A. I. Kryukov

Identification of the specific topographic features of the neck vessels for the prevention of bleedings during tonsillectomy

The objective of the present work was to study syntopy of the large neck vessels in relation to the capsule of palatine tonsils with the use of the MRI technology. A total of 109 patients (218 palatine tonsils) presenting with chronic tonsillitis were available for the examination including 64 women and 45 men at the age varying from 15 to 54 years. All of them underwent MRI-guided vascular visualization in the paratonsillar region together with the measurements of the vessels extending to the capsule of the palatine tonsils at the level of the upper and lower poles, and also close to the mid-third of each palatine tonsil. The distance from the external carotid artery to the upper and lower poles of the palatine tonsils was found to be 17.1±1.01 mm and 10.3±0.18 mm respectively and in the mid-third the palatine tonsil 10.7±0.12 mm; the distance from the internal carotid artery to the upper and low poles of the palatine tonsil amounted to 14.5±0.84 mm and 16.8±0.77 mm respectively while that to the mid-third of the palatine tonsil was 15.3±0.07 mm. The branches of the external carotid artery feeding the palatine tonsils are the most frequent sources of bleedings; the following measurements were obtained: the maxillary artery 16.4±0.43 mm (17.4%) - the upper pole 9.6±0.02 mm (46.2%), the mid-third of the palatine tonsil 18.5±0.74 mm (29.5%) - the lower pole; the lingual artery 4.7±0.02 mm (6.8%) - the mid-third of the palatine tonsil, 6.2±0.82 mm (56.8%) - the lower pole; facial artery: 4.2±0.01 mm (0.76%) - the mid-third of the palatine tonsil; the occipital artery 25.6±0.12 mm (19%) - the upper pole; 14.8±0.11 mm (18.9%) - the mid-third of the palatine tonsil 9.56±0.12 mm (3.8%) - the lower pole; the tonsillar artery 1.88±0.01 mm (9.8%) - the upper pole; 2.51±0.01 mm (23%) - the mid-third of the palatine tonsil; 2.12±0.01 mm (11%) - the lower pole. The distance from the internal jugular vein to the capsule of the palatine tonsils in the region of the upper pole of the palatine tonsil was 28.3±1.01 mm, in the lower pole region 26.6±1.54 mm, and in the region of the mid-third of the palatine tonsil 22.7±1.24 mm. It is concluded that the results of the present study may be useful for the planning of the surgical strategy for the treatment of the patients presenting with chronic tonsillitis and for the prevention of hemorrhagic complications of tonsillectomy.

Olfactory neuroepithelium as a model for the studies of molecular mechanisms of schizophrenia

Olfactory neuroepithelium (OE) is shown to be a suitable experimental model to study neuronal biomarkers of psychiatric diseases including schizophrenia. Olfactory neuronal precursors can be useful for studying neurodevelopmental stages, neuronal markers, pharmacological screening. However, a limited number of research groups have used this cell model in a small number of patients and healthy people that can be explained by several factors. Based on literature reports and own research, the authors analyze the advantages and limitations of OE-derived cell/tissue models. The main limitations of these models are decreased rate of harvesting and culturing OE-derived cell and low percentage of patients who agreed to participate in the study. Our results showed that only 10% of patients with schizophrenia signed informed consent for nasal biopsy, 80% of them underwent biopsy.

Otomycosis: the modern view of etiology and management

This article deals with the modern approaches to the diagnostics and treatment of fungal ear infection depending on the localization of the inflammatory process and the species of the causative fungal agent with special reference to the factors underlying the development of otomycosis under the present-day conditions based on the results of the analysis of the studies carried out during the period from 2010 to 2014. The materials of the examination of 2152 patients who applied for the medical care to various clinical departments of the Institute and were found to present with chronic inflammatory ear pathology were available for the analysis. Fungal lesions were diagnosed in 495 (23%) patients with this condition. Fungal lesions of the external ear were the predominant form of pathology; they were documented in 331 (67%) patients. Fungal otitis media was diagnosed in 85 (17%) patients and fungal lesions of the postoperative cavity in 79 (16%) patients suffering from otomycosis. 65% of the patients presenting with external fungal otitis, 20% of those with fungal otitis media, and 95% of the patients with inflammation of the postoperative cavity were infected with mold fungi dominated by the genus Aspergillus spp. 79 (16%) patients suffering from otomycosis. In 35% of the patients presenting with fungal external otitis, 80% of those with fungal otitis media, and 5% of the patients with inflammation of the postoperative cavity of the middle ear, the causative agents of the disease were the fungi Candida spp. The authors describe the modern schemes for the treatment of otomycosis elaborated at the L.I. Sverzhevskiy Research Institute of Clinical Otorhinolaryngology.

The application of contrast-enhanced X-ray salpingography for the evaluation of the effectiveness of catheterization of the acoustic tube with the use of the Eustachian catheters

The objective of the present study was to evaluate the effectiveness of the administration of a medication into the middle ear structures during catheterization of the acoustic tube (AT) in the course of the contrast-enhanced X-ray salpingographic investigation. The study included 18 patients (18 ears) presenting with chronic otitis media and the perforated tympanic membrane without the disturbances of the ventilation function of the auditory tube. All the patients were allocated to two groups depending on the type of the Eustachian catheters being used. Group 1 was comprised of 9 patients treated with the use of traditional Giyots catheter, group 2 was composed of another nine patients who were treated with the use of the Eustachian catheters having an original shape with a specific configuration of its distal part. The X-ray studies were carried out before and after catheterization of the acoustic tube with the administration of 1 ml of the hypaque contrast medium. The study has demonstrated that the X-ray contrast agent did not penetrate into the inner structures of the middle ear of the patients comprising group 1 whereas in the patients of the second group the contrast medium reached as far as the bony portion of the acoustic tube.

Observation of the intra-adenoid cysts in the nasopharynx

The objective of the present study was to demonstrate the clinical significance and possibilities of diagnostics and treatment of the intra-adenoid cysts in the nasopharynx as exemplified by an original observation of an individual case. The cystic structures in the nasopharynx rarely manifest themselves clinically and are known to produce the non-specific symptoms. The patients admitted to the L.I. Sverzhevskiy Research Institute of Clinical Otorhinolaryngology for the surgical treatment of nasopharyngeal cysts account for 0.05% of the total number of the hospitalized subjects. This article reports a case of two large intra-adenoid cysts in the nasopharynx of one patient complicated by bilateral exudative otitis media. The successful outcome of the surgical treatment of this condition was achieved by means of endonasal marsupilization of the cysts under the laser-assisted endoscopic control with simultaneous bilateral shunting of the tympanic cavity.

The peculiarities of the clinical picture and treatment of inflammatory ENT diseases in the frequently ill children

The objective of the present study was the analysis of the current state of the problem of the frequently ill children. The authors present the classification of the frequently ill children together with information concerning the influence of various factors on the incidence of pediatric pathologies with special reference to the major pathogenic agents responsible for the formation of the areas of chronic inflammation in the ENT organs of the children. The approaches to the treatment and rehabilitation of the patients belonging to this age group requiring the follow-up monitoring are considered. It is concluded that the comprehensive strategy is needed for providing the adequate care to such children including specific preventive vaccination, well-timed adequate treatment of acute respiratory conditions, rehabilitative therapy with the use of the adaptogenic substances, the development of resistance to the cold and other unfavourable factors, implementation of the relevant socio-medical programs.

Organizational aspects of the improvement of the effectiveness of the research and practical activities in otorhinolaryngology

The authors discuss the problems pertaining to the methods for the improvement of the effectiveness of the research and practical activities in otorhinolaryngology and public health care at large. Special attention is given to the elaboration and implementation of the flexible approaches to the management of on-going research activities and initiatives, the development of horizontal complementarity, and the capability of the scientific groups for self-organization with a view to efficacious achievement of the assigned goals. The model of the research work based on the cluster strategy is presented as exemplified by organization of these activities at the L.I. Sverzhevskiy Research Institute of Clinical Otorhinolaryngology, Moscow. The model makes possible the effective interaction of the institute with other research institutions and industrial enterprises, it promotes the large-scale implementation of the newly developed innovative products.

Preoperative MRI diagnostics of the topographic features of neck arteries in the patients presenting with chronic tonsillitis

The objective of the present study was to determine the frequency of abnormalities of the major neck vessels and elucidate the specific features of blood supply of palatine tonsil based on the results of MRI performed in the vasculature-targeting regimen. A total of 109 patients presenting with chronic tonsillitis (including 64 women and 45 men at the age varying from 15 to 54 years) were available for the examination. All the patients underwent the MRI diagnostic study of the neck vessels by way of the preliminary evaluation of their condition at the pre-hospital stage. Abnormalities in the internal carotid artery were documented in 11.9% of the cases (including C- and S-shaped tortuosity of internal carotid artery in 6.88%, kinking and coiling of internal carotid artery in 4.13% and 0.92% of the patients, respectively). The majority of the detected abnormalities were located above the upper pole of the palatine tonsil which allowed to avoid the risk of the injury to the main neck vessels and prevented possible hemorrhage. One patient (0.46%) presented with kinking of the right internal carotid artery located in the immediate proximity to the capsule of the palatine tonsil close to its mid-third portion. There was no evidence that the present study gave rise to any malformation of the internal carotid artery and internal jugular vein. The proposed diagnostic method makes it possible to detect a rare anatomical feature of the development of the internal carotid artery discovered in a single patient (0.04%) out of the 2398 operated ones. This finding is of clinical significance and needs to be borne in mind when preparing the planned surgical intervention for the treatment of chronic tonsillitis. The results of the present study should be taken into consideration when prescribing the surgical treatment to the patients suffering not only from chronic tonsillitis but also from other ENT diseases, in the first place pharyngotympanic tube pathology.