11
Vestn Otorinolaringol
. 2020;85(2):6-13. doi: 10.17116/otorino2020850216.
[Exudative Otitis Media as a Manifestation of Spontaneous Otoliquorrhea]
[Article in Russian]
A I Kryukov 1, E V Garov 1, E I Zelikovich 1, M V Tardov 1, O V Fedorova 1, T G Martirosyan 1
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PMID: 32476382 DOI: 10.17116/otorino2020850216
Abstract in English , Russian
Spontaneous otoliquorrhea (SOL) often mimics the picture of exudative otitis media (EOM), which leads to delayed diagnosis of the underlying disease.

Purpose of study: Is to evaluate causes, clinical features and diagnostic algorithm for patients with SOL.

Patients and research methods: From 2007 to 2018, 33 patients with SOL underwent examination and treatment in the Department of Ear Microsurgery of the Institute. At the preoperative stage, all patients underwent a complete examination, including examination of ENT organs, anthropometric, biochemical, audiological, ultrasound and radiological tests, which made it possible to make the correct diagnosis.

Results: SOL was more likely to occur in women over 50 who are obese (69.7%, stage II-III). The disease onset in 51.6% of patients was preceded by conditions accompanied by a short-term or prolonged increase in intracranial pressure. SOL was manifested by the clinical picture of EOM in 72.7% of cases, only in 45.5% of cases was accompanied by release from the ear and nose, was often intermittent and complicated by meningitis in 12.1% of patients. Difficulties in diagnosing the disease are caused by clinical manifestations of exudative or acute otitis media in the absence of a causative factor, which led to the verification of SOL from 1 to 4 years in 81.9% of patients who received long-term treatment for other ENT diseases.

Conclusion: The master factors in the diagnosis of SOL are otomicroscopy and endoscopy of the nasopharynx, Halo test and screening determination of glucose level in the obtained discharge, as well as high-resolution CT of the temporal bone, which allows to localize the cerebrospinal fluid fistula and to determine the size of the defect.

Keywords: diagnosis; exudative otitis media; spontaneous otoliquorrhea.

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12
Vestn Otorinolaringol
. 2020;85(1):45-47. doi: 10.17116/otorino20208501145.
[New Ways of Solving the Problem of Restenosis in the Surgical Treatment of Congenital Choanal Atresia in Children]
[Article in Russian]
E N Kotova 1, E O Vyazmenov 1, M R Bogomilsky 1
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PMID: 32241988 DOI: 10.17116/otorino20208501145
Abstract in English , Russian
This article presents the literature data and our own findings on the surgical treatment and options for solving the problem of restenosis in congenital atresia of the choanae (CAC) in children.

Purpose: In order to solve the issues of prevention of the fibrosis in the postoperative period in patients with CAC, the prospects of using the carboxymethyl cellulose gel-sodium salt (CGSS) were assessed.

Patients and methods: This medicine was used in patients, who were: primarily operated, after a period of wearing a protector (n=17); primarily operated without using a protector, at the final stage of the operation and in the early postoperative period (n=15); reoperated because of the restenosis, also at the final stage of the operation and in the early postoperative period (n=12).

Results: We present our results of application of the carboxymethyl cellulose gel-sodium salt for the prevention of scar adhesions in this condition: endoscopy of the nasal cavity and choanal region in all 44 patients with follow-up observation (from 1 year to 5 years) showed no signs of restenosis.

Conclusion: The use of sodium carboxymethyl cellulose sodium salt in the intra- and postoperative period may be one of the ways of solving the problem of restenosis after surgery in children with CAC along with the use of endoscopic techniques for performing choanotomy.

Keywords: carboxymethyl cellulose gel-sodium salt; children; congenital atresia of the choanae; restenosis; transnasal surgery.

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13
Vestn Otorinolaringol
. 2020;85(1):22-24. doi: 10.17116/otorino20208501122.
[The Role of Group A β-Hemolytic Streptococcus in the Etiology of Acute Inflammatory Pathology of the Pharynx in Children and Adolescents]
[Article in Russian]
M M Evsikova 1, E Yu Radtsig 1, M A Varavina 1
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PMID: 32241983 DOI: 10.17116/otorino20208501122
Abstract in English , Russian
Group A β-hemolytic streptococcus (GABHS) is the most important bacterial agent in the genesis of acute inflammatory conditions of the pharynx due to the possible development of local and systemic complications. During the seasonal increase of incidence of respiratory viral infections, the possibility of viral-bacterial co-infection is often not taken into account.

Aim: Determine the incidence of GABHS in children with catarrhal symptoms (rhinorrhea, cough) and without them.

Material and methods: 69 children with signs of acute tonsillopharyngitis (ATP) in the first 2 days of the disease were examined. Patients were divided into 2 groups depending on the presence or absence of rhinorrhea and cough. All patients underwent a comprehensive otorhinolaryngological examination and bacteriological examination of smears from the surface of the posterior pharyngeal wall and lacunae of the tonsils. Obtained data was processed by basic statistical methods.

Results: Incidence of GABHS in children with ATP without catarrhal symptoms was 9.5%, with rhinorrhea and cough - 3.7%. Median age for the detection of GABHS in patients with ATP was 5.6 years. A statistically significant symptom of GABHS-positive patients in our study was the enlargement of the anterior cervical lymph nodes; plaques on the tonsils were found only in 20% of cases.

Conclusion: GABHS is predominant in patients with ATP without catarrhal phenomena, however, the presence of rhinorrhea and coughing in a patient does not exclude the possibility of the presence of GABHS infection, therefore, patients with ATP should undergo an objective examination for GABHS.

Keywords: clinical recommendations; pharyngitis; tonsillitis; tonsillopharyngitis; β-hemolytic group A streptococcus.

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14
Vestn Otorinolaringol
. 2020;85(2):73-77. doi: 10.17116/otorino20208502173.
[Damage to the Inner Ear With Syphilitic Infection]
[Article in Russian]
O M Doronina 1 2, A V Gurov 1 2, D V Zaslavsky 3, Yu S Egorova 3, D S Ogorodnikov 1
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PMID: 32476396 DOI: 10.17116/otorino20208502173
Abstract in English , Russian
The epidemiology of neurosyphilis is presented in article. The pathogenetic mechanisms of involvement in the syphilitic process are described already in the early stages of the disease of the central and peripheral nervous system and, in particular, of the auditory and vestibular analyzers. Described classical clinical forms of neurosyphilis. Statistical data on the incidence of syphilis in Russia from the 20-30s of the last century to the present are given. Presented analysis of the development of the incidence rate in Russia of syphilis and neurosyphilis, the main methods for the diagnosis of neurosyphilis. The changes in the structure of neurosyphilis disease that have occurred over the past 20 years, which are characterized by nonspecificity, course wear and inversion of typical clinical symptoms, as a result of pathomorphism, are described. The article describes the mechanism for the development of the pathological process in the inner ear with syphilitic infection. Described changes in the capillary wall of the vascular streak, leading to impaired hematolabyrinth barrier function and the development of the labyrinth hydrops. Literature data on the electron microscopic study of the vascular strip of the rabbit webbed snail infected with syphilis are presented. The article also collected literature data on indicators obtained by audiological and vestibulological studies of the inner ear in cases of early and late neurosyphilis. The article focuses on the possible only manifestation of neurosyphilis in the form of cochleovestibular symptoms.

Keywords: acoustic analyzer; neurosyphilis; syphilis; vestibular analyzer.

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15
Vestn Otorinolaringol
. 2020;85(2):26-30. doi: 10.17116/otorino20208502126.
[A Meta-Analysis of Clinical Studies in Otorhinolaryngology]
[Article in Russian]
A A Korneenkov 1, Yu K Yanov 1, S V Ryazantsev 1, E E Vyazemskaya 1, S V Astashchenko 1, E S Ryazantseva 1
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PMID: 32476385 DOI: 10.17116/otorino20208502126
Abstract in English , Russian
The objective: Of the work was to describe the basics of a meta-analysis with features for evaluating models with fixed and random effects, to present principles for interpreting the graphical results of a meta-analysis (forest plot or blobogram) of comparative reviews of randomized clinical trials (RCTs).

Material and methods: To illustrate the possibility of efficient use of the R software environment for meta-analysis, we used the results of RCTs of various tonsillectomy methods already published in the Cochrane Database review.

Results: The article provides explanations for the calculation of effect size, heterogeneity statistic, and other meta-analysis statistics and their interpretation for evaluating RCTs and recommendations for choosing a model depending on the on the general research concept.

Conclusion: The described method allows meta-analysis and gives an idea of the principles for preparing the results of clinical trials with the expectation of their subsequent use in systematic reviews and meta-analysis.

Keywords: R software environment; R-language; blobogram; chronic tonsillitis; effect model; forest plot; meta-analysis; randomized controlled studies; relative risk; systematic review.

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16
Vestn Otorinolaringol
. 2020;85(2):14-20. doi: 10.17116/otorino20208502114.
[Hearing Loss Due to Mutations or Lack of the Gene Coding Protein Stereocillin]
[Article in Russian]
T G Markova 1 2, N N Alekseeva 1 2, O L Mironovich 3, E A Bliznets 3, M R Lalayants 1 2, A V Polyakov 3, G A Tavartkiladze 1 2
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PMID: 32476383 DOI: 10.17116/otorino20208502114
Abstract in English , Russian
Objective: The description of a clinical picture and audiological features at the hearing loss caused by changes of a STRC gene, coding protein stereocillin (MIM: 606440). Mutations in the numerous genes responsible for the inner ear proteins are the reason for congenital sensorineural hearing loss. The main cause of congenital bilateral sensorineural hearing loss in the Russian Federation are mutations in GJB2 gene it reaches up 68% of cases identified in infancy. GJB2 gene tests already became routine around the world. Possibilities of new methods based on sequencing of new generation (NGS, next generation sequencing) allow to conduct a research of more rare genes connected with a hearing impairment. The most often among GJB2 negative patients reveal mutations and deletion of a gene of STRC.

Patients and methods: Full audiological examination of 5 children and one adult with a hearing loss from 2 unrelated families is provided. Mutations in STRC gene were identified. All children are examined aged before 8 years, and 3 children failed universal audiological screening in maternity hospital, to two children screening was not carried out as they were born till 2009.

Results: The children with the sensorineural hearing loss connected with mutations and deletion of STRC gene failed hearing screening in maternity hospital because of the OAE is not registered, what indicates the congenital nature of a hearing loss. Recently it could not be noticed earlier because of slight increase of hearing thresholds and was regarded only as the early onset. Our data emphasize that the of thresholds from 35 to 60 dB in frequencies 0,5-4 kHz is common for mutations/deletions of STRC gene.

Conclusion: The development of molecular genetics methods confirms the hereditary causes of GJB2-negative patients and expands indications for family counseling. Special approach for child with hearing loss so early revealed is necessary and the consultation of parents frightened of screening results is very important.

Keywords: STRC gene; congenital hearing loss; mild-to-moderate hearing loss; nonsyndromal sensorineural hearing loss.

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17
Vestn Otorinolaringol
. 2020;85(2):49-52. doi: 10.17116/otorino20208502149.
[Bilateral Temporal Bone Xanthoma Associated With Hyperlipidemia]
[Article in Russian]
M V Subbotina 1, O V Kanya 2
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PMID: 32476390 DOI: 10.17116/otorino20208502149
Abstract in English , Russian
Presented clinical observation of a 42-year-old patient with bilateral xanthoma of the temporal bone, who has been treated for a long time for bilateral external otitis media, repeatedly mastoiditis. In this case, hyperlipidemia was detected only after the diagnosis of xanthoma was established. In this case, histological and clinical data helped to diagnose xanthomas and exclude chronic otitis media: the preservation of the auditory ossicles and hearing despite a large destruction of the temporal bone; satisfactory condition of the patient for many years in the presence of volumetric formations in both temporal areas extending into the cranial cavity, spreaded from the brain substance and not accumulating contrast according to computer and magnetic resonance imaging; normalization of hearing against the background of prolonged heating of the body - 'melting' of fats and opening the ear canal. Fistulas, through which a yellowish secret stood out either in the external auditory canal or in the behind-the-ear area, served as a kind of 'whisper valve', which made it possible to stop the pain syndrome and did not lead to the development of cerebral symptoms.

Keywords: differential diagnosis of mastoiditis; hypercholesterolemia; temporal bone xanthoma.

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18
Vestn Otorinolaringol
. 2020;85(2):21-25. doi: 10.17116/otorino20208502121.
[OTOF-related Auditory Neuropathy Spectrum Disorder]
[Article in Russian]
M R Lalayants 1, O L Mironovich 2, E A Bliznets 2, T G Markova 1 3, A V Polyakov 2, G A Tavartkiladze 1 3
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PMID: 32476384 DOI: 10.17116/otorino20208502121
Abstract in English , Russian
Otoferlin (OTOF) gene mutations are the most common cause of hereditary ANSD according to investigations in several countries.

The aim: Of this study was to estimate the prevalence of OTOF mutations in Russian children with ANSD and evaluate audiological and clinical features of OTOF-related ANSD.

Patients and methods: 28 children with bilateral ANSDwere enrolled in the investigation. Two step genetic testing was performed: first step - GJB2 gene testing to exclude GJB2-related hearing loss; second step - NGS-based sequencing to explore another 35 hearing loss genes (including OTOF).

Results: OTOF mutations, including 6 new variants, were found in 5 children with ANSD (18%). All 5 children had no risk factors for hearing loss and passed hearing screening. OAE and cochlear microphonics were present till the last testing at the age of 4-5 years. ABR were not detectable. The ASSR were measurable bilaterally at all frequencies in all cases, but they did not correlate with behavioral thresholds that revealed severe hearing loss. Hearing thresholds were stable during follow up period. 3 children underwent cochlear implantation. After cochlear implantation auditory nerve action potentials to electric stimulation were detected within normal range.

Conclusion: Genetic testing of children with ANSD and first of all OTOF testing enables to reveal hearing loss etiology and provide the optimal rehabilitation approach, including cochlear implantation, as early as possible.

Keywords: auditory neuropathy; cochlear implantation; hereditary hearing loss; otoferlin.

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19
Vestn Otorinolaringol
. 2020;85(1):30-33. doi: 10.17116/otorino20208501130.
[Congenital Laryngeal Paralysis in Children]
[Article in Russian]
M L Zakharova 1, P V Pavlov 1
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PMID: 32241985 DOI: 10.17116/otorino20208501130
Abstract in English , Russian
Aim: To optimize the current algorithms of diagnosis and treatment of children with congenital laryngeal paralysis.

Method: A retrospective study of case histories of patients with congenital laryngeal paralysis who were examined and treated at St. Petersburg State Pediatric Medical University.

Results: For the period from 1995 to 2015, 30 children with various forms of congenital laryngeal paralysis were under medical supervision at the Clinic for Otorhinolaryngology at St. Petersburg State Medical University.

Conclusion: In cases of stage 1-2 laryngeal stenosis in children older than 3 years 6 months, the chordarythenoidotomy may be the procedure of choice. In cases of stage 2 laryngeal stenosis, in children with tracheostomy, we consider laryngotracheoplasty with the insertion of costal autograft in the back wall of the larynx at the age of 4 years as the optimal choice.

Keywords: congenital malformations of the larynx; laryngeal paralysis in children.

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20
Vestn Otorinolaringol
. 2020;85(1):10-13. doi: 10.17116/otorino20208501110.
[Treatment of Exudative (Secretory) Otitis Media in Young Children Taking Into Account the Anatomical Features of the Auditory Tube]
[Article in Russian]
M M Polunin 1, O V Chernova 2
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PMID: 32241981 DOI: 10.17116/otorino20208501110
Abstract in English , Russian
Aim: To study the efficacy and safety of treatment of exudative (secretory) otitis media (EOM) in children of early age taking into account the anatomical features of the auditory tube.

Material and methods: We examined and treated 30 children (51 ears) by balloon dilatation (BD) at the age of 1 to 3 years, with recurrent EOM (more than 6 months). The 21st child was diagnosed with a 2-sided process, and 9 with a one-sided process. All patients have previously unsuccessfully used conservative methods of treatment. According to the results of the examination and treatment, the children were divided into 2 groups. In group 1 (16 children, 30 ears) included children suffering from ESR in combination with hypertrophy of adenoids 2-3 art. with a block of pharyngeal mouths of auditory tubes, which at stage 1 of treatment was carried out endoscopic adenotomy and shunting of the tympanic cavities. In follow-up, this group of children after shunt loss was diagnosed with relapse of EOM (type B was registered on tympanometry). In this group, balloon dilation of auditory tubes was performed in the second stage after adenotomy and bypass surgery. In group 2 (14 children, 21 ear) included children with relapsing course of EOM, the adenoid vegetation 1 degree without block the pharyngeal orifices of the auditory tubes, which in the first phase was conducted on bypass the tympanic cavity. After the loss of shunts, during the control examination, a relapse of EOM was diagnosed, in connection with which, the children underwent balloon dilation of the auditory tubes.

Results: During tympanometry in 1 month. complete restoration of middle ear function in 17 children (56.7%, 28 ears) (tympanograms type A) was revealed. 4 children (13.3%, 6 ears) were diagnosed with partial recovery of middle ear function (tympanograms type C). 9 children (30%, 17 ears) retained exudate in the tympanic cavity, these patients underwent a second course of conservative therapy, after which the function of the middle ear was restored. 9 children after BD with persistent exudate in the middle ear cavities underwent tympanostomy (in this case, long-term wearing shunts were used).

Conclusion: Balloon dilation of the cartilaginous part of the auditory tube is minimally invasive, effective in 70% of cases and a safe approach to the treatment of children suffering from a recurrent course of EOM.

Keywords: balloon dilation of the auditory tube; early childhood; exudative otitis media; the anatomical and topographical features of the auditory tube.

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