Vol 23, No 3 (2021)
Articles
Treatment and diagnostic features of odontogenic maxillary sinusitis
Abstract
Nowadays, the share of odontogenic maxillary sinusitis according to various authors can reach 40% among all sinusitis. The literature review of the diagnostic and treatment features of odontogenic maxillary sinusitis is done. The use of modern methods of radiation examination allows us to identify the cause of sinusitis and reveal its odontogenic nature. The main thing in the treatment of odontogenic sinusitis is the elimination of the stomatogenic cause of the disease. There are several different types of surgical treatment of maxillary sinus disease: Caldwell-Luke operation, endoscopic transnasal approach with access through the lower and/or middle nasal passage. Our clinical experience of treatment of 36 patients with odontogenic maxillary sinusitis at the ENT department. Odontogenic maxillary sinusitis does not have specific symptoms. There are no recommendations how to choose any approach according to pathology, anatomy, additional diseases etc.
Consilium Medicum. 2021;23(3):203-205
203-205
Complications of rhinosinusitis
Abstract
The article presents a literature review of the problem of intracranial and orbital rhinosinusitis complications. The modern classification of rhinosinusitis according to European Position Paper on Rhinosinusitis and Nasal Polyps - 2020 is presented. The possible complications of acute and exacerbation of chronic inflammatory diseases, the features of development associated with the topographical and anatomical localization in the facial and cerebral skull region. The advantages of paranasal sinuses computed tomography and magnetic resonance imaging in the diagnosis of pathological processes, especially in cases of complicated forms of rhinosinusitis, are described. Also, a clinical example of the orbital abscess development, its diagnosis difficulties, and the choice of a surgical treatment algorithm are presented. In conclusion, recommendations for practicing ENT surgeons are presented, reflecting the key points of diagnosis and treatment of complicated forms of rhinosinusitis.
Consilium Medicum. 2021;23(3):206-209
206-209
Topical therapy in the treatment of patients with acute rhinosinusitis in adults
Abstract
Acute rhinosinusitis is one of the most common diseases in the world, characterized by acute inflammatory processes in the nasal cavity and paranasal sinuses, lasting less than 4 weeks. According to statistics, in Russia, this disease is recorded in 6-15% of the population annually, in European countries in every seventh person, while there is a tendency to an increase in the incidence. Acute viral rhinosinusitis has the highest incidence among all rhinosinusitis and occurs in most patients in a mild form, however, untimely treatment of inflammation of the nasal mucosa can lead to obstruction of the natural anastomoses, impaired physiological ventilation and drainage of the paranasal sinuses, stagnation of secretions with further development acute bacterial rhinosinusitis. The overuse of local vasoconstrictor drugs (intranasal decongestants) leads to the development of drug-induced rhinitis, long-term imbalance of autonomic innervation of the nasal mucosa and edema, called "rebound syndrome". In the article we consider the issues of etiology, pathogenesis, features of the course of rhinosinusitis. The principles of differential diagnosis of viral and bacterial rhinosinusitis are stated, taking into account the latest recommendations and research in this area. The features of the use of the most frequently used topical preparations in acute rhinosinusitis in the practice of an ENT doctor have been analyzed.
Consilium Medicum. 2021;23(3):210-215
210-215
Clinical and radiation diagnostics of mixed forms of chronic sinusitis in combination with dentoalveolar pathology
Abstract
The choice of diagnostic tactics and methods of conservative and surgical treatment of mixed polypous and polypous-purulent types of chronic rhinosinusitis in patients with concomitant dentoalveolar pathology, comorbid somatic pathology depends on the availability of clinic’s technical supply and the patient's mood to make the optimal choice. The literature does not provide a unified algorithm for the examination and management of patients with chronic mixed polypous and polypous-purulent types of sinusitis occurring against the background of dentoalveolar pathology. Aim. Justification of differentiated approach to the diagnosis of chronic mixed polypous and polypous-purulent rhinosinusitis in patients with dentoalveolar pathology. Materials and methods. In 200 patients with these types of rhinosinusitis, pathological changes in the paranasal sinuses, nasal cavity and dentoalveolar apparatus were revealed. Results. In activation of the focus of odontogenic infection, pathological changes in the nasal cavity and paranasal sinuses were more severe at the side of odontogenic infection focus; in inactive odontogenic process and in presence of rhinogenic provoking factors, the severity of pathological changes in the nasal cavity and paranasal sinuses were similar at both sides. With each relapse of activation of the focus of odontogenic infection, the duration and severity of sinusitis increased. Conclusion. The basic diagnostic method for examining patients with mixed polypous and polypous-purulent types of chronic sinusitis in combination with dentoalveolar pathology is cone-beam computed tomography, which let to assess the severity of odontogenic infection focus against the background of pathological changes in the nasal cavity and paranasal sinuses to select the optimal therapeutic tactics.
Consilium Medicum. 2021;23(3):216-221
216-221
Results of treatment for ronchopathy and obstructive sleep apnea syndrome in children with adenoid hypertrophy/vegetations
Abstract
Introduction. There are various sleep disorders that are striking and depressing at the same time in their diversity. One of the urgent problems that modern medicine is working on is problems with breathing during sleep, including obstructive sleep apnea syndrome (OSAS). The prevalence of this disease in children ranges from 1.2 to 5.7%. Adenotomy is an absolute indication for children with OSAS and adenoid hypertrophy. Aim. To study the frequency of occurrence of the OSAS in patients admitted to their hospital otorhinolaryngological department of Rauhfus Children’s Municipal Multi-Specialty Clinical Center of High Medical Technology for the planned surgical treatment of adenoid hypertrophy; to assess the effect of adenotomy on the course of OSAS in children. Materials and methods. 42 children aged from 4 to 12 years were examined; all patients underwent computer-based pulse oximetry, rhinomanometry, and nasopharyngeal endoscopy. Results. After adenotomy, nasal patency in children improved significantly: from 289.26 ml/s to 467.00 ml/s; the mean night saturation and desaturation nadir values in children during treatment improved from 97.31 to 97.68% and from 87.58 to 91.52%, respectively; sleep apnea syndrome was detected in 88% of all patients; 1 month after adenotomy, in 66.67% of the examined children OSAS was not detected.
Consilium Medicum. 2021;23(3):222-225
222-225
Correction of the nasal septum in children with surgical pathology of the paranasal sinuses (literature review)
Abstract
Diseases of a nose and paranasal sinuses are in the lead among pathology of upper respiratory tract. The incidence of chronic sinusitis in children ranges from 16 to 34%. Deviation of a nasal septum is detected in 74% of children at the age of 14 years. There are researches proving efficiency of one-stage performing septoplasty and FESS operations at adult patients. At the same time, data on efficiency and safety of carrying out one-stage septum-operation and FESS at children’s age aren’t enough. Improvement of nasal breathing and providing broad access to the surgical area is a result of such interventions. It is also possible to refer decrease anesthesiology load of the child and readmission number. Carrying out low-invasive operations on structures of nose and paranasal sinuses under endoscopic control allows to reduce traumatization of a mucous membrane and improves visibility of the surgery field for the operator. Simultaneous surgical treatment of paranasal sinuses and a nasal septum deviation using methods of FESS in children is a perspective and safe method of treatment. Such surgery demands good practical skills, up-to-date equipment, correct algorithm of performing surgical intervention and also thorough observation of the patient in preoperative and postoperative periods.
Consilium Medicum. 2021;23(3):226-230
226-230
Tactics of managing patients with primarily detected nasopharyngeal neoplasm. Case reports
Abstract
In 5% of cases in the nasopharynx of an adult can be found a neoplasm with benign or malignant nature. Clinical manifestations of such pathology are next: persistent dysfunction of the auditory tubes, nasalness and postnasal drip syndrome. Endoscopy of the nasopharynx, computed tomography of the sinuses and magnetic resonance imaging of the head are the main diagnostic criteria for detecting neoplasms in this area. The tactics of treatment depends on the dysplasia type of the pathological process and varies from endoscopic one-stage resection to chemoradiation treatment. Using the example of two clinical cases, we will consider an algorithm for diagnosis and treatment the patients.
Consilium Medicum. 2021;23(3):231-235
231-235
Screening method for diagnosis of pharyngolaryngeal reflux
Abstract
Pharyngolaryngeal reflux (PLR) can cause the upper respiratory tract pathology. To diagnose PLR based on complaints is rather difficult, due to the absence of typical manifestations of reflux syndrome in some cases of the disease. The use of daily impedance pH monitoring of the esophagus is not always possible due to the invasiveness and unavailability of the method. The aim of the study was to develop an affordable non-invasive method for diagnosing PLR. The study group consisted of 48 patients with PLR proven by the results of impedance pH-monitoring. The control group consisted of 20 healthy patients. The “Pharyngolaryngeal reflux index” questionnaire was developed based on the analysis of patient complaints. The questionnaire was assessed using ROC analysis. Patients who scored 5.5 points according to the results of the questionnaire with a probability of 93.2% have PLR. Thus, a method for the diagnosis of PLR has been developed, including the simultaneous comparison of the laryngoscopic signs of PLR with the highest diagnostic sensitivity (hyperemia, edema, maceration of the interarytenoid mucosa) and “Pharyngolaryngeal reflux index" questionnaire results, which allows diagnosing of PLR.
Consilium Medicum. 2021;23(3):236-239
236-239
A patient with lacrimation at an otorhinolaryngologist consultation
Abstract
Lacrimation is one of the most common symptoms in ophthalmic practice. Most patients first visit an ophthalmologist, but the otorhinolaryngologist also plays an important role in determining the etiology of the disease and in the choice of management for such patients. This review presents a literature search that addresses the diagnosis and treatment of patients with epiphora. Identifying the cause of lacrimation is the main factor in making the correct diagnosis and choosing the optimal treatment method. Endonasal dacryocystorhinostomy is of particular importance. The multidisciplinary approach of the ophthalmologist and otorhinolaryngologist allows for the success of the epiphora treatment.
Consilium Medicum. 2021;23(3):240-243
240-243
Effect of intranasal fluticasone propionate on respiratory obstruction in pollen allergy
Abstract
Background. Allergic rhinitis (AR) remains the most common manifestation of pollen allergy, with nasal congestion as the leading symptom. About half of patients with AR have comorbidity with bronchial asthma (BA). Intranasal corticosteroids (INC) have a positive effect on the manifestations of rhinitis and concomitant comorbid pathology. The choice of adequate treatment, rejection of ineffective combinations, polypharmacy remains a widely demanded area of research in real clinical practice. Aim. To evaluate the effect of monotherapy of INC with fluticasone propionate (FP) on nasal and bronchial obstruction in pollen comorbid AR and BA and the possibility of obtaining therapeutic benefits from additional administration of systemic antihistamines (AH). Materials and methods. A prospective 5-week, double-blind, placebo-controlled study of monotherapy with INC FP and combined therapy of FP with the non-sedative AH loratadine in patients with concomitant AR and BA was carried out. The study included 72 patients with the first diagnosis of AR, with existing BA and sensitization to plant pollen. Two comparable patient groups were formed with different therapeutic approaches. Examination, allergy testing, ECHRS questionnaire, symptom severity scale were used to assess symptoms. Active anterior rhinomanometry and spirometry were used to assess the level of obstruction of the upper and lower airways.Results. A high level of polysensitization was found in the examined persons with comorbid pathology. Significant reduction in nasal congestion was found both in the group receiving FP and in the group with combination therapy. However, the use of antihistamines in addition to FP did not significantly affect on congestion symptom. After treatment, there was a decrease in nasal resistance in both groups. The total nasal volumetric flow significantly increased in both groups. The change in the parameters of external respiration is shown. Significant changes in peak expiratory flow rate and forced expiratory volume in the first second after the completion of treatment were found in both groups. Conclusion. A high incidence of polysensitization has been shown in patients with AR and BA. The efficacy and safety of FP has been proven by subjective assessment and objective instrumental methods for studying upper and lower airway obstruction. The addition of AH did not significantly change the effectiveness of therapy.
Consilium Medicum. 2021;23(3):244-249
244-249
Comparative analysis of the results of cochlear implantation under general and local anesthesiain patients with comorbid pathology
Abstract
The article is devoted to an urgent problem - the correction of hearing impairment in patients with concomitant diseases. The results of a comparative analysis of data from patients with somatic diseases who underwent cochlear implantation (CI) for severe to profound hearing loss hearing loss of the fourth degree and deafness under local and general anesthesia are presented. Materials and methods. On the basis of the National Medical Research Center for Otorhinolaryngology of the Federal Medical-Biological Agency of Russia, CI was performed under local anesthesia for 10 patients with concomitant diseases, which represented difficulties for the use of general anesthesia (main group). All patients in the preoperative stage precisely informed about each stage of the surgery and with the cue-cards (with questions) to maintain contact with them during CI. The control group consisted of 10 patients who underwent CI under general anesthesia. CI was performed according to a standard technique. After the operation, a survey of patients of both groups about subjective sensations during the operation and in the early postoperative period was carried out.Results. CI under local anesthesia takes an average of 18±5.2 min, taking into account the time of anesthesia, which is 15±5.3 min less than with general anesthesia (p<0.001). When performing CI under local anesthesia, clear thresholds for recording acoustic reflexes stapedial muscle are determined, since in this case the effect of muscle relaxants is excluded. Against the background of local anesthesia, the necessary effect was achieved rather quickly, there was no increase in blood pressure to high numbers, patients answered all the signs and questions by reading the information from the cue-cards. A survey of patients revealed a good tolerance to local anesthesia. The number of patients in the main group which had a complaints in the early postoperative period was less than in the control group (p<0.05). The duration of hospital staying in patients of the main group averaged 1.15 days (from 1 to 3 days), which is significantly less than in the control group - from 3 to 7 days, on average 4.05 days (p<0.05). When conducting CI under local anesthesia, none of the patients showed a destabilization of comorbidity pathology in the postoperative period.Conclusion. CI under local anesthesia in patients with concomitant pathology has several advantages over general anesthesia. The use of local anesthesia will increase the availability of CI for elderly comorbid patients and mitigate the risks of general anesthesia.
Consilium Medicum. 2021;23(3):250-255
250-255
Antiseptics as an alternative to systemic antibiotic therapy
Abstract
Sore throat is one of the most frequent reasons for going to the doctor and prescribing irrational antibacterial therapy. The reasons for this are many -from the difficulties of etiological diagnosis and the development of relapses and possible severe complications to the personal attitude of doctors and patients to the choice of treatment. At the same time, the issue of antibiotic resistance, side effects associated with the appointment of antibacterial therapy, is one of the most important problems of modern health care around the world. Difficulties in the process of clinical observation of patients, the peculiarities of the course of infectious and inflammatory diseases of the pharynx are factors requiring constant improvement of methods of providing medical care. Antiseptics play a significant role in the treatment of sore throat, exceeding the frequency of use of antibiotics. So, one of the antiseptics used topically, the effectiveness of which has been proven in clinical studies, is Strepsils, which includes 2,4-dichlorobenzyl alcohol and amylmetacresol. The results of clinical studies of the drug indicate its positive effect in patients with sore throat. All this things allow us to recommend that this complex antiseptic be more often included in the treatment of infectious and inflammatory diseases of the oral cavity and pharynx.
Consilium Medicum. 2021;23(3):256-260
256-260
Long COVID-19
Abstract
The term “long COVID-19” describes the long-term effects of the novel coronavirus infection COVID-19. Patients with severe COVID-19 who require hospitalization, as well as those who are on outpatient treatment with mild clinical forms of the disease, often report persistent fatigue, shortness of breath, pain, cough and other respiratory and extrapulmonary symptoms for weeks and months. The generally accepted time frame that separates the duration of the acute and subacute phase of infection from the long COVID-19 is 28 days. The article describes the duration and the course of clinical disorders caused by COVID-19 and their persisting after the end of the acute phase of the disease. In addition, the current understanding of the causes of long-term consequences and the possibilities of drug and non-pharmacological correction are presented.
Consilium Medicum. 2021;23(3):261-268
261-268
COVID-19 and community-acquired pneumonia
Abstract
The article is devoted to the diagnosis and differential diagnosis of COVID-19 and community-acquired pneumonia. It provides a comparative analysis of clinical, laboratory and computed tomographic signs of diseases. The issues of rational antibiotic therapy for COVID-19 and community-acquired pneumonia are discussed.
Consilium Medicum. 2021;23(3):269-274
269-274
The actuality of preventing influenza and pneumococcal infection during the ongoing COVID-19 pandemic
Abstract
The article discusses the issues of vaccine prevention of influenza and pneumococcal infections during the ongoing pandemic of the new coronavirus infection COVID-19. Statistical data on the prevalence of these infections at the current time are provided. Co-infection can increase the symptoms of the diseases in these cases, and managing this condition is important for certain groups of patients. Respiratory viruses induce the attachment of pneumococcus, Pseudomonas aeruginosa and Hemophilus bacillus to the epithelial cells of the respiratory tract. The WHO position on influenza vaccination in the context of the COVID-19 pandemic is presented, and its main provisions are analyzed. Recommendations on the use of the main types of vaccines are given. Currently, the priority is to use 4-valent vaccines that ensure the development of the most stable immunity. In the Russian Federation, such a vaccine that meets all WHO recommendations is Ultrix Quadri, a tetravalent inactivated split influenza vaccine. The drug is a mixture of protective surface and internal antigens of influenza viruses of type A [subtypes A(H1N1) and A(H3N2)] and type B (Yamagata line and Victoria line). The use of vaccination schemes for pneumococcal infection was also discussed.
Consilium Medicum. 2021;23(3):275-279
275-279
The structure of comorbidities in cases of fatal outcomes in HIV-infected patients held at reform facilities of the Federal Penitentiary Service of Russia
Abstract
Aim. To study the structure of comorbidities in HIV-infected patients who died in institutions of the penal system. Materials and methods. The material of the study was the data of a retrospective analysis of 515 clinical cases with fatal outcomes from diseases in the institutions of the Federal Penitentiary Service of Russia in the Udmurt Republic from 2004 to October 2020. The study group (group I) consisted of 91 patients from among the persons infected with HIV, the control group (group II) - patients with HIV-negative status (424 patients). Statistical processing of the material was carried out using the methods of variation statistics. Significance was assessed using the Pearson Chi-square test (х2), Student's t test. During the study, the structure of concomitant diseases in cases of lethal outcomes was studied in dynamics. For the statistical processing of indicators and the implementation of a medium-term forecast (for three periods (years) ahead) of the values of the studied epidemiological indicators, the determination coefficient R2 was used. Results. As part of the in-depth analysis of mortality, it was proved that HIV-infected patients, unlike those with HIV-negative status, significantly more often suffer from diseases of the circulatory system (I00-I99), which were diagnosed on average in 47.1% of cases (х2=1 1.557, р<0.001), diseases of the digestive system (K00-K93) diagnosed on average in more than half (58.3%) of clinical cases (х2=12.829, р<0.001), diseases of the nervous system (G00-G99) diagnosed on average in 73.4% (х2=74.151, р<0.001), as well as diseases of the urinary system (N00-N99), diagnosed on average in 20.8% of patients (х2=7.993, р=0.005). With the implementation of the mid-term forecast, an increase in the structure of concomitant pathologies of diseases of the circulatory system (R2=0.4023) and diseases of the digestive system (R2=0.4807) is expected. The share of diseases of the nervous system will remain stably high (R2=0.3242). Conclusion. HIV-infected patients in penitentiary institutions are characterized by polymorbid conditions, which require timely diagnosis and therapy in order to reduce the risk of poor outcomes and disability.
Consilium Medicum. 2021;23(3):280-284
280-284
285-291
Description of COVID-19 infection course in a patient with multiple comorbidity: hairy cell leukemia, chronic generalized sarcoidosis and deep vein thrombosis in the lower extremities. Case report
Abstract
This article presents an unusual case of a mild novel coronavirus infection COVID-19 in a patient with multiple comorbidity, including hairy cell leukemia, chronic generalized tuberculosis deep vein thrombosis in the legs which manifested with mild symptoms of general intoxication only.
Consilium Medicum. 2021;23(3):292-295
292-295
Aminodihydrophthalazinedione sodium in prevention, therapy and rehabilitation of patients with respiratory diseases
Abstract
The modern approach to the prevention and treatment of acute respiratory viral infections consists in the use of drugs that increase the body’s defenses, helping to create a barrier to the penetration of the virus. Immunomodulators exhibit a nonspecific effect in acute respiratory viral infections, which makes it possible to use them against various types of respiratory viruses without accurate laboratory diagnostics and expands clinical capabilities. In the first part of the review, the features of sodium aminodihydrophthalazinedione and the experience of its use in respiratory pathology are considered. The pandemic of the novel coronavirus infection (COVID-19), spread by the novel coronavirus SARS-CoV-2, has become a challenge to health systems around the world. The second part of the review reviews the results of the first studies on the use of sodium aminodihydrophthalazinedione for the prevention and treatment of new coronavirus infection. Recently, much attention has been paid to the long-term consequences of the postponed coronavirus infection. In the final part of the review, various aspects of the “post-COVID syndrome” are discussed and the possibilities of aminodihydrophthalazinedione sodium at the stage of rehabilitation after a coronavirus infection are discussed.
Consilium Medicum. 2021;23(3):296-303
296-303