Τετάρτη 29 Δεκεμβρίου 2021

Features of the clinic, diagnosis and treatment of parapharyngeal abscesses in children: analysis of 121 observations

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Vestn Otorinolaringol. 2021;86(6):62-68. doi: 10.17116/otorino20218606162.

ABSTRACT

Parapharyngeal and retropharyngeal abscesses (PPA) in children are a rare pathology, for the diagnosis of which it is necessary to use additional instrumental examination methods. The tactics of treating patients remains a subject of discussion.

OBJECTIVE: To analyze the features of the clinic, diagnosis and treatment of PPA in children.

MATERIAL AND METHODS: According to the hospital database, a retrospective analysis of the medical histories of children discharged from the clinic with a diagnosis of "J39.0 Retropharyngeal and parapharyngeal abscess" was carried out in the period from 01.01.14 to 31.12.19. In all cases, the diagnosis was confirmed by computed tomography (CT) data with contrast enhancement. Complaints at the time of treatment, anamnesis and instrumental diagnosis data, clinical features of the course of the disease and the e ffectiveness of treatment were analyzed.

RESULTS: 121 children were treated for PPA (average age 73±41 months; Me=52.5 months), which is 0.4% of all hospitalized in the otorhinolaryngological department, 0.7% of the number of emergency hospitalizations, 0.8% of the number of hospitalized children with pharyngeal diseases, and 8.3% of the number of patients with pharyngeal abscess. Abscesses were more often localized in the upper pharynx, at the level of the I-II cervical vertebrae (49.6% of all observations); abscesses were found least often in the pharyngeal space (5.8%), there was no statistically significant difference between the right-sided and left-sided location: 47.9% and 46.2%, respectively. Surgical treatment was performed in 98 (81%) patients in the presence of an abscess capsule or an abscess diameter of more than 2 cm according to CT; the remaining 23 (19%) children were treated conservatively. The opening of the abscess was performed endopharyngeal, in the case of a pronounced deep lateral location of the abscess and its proximity to large blood vessels - with access through the tonsillar niche after preliminary tonsillectomy (19.4% of those operated).

CONCLUSION: The final diagnosis of parapharyngeal and retropharyngeal abscess can be established by contrast-enhanced computed tomography. Conservative treatment is indicated for a limited group of patients at the initial stages of the disease, most patients need surgical treatment.

PMID:34964332 | DOI:10.17116/otorino20218606162

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Auditory tube dysfunction in children. Part 2

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Vestn Otorinolaringol. 2021;86(6):99-104. doi: 10.17116/otorino20218606199.

ABSTRACT

The presented literature review examines in detail the methods for diagnosing the auditory tube, the history of development of studies of the Eustachian tube and the treatment of its dysfunction in children. The issue of dysfunction of the auditory tube as one of the causes of the formation of chronic hearing loss in childhood is increasingly being identified because of the rapid development of technologies and methods for examining patients. Aim is to study the multiple etiologic factors of the disease and the need for an integrated approach to the study of this condition.

PMID:34964338 | DOI:< a href="https://doi.org/10.17116/otorino20218606199" target="_blank" rel="noopener" class="underlink bluelink">10.17116/otorino20218606199

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Neutrophil extracellular traps in the pathogenesis of chronic rhinosinusitis

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Vestn Otorinolaringol. 2021;86(6):105-112. doi: 10.17116/otorino202186061105.

ABSTRACT

The review presents the current understanding of the pathogenesis of chronic rhinosinusitis. The causes of damage to the mucous membrane of the paranasal sinuses are most often the result of a combination of immunological, infectious and anatomical factors. This indicates the need for a multidisciplinary approach to the study of the pathogenesis of this pathology. There is no single universally recognized classification of chronic rhinosinusitis, which takes into account histological and immunological changes in the mucous membrane of the paranasal sinuses. The discovery of the mechanism of completion of the life cycle of neutrophils - the formation of a neutrophil extracellular trap or NETosis, different from necrosis and apoptosis, opened up new prospects in the study of the pathogenesis of inflammatory processes, including rhinosinusitis. Neutroph il extracellular traps reduce the permeability of the epithelial barrier in the mucous membrane of the paranasal sinuses. This determines their possible role in the etiopathogenesis of rhinosinusitis. In recent years, more and more attention has been paid to the feasibility, effectiveness and safety of therapy that affects the immune component of the inflammatory process, including NETosis. The data obtained in the study of extracellular traps can be used in clinical practice. It is neutrophil extracellular traps that can become a potential target in the treatment of patients with chronic rhinosinusitis.

PMID:34964339 | DOI:10.17116/otorino202186061105

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The effectiveness of auditory training using virtual reality technologies in persons with chronic sensorineural hearing loss

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Vestn Otorinolaringol. 2021;86(6):17-21. doi: 10.17116/otorino20218606117.

ABSTRACT

OBJECTIVE: To study the effectiveness of auditory training using virtual reality technologies in people with chronic sensorineural hearing loss in dynamics.

MATERIAL AND METHODS: The study included 68 patients aged from 24 to 97 years (mean age 57.63±15.87 years) with latent hearing loss (hearing loss at high frequencies), I degree of hearing loss and its variations. Auditory training was carried out on the basis of the Diagnostic and Rehabilitation System for spatial and speech hearing based on virtual reality using various audiovisual scenarios ReviAudio and control of speech perception, spatial hearing and hearing quality using the SSQRus questionnaire.

RESULTS: A comparative analysis of the training results using the ReviAudio software revealed positive trends in the patient's response time and the patient's accuracy in determining the direction of the target signal, regardless of the symmetry and asymmetry of hearing loss. Patients with asymmetric hearing impairment observe an improvement in spatial hearing parameters, patients with symmetric hearing loss - speech perception and hearing quality, patients with latent hearing loss report an improvement in the quality of hearing. The auditory training is effective in individuals with mild chronic sensorineural hearing loss and in individuals with latent hearing loss as an adjunctive treatment.

PMID:34964323 | DOI:10.17116/otorino20218606117

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A case of ear miasis in a 2-month-old child

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Vestn Otorinolaringol. 2021;86(6):113-116. doi: 10.17116/otorino202186061113.

ABSTRACT

A clinical case is presented - a rare observation of ear myasis in a 2-month-old child.

PMID:34964340 | DOI:10.17116/otorino202186061113

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Laryngeal cysts in children

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Vestn Otorinolaringol. 2021;86(6):57-61. doi: 10.17116/otorino20218606157.

ABSTRACT

Laryngeal cysts in children are relatively rare, occupying the 4-5th place in the structure of congenital malformations. The paper presents the combined experience of two Russian pediatric otorhinolaryngological clinics traditionally involved in the rehabilitation of patients with congenital and acquired pathology of the larynx.

OBJECTIVE: To analyze the features of the clinic, diagnosis and treatment of laryngeal cysts in children.

MATERIAL AND METHODS: The study included 68 children with laryngeal cysts aged from 3 days to 16 years (on average 39.5±37.0 months, Me=15.5 months). The cyst was localized in the vestibular region of the larynx in 15 (22.1%) patients, in the vocal region - in 15 (22.1%) patients, and in the sub-vocal region - in 38 (55.9%) patients. Data on the presence of a history of tracheal intubation were available in 35 ( 89.7%) children, including 35 (92.1%) of 38 children with a subfold cyst. 11 patients were admitted with a previously applied tracheostomy.

RESULTS: The main reasons for going to the clinic were signs of laryngeal stenosis (stridor, signs of obstruction of the upper airways) in 60.3% of patients, dysphonia - in 33.8%, and in 5.9%, the detection of a cyst became an accidental finding. To eliminate the cyst, the method of laser marsupialization was used in 10 patients, coagulatory ablation - in 2 patients, in the remaining 56 patients, decortication was performed with microinstruments, followed by laser treatment of the cyst bed. In the follow-up, children were traced from 6 months to 7 years. We did not observe a recurrence of a cyst in any case.

CONCLUSION: Currently, the lining department is the "favorite" localization of the cyst in childhood. Subclavian cysts are more common in preterm infants who need tracheal intubation. A necessary condition for radical elimination is the resection of the cyst walls.

PMID:34964331 | DOI:10.17116/otorino20218606157

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The Hypothalamic Paraventricular Nucleus Is the Center of the Hypothalamic–Pituitary–Thyroid Axis for Regulating Thyroid Hormone Levels

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Thyroid, Ahead of Print.
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