasal breathing children, the positive triangle occurs in 84.60% of cases. In children with habitual mouth breathing the distribution is almost even. A significant difference was found when comparing the height of the negative triangle in children with nasal breathing difficulties and nasal breathing children (t = 6.06; p <0.001). Conclusion: In mouth breathing children there is a lower and posterior position of the hyoid bone compared to nasal breathing children. The negative triangle is characteristic for children, who have difficult nasal breathing, whereas the positive triangle is specific for nasal breathing children.

RHINOSINUSITIS IN PATIENTS IN POST-COVID-19 PERIOD: ETIOLOGY, CLINICAL AND MORPHOLOGICAL CHARACTERISTICS.

The aim is to identify the etiology, clinical and morphological features of rhinosinusitis in patients in post-COVID-19 period. Materials and methods: In the present study, it was carried out the analysis of 11 cases of rhinosinusitis, which developed after COVID-19 infection. The diagnosis of rhi¬nosinusitis was established on the basis of anamnesis, clinical and laboratory examination, specialized instrumental examination (rhinoendoscopy, X-ray, magnetic resonance imaging, spiral and 3D computed tomography). All patients underwent endoscopic sanitation of the nasal cavity, expansion of the maxillary anastomosis, maxillary sinusotomy, sanitation of the maxillary sinuses and removal of pathologically altered tissues. Microbiological examination of the swab from the nasal cavity was carried out in all patients. Histological and morphometric research methods were used during the morphological study of surgical material. The nonparametric Mann-Whitney U test was used to compare the means in the groups. Results: The conducted comprehensive study made it possible to identify chronic atrophic rhinosinusitis at the stage of exacerbation caused by associations of bacteria and fungi in patients in post-COVID-19 period. Among bacteria, the authors most often noted Staphylococcus aureus, Staphylococcus epidermidis, Klebsiella pneumonia, Streptococcus pneumonia and Enterococcus faecalis. Among fungi, there were Aspergillus, Candida, Mucor and Coccidioides. Fungal infection was characterized by invasion into the mucous membrane of the nose and paranasal sinuses. In patients in post-COVID-19 period the invasive bacterial-fungal chronic atrophic rhinosinusitis at the stage of exacerbation was predominantly bilateral, characterized by the involvement of several or all paranasal sinuses in the process. Patients with such pathology complained of periodic fever, headaches and malaise; nasal congestion and constant difficulty in nasal breathing; yellowish-greenish-reddish discharge from the nasal cavity, sometimes with a fetid odor; discomfort and pain in the area of paranasal sinuses; immobility of the eyeball, hyposmia or anosmia; reduction or complete loss of vision. Frequent risk factors for the development of invasive bacterial-fungal chronic atrophic rhinosinusitis at the stage of exacerbation in patients in post-COVID-19 period were the information about moderate or severe course of this infection in anamnesis; comorbidities (predominantly diabetes mellitus, hypertensive disease and ischemic heart disease). Conclusions: The study conducted by the authors made it possible to identify the etiological, clinical and morphological features, as well as risk factors of rhinosinusitis in patients in post-COVID-19 period. This information will contribute to a better understanding of such pathology by the doctors and improve the diagnostic and treatment process.

Анализ микробиоты с поверхности небных миндалин у пациентов с ларингофарингеальным рефлюксом

Due to the large number of patients with complaints of discomfort and sore throat not associated with infectious tonsillopharyngitis, the question of the role of various microorganisms in the occurrence of these complaints remains open. Objective. Analysis of the species microbial landscape of the pharyngeal surface of the palatine tonsils in patients with laryngopharyngeal reflux. Patients and methods. The study included 120 women and 71 men with a median age of 38.0. Patients with acute tonsillopharyngitis (selection was carried out according to the Centor criteria) and patients with difficulty in nasal breathing were not included. The patients underwent oropharyngoscopy, analysis of the results of cultural inoculation from the mucous membrane of the pharyngeal surface of the palatine tonsils, assessment of complaints from the throat on the VAS (visual analogue scale). Results and discussion. It was found that most of the patients were worried about sore throat, the median quantitative assessment was 4.0, patients rated the feeling of a foreign body or lump at 3.0, difficulty in swallowing food, liquid, or tablets, at 0.0. When collecting an anamnesis, it was possible to find out that pain and discomfort in the throat bothered patients for a long time from 2 weeks to several years. Often, patients associated sore throats with general hypothermia; taking chilled drinks; with a viral infection with a chronic bacterial infection; therefore, numerous studies were carried out to detect pathogenic microflora. Conclusion. On the surface of the palatine tonsils in patients with laryngopharyngeal reflux (LPR), in addition to normal, opportunistic, and pathogenic microflora, representatives of the intestinal flora were found in clinically insignificant amounts of colony-forming units; in 63% of patients with LPR, caseous plugs were found in the lacunae of the palatine tonsils; patients with tonsillolitis (47%) felt bad breath themselves, which others did not notice; patients with LPR are characterized by difficulty in swallowing tablets and sore throat with an empty throat; systemic antibiotic therapy for pain with an empty throat, which was received by 98% of patients, was ineffective.

Клинические аспекты ларингофарингеального рефлюкса

Laryngopharyngeal reflux (LPR) as the cause of symptoms in the absence of symptomatic gastroesophageal reflux disease (GERD) is often questioned. But it is worth remembering that GERD is a whole complex of symptoms that occur when the mucous membrane is damaged. We aimed to study the clinical symptoms of LPR without esophageal symptoms. The study included 66 women and 34 men with complaints typical of LPR, aged 18 to 70. The study included patients with typical LPR complaints without esophageal symptoms who rated them at more than 13 points according to the RSI questionnaire. 91 patients (95%) complained of hoarseness; 93 (97%), of a sore throat; 88 (92%), of excessive mucus coughing up or its running off from the nose; 36 (38%), of difficulty swallowing; 43 (45%), of coughing after eating or after lying down; 68 (71%), of shortness of breath or episodes of suffocation; 64 (67%), of excruciating or hacking cough; 84 (88%), of feeling of something sticky in the throat or a lump in the throat. In addition to the typical symptoms of LPR, patients may experience difficulty in nasal breathing; sneezing in the absence of respiratory allergies; burning and bitterness in the mouth; bad breath due to the formation of tonsilloliths; complaints from the ear not recorded by objective methods of research. 23% of patients with LPR suffer from carcinophobia. We concluded that LPR affects the larynx and all parts of the pharynx. The appointment of omeprazole 20 mg 30 minutes before meals in the morning 1 time per day for 6 weeks significantly reduces the symptoms of LPR. A new questionnaire is required for the early detection of LPR symptoms by a questionnaire method.

Применение интраоперационной навигации в эндоскопической хирургии доброкачественных костно-фиброзных образований околоносовых пазух и основания черепа

Objective. Evaluation of the effectiveness and safety of the use of electromagnetic computer navigation in endoscopic surgery of benign fibro-osseous mass of the paranasal sinuses and skull base. Materials and methods. The retrospective study included 21 patients who underwent endoscopic removal of fibro-osseous mass of paranasal sinuses and skull base at the Burdenko Center from 2010 to 2021. The patients were divided into 2 groups: the 1st group included 10 patients with the use of electromagnetic navigation intraoperatively, the 2nd group included 11 patients who were treated without the use of navigation. Median follow-up was 24 months [IQR 12,00, 48,00]. Results. Most often, patients complained of headache (15; 71,4%). In 14 (66,7%) cases, the ethmoid labyrinth was involved; in 11 (52,3%) cases, the sphenoid sinus; in 15 (71,4%) cases, the base of the skull, with intracranial distribution in 5 (23,8%) cases; and in 8 (38%) cases, the wall of the orbit. Surgical treatment was performed radically in 10 (47,6%) patients. The median intraoperative blood loss was 100.00 mL. Intraoperative complications occurred in 3 (14,3%) patients; postoperative complications, in 2 (9,5%) patients. Pathology recurrence occurred in 4 (19,0%) patients, more often in young people (median age 19,50, р = 0,179). The median duration of hospital stay was 3,00 bed-days. It was found that the localization of pathology in the sphenoid sinus is associated with an increased risk of nonradical removal of the formation (р = 0.009). Factors that could influence the choice of the surgeon in favor of intraoperative navigation include visual impairment in the clinical picture of the disease (p = 0,090) or the absence of difficulty in nasal breathing (p = 0.024); localization of the mass only in the sphenoid sinus (p = 0,063) or with involvement of the base of the skull (p = 0.149). The use of intraoperative navigation slightly increases the radicalness of surgical treatment and reduces the incidence of perioperative complications.

Treatment of upper respiratory tract infections: the role of doxycycline

Upper respiratory tract infections (URTI) are a large group of infectious diseases (mainly viral and bacterial), affecting the mucous of the nasal cavity, paranasal sinuses, pharynx and larynx. URTI are very common in inpatient and outpatient clinical practice. In this article, we present a clinical case of Patient N., 20 years old, consulted with upper respiratory tract damage caused by Chlamydia pneumoniae. The patient admitted to clinical diagnostic center on 07.07.2021 with complaints of pain in the left maxillary sinus with irradiation to the left temporal region, difficulty in nasal breathing, pain in the pharynx, aggravated by swallowing, and increased body temperature (37,5 °C). The patient was consulted by an interdisciplinary team (ENT doctor and clinical pharmacologist). After carrying out physical, instrumental and laboratory tests the diagnose Chlamydia pneumoniae - associated URTI was established and, the patient was prescribed doxycycline at a dose of 100 mg 2 two times a day on the 1st day following by 100 once a day for the next 6 days with a positive effect. The doxycycline was choisen because of a more favorable safety and efficacy profile compared to fluoroquinolones and some other antibacterial agents. After 7 days of treatment, the patient recovered completely. Among all doxycycline drugs available on the market of the Russian Federation, Doxycycline Express (JSC Pharmstandard-Leksredstva) stands out due to its high quality, bioequivalence to the original drug and comfortable regime of use due to the dosage form (dispersible tablets), that increases the patient’s compliance and allows it to be used by some special categories of patients (elderly and senile patients, patients with dysphagia, etc.

Volumetric osteoconchoplasty method

Introduction.Pathology of the inferior turbinates (IT) was found in 76.1% of patients with difficulty in nasal breathing. If nasal breathing cannot be restored with conservative measures, surgical intervention becomes the method of choice.Materials and methods.Under local infiltration anesthesia, the IT is fractured and retracted medially (medialization). In the anterior section of the HHP, a vertical incision 0.5 cm long to the bone is made, through which the mucosa is peeled off from the bone base of the concha with a raspator-suction and a small tunnel from 2 to 3 cm long is created. shell surfaces and a small area of the mucosa of the lateral surface of the IT and the lateral wall of the nasal cavity. After insertion into the created tunnel of the required size of the "spreader-implant" plate, treated with a thin layer of LTK glue, the shell is slightly pressed with a self-inflating latex-foam rubber swab introduced into the IT for 10–15 minutes. At the end of the operation, after removing the tampon, the edges of the incision are processed with LTK glue.Results.The results of the study demonstrate the effectiveness of the developed method for the rapid restoration of nasal breathing after rhinosurgical interventions. We use this technique in the overwhelming majority of cases of fibrous and bone forms of IT hypertrophy. In cases of the cavernous form, we perform a submucous conchotomy with a shaver, which makes it possible to very accurately remove exactly that part of the concha that violates the patency of the nasal cavity. In all cases, we consider it compulsory to carry out the IT lateroposition according to our method, which significantly improves the result of the operation. The surface of the shell remains completely covered with mucosa and as a result of matching the edges of the incision, the wound surface is absent. At the same time, after the operation, the shell remains full anatomically and functionally, i.e. consists of the bone skeleton and the corresponding volume of soft tissues.Conclusion.The question of how to predict in the long-term postoperative period the normal size of the modeled IT, apparently, is currently not answered even by highly qualified rhinosurgeons. In this regard, there remains a need to search for new technologies for treating patients with chronic hypertrophic rhinitis.