Multicentre clinical trial to evaluate microbial spectrum in acute diffuse otitis externa in the residents of Ukraine

Introduction: Acute diffuse otitis externa is a spread skin inflammation of the external ear canal of the bacterial origin. It is reported at an incidence of up to 10% among healthy population of all age groups. Treatment is known to be based on the empirical approach for prescribing topical antibacterials. Therefore studying the bacterial spectrum of otitis externa causative agents is of great value in terms of relevant antimicrobial therapy. Aim: The objective of the study was to evaluate microbial spectrum in diffuse otitis externa in patients – residents of Ukraine. Materials and methods: Four hundred and ninety-three out-patients diagnosed with acute diffuse otitis externa were enrolled. Microbial composition of the external ear canal microflora was tested and aetiologically relevant titres of colony-forming units (CFU) were determined. Criteria for evaluation: titres of 104 to 106 CFU and >106 CFU were considered aetiologically relevant. titres of <104 CFU were considered aetiologically nonrelevant. Results and discussion: In the majority of cases of acute diffuse otitis externa, infection with Staphylococcus aureus in aetiologically relevant titres is reported in 53.2% and Pseudomonas aeruginosa in 23.6%. Cases of multimicrobial infection predominantly involving Gram-negative flora were also reported in 27.9%; each of them results in no more than 2 to 3% of otitis externa. Titres of Candida spp. (3.2%) and Staphylococcus epidermidis (2.6%) were measured as aetiologically non-relevant. Conclusion: common microbial pathogens in acute diffuse otitis externa in patients of the Ukrainian population are Staphylococcus aureus and Pseudomonas aeruginosa. Multimicrobial associations predominantly involving Gram-negative flora, which do not exceed 2 to 3% of cases. Fungal infections are a rare cause of otitis externa.

The distance education at the department of otolaryngology of I. Horbachevskyy Ternopil national medical university

The article describes a possible set of free electronic equipment and software with which the authors broadcast the process of examination and treatment of patients with ear, throat and nose diseases via the Internet in case of the distance educational process. The Microsoft Teams software can be used for conducting practical classes and lecturing at a distance, as it provides the ability to fully transfer all the necessary information from clinical disciplines, but its effectiveness is not the same as in offline training.

Optimization of the approach to conducting tonsillectomy

Actuality: Recurrent tonsillitis considers to be one of the most common ENT diseases. Tonsillectomy as the method of recurrent tonsillitis’ treatment is being performed as usual as 20% of all surgeries in ENT departments. The critical criteria for the success of tonsillectomy for the surgeon are the frequency of perioperative complications, long-term results of treatment, and the patient's recovery time. For the patient, those criteria are the severity of pain, psychoemotional stress, the time spent in the hospital, and how fast he can return to his daily life routine. The factors that significantly affect the outcome of tonsillectomy are the choice of anesthetic management and perioperative medical hemostatic support. Aim: Our study aimed to optimize the approach to carry out tonsillectomy by preoperative application of the tranexamic acid 10% solution and optimize the approach to choosing between endotracheal anesthesia and local anesthesia. Materials and methods: Clinical studies were made among 212 patients with recurrent tonsillitis who went through a bilateral tonsillectomy. The patients were divided into three groups. The 1st group included 54 patients undergoing tonsillectomy using endotracheal anesthesia with the administration of tranexamic acid at the rate of 10 mg/kg of body weight. The 2nd group consisted of 97 patients undergoing tonsillectomy using local anesthesia. A 3rd (control) group included 61 patient undergoing tonsillectomy using endotracheal anesthesia. The first and control (3rd) groups of patients were compared to assess the efficacy of using tranexamic acid.Factors such as the duration of the surgery, the amount of blood loss, intraoperative events, the number of incidents of primary and secondary bleeding, and laboratory data were considered. The second and control (third) groups were compared to evaluate the impact of anesthetic management. We considered the factors such as duration of surgery, the amount of blood loss, intraoperative events, number of incidents of primary and secondary bleeding, assessment of pain syndrome, necessity of analgesics administration, length of hospital stay, and recovery period. Conclusions: tonsillectomy surgery using local anesthesia requires less time to perform, has less blood loss, fewer intraoperative events, and lessincidents of primary and secondary bleeding. The average level of pain is higher in patients using endotracheal anesthesia. The use of tranexamic acid 10% significantly reduces the amount of blood loss, helps to reduce intraoperative complications, and lower the emergence of postoperative bleeding and its intensity.

Peculiarities of the upper airways condition in patients with snoring and obstructive apnea during sleeping

Aim: study the anatomical features of the upper respiratory tract in patients with ronchopathy of varying degrees of clinical manifestations. Materials and methods: 60 patients with persistent snoring were under supervision. They were divided into four clinical groups depending on the degree of snoring and obstructive sleep apnea. All patients underwent clinical and instrumental examination, which included cardio-respiratory monitoring and MRI examination of the upper respiratory tract. Results: In the comparative analysis of results of clinical studies of the upper respiratory tract of patients with and without obstructive sleeping apnea, there was a statistically significant narrowing of the retroglossal space in 45,7% and 16%, respectively. In the analysis of morphometric parameters of the upper respiratory tract in patients with sleep-disordered breathing of varying severity, there was a narrowing of the retropalatinal and retroglossal lumens of the pharynx due to the increase in the soft palate and tongue with its dislocation posteriorly. It is stated that more pronounced narrowing of the lumen of the upper respiratory tract leads to respiratory disorders during sleeping. The most severe manifestation of respiration deterioration during sleeping were observed in the narrowing of the upper respiratory tract at several levels.

Values of laryngeal stroboscopy in patients with chronic laryngitis exposed to occupational factors

Topicality: Chronic laryngitis occupies one of the leading positions in the structure of laryngeal pathology. Among other things in the etiology of chronic laryngitis, occupational factors, including a chemical exposure, play an important role. Laryngeal storoboscopy is one of the most informative methods of examination of the vocal apparatus in phoniatrics that allows observing rapid oscillating motion of the vocal folds during phonation, which cannot be seen without instrumental methods. Aim: to investigate the functional condition of the vocal apparatus based on the values of laryngeal storoboscopy in patients with chronic laryngitis who were exposed to chemical factors. Materials and methods: Seventy-five patients with chronic laryngitis and 15 healthy individuals of the control group were examined. The patients were divided into groups based on the type of chronic laryngitis (group 1 one was made up of those who had a catarrhal type, group 2 had subatrophic type patients) and the intensity of chemical factors in the production of nitrogen compounds (subgroup A included patients who worked in manufacturing workshops where the level of chemicals in the air did not exceed maximum allowable levels, whereas subgroup B experienced an exposure to elevated chemical levels). Groups 1A and 2A included 23 and 20 patients, respectively; groups 1 B and 2B were composed of 17 and 15 patients, respectively. The patients underwent a specialized phoniatric examination and they were determined the maximum phonation time (MPT). We performed a video laryngeal stroboscopic examination on the equipment complex of «Karl Storz» (Germany). The results were evaluated by calculating the integrated score of phonator oscillations recorded during a stroboscopic study. Results and discussion: Patients with chronic laryngitis – employees of the public joint-stock company «AZOT» were examined. This is a large chemical production with several manufacturing workshops involved into various technological processes. According to the intensity of the influence of chemical factors, the manufacturing workshops differ significantly; therefore the intensity of the influence of the factors of the production environment on the upper respiratory tract varies in those working in the production of nitrogen-containing compounds. We compared the results of the survey of patients included in subgroups A and B. The MPT in patients of group 1A was 18.6±1.6 sec versus 13.6±1.2 sec in group 1B; in group 2A, it was 13.4±1.1 sec versus 10.8±0.8 sec in group 2B and 21.2±1.6 sec in the control group. Values in all study groups significantly (p<0.05) differed from the control. Also in groups 1B, 2A and 2B, the MPT was significantly lower than in group 1A. Thus, in patients with chronic laryngitis, who worked in conditions of increased exposure to chemicals present in the air of the production environment, the recorded MPT was significantly lower than in the controls, which is indicative of the impaired function of the vocal apparatus. Based on laryngeal stroboscopy findings, voice dysfunction revealed in patients with chronic laryngitis was more often manifested by changes in the vibratory cycle, desynchronized vocal apparatus and weakened amplitude of oscillations. According to the average score of video laryngeal stroboscopy in all groups of examined patients with chronic laryngitis, a significant (p &lt;0.05) difference was revealed in comparison with controls, as well as between some groups. In particular, in group 1A the integrated score of laryngeal stroboscopy data was 7.9±0.2, in 1B – 8.8±0.6, in 2A – 10.5±0.8 and in 2B – 12.1±1.0. The normal value is 5.010±0.001. Patients with higher scores had more severe laryngeal impairments and disease course. In group 2 (both A and B subgroups), changes according to video laryngeal stroboscopy were significantly more pronounced than in group 1A. In group 2B, the impairments were more severe as compared with both subgroups of group 1 and group 2A. Thus, in all studied groups of patients with chron ic laryngitis there are seen significant impairments of the vocal apparatus. At the same time, based on the findings of clinical methods and objective instrumental examination, there is a tendency to the deterioration in the functional condition of the vocal apparatus with increased chemical exposure in production. In particular, in groups B, compared with groups A, there is a marked increase in the desynchronization of vibrational oscillations, the number of cases with lack of stroboscopic comfort increases, the number of cases of hypertonia of the vestibular larynx increases. Similar trends apply to other parameters of video laryngeal stroboscopy in groups. On the whole, a quantitative assessment with the help of scores of integrated laryngeal stroboscopy allows accurate determining the severity of changes in the phonatory activity of the vocal apparatus and objectifying the diagnosis of chronic laryngitis against the background of chemical factors. The obtained data will be useful for improving the quality of diagnosis of voice disorders in chronic laryngitis, they can also be beneficial for vocational selection and addressing issues of occupational examination. Conclusions: 1. An impaired voice function according to laryngeal stroboscopy in patients with chronic laryngitis was manifested by changes in the vibratory cycle, mainly by desynchronized vocal apparatus and weakened amplitude of oscillations. 2. With the help of video laryngeal stroboscopy it is possible to objectify, quantify and determine the severity of phonatorial disorders in chronic laryngitis against the background of the exposure to chemical factors. 3. The degree of voice dysfunction according to laryngeal stroboscopy in patients with chronic laryngitis depends on the level of chemical exposure.

Clinical and immunological changes in patients with chronic inflammatory diseases of the upper respiratory tract at different periods after administration of influenza vaccine. Message 1. The influence of parenteral influenza vaccination on the clinical condition and indicators of systemic humoral immunity in patients with chronic inflammatory diseases of the upper respiratory tract

Topicality: Today, as an assessment of the effectiveness of vaccination against influenza infection is to determine the level of antibodies against influenza virus hemagglutinin, which is determined by the reaction of inhibition of hemagglutination. It is known that the effect of vaccination with modern drugs is short-lived, compared with what remains after the disease. Therefore, there is a need for further vaccinations, which are carried out without taking into account the state of immunity in those who will be vaccinated. This raises the question of the appropriateness of this approach in individuals who, according to this indicator, can already be considered protected from influenza infection and how often such patients occur in clinical practice. Material and methods: From the autumn-winter period of 2019 to November 2020, 32 donors and 32 patients with chronic inflammatory diseases of the upper respiratory tract chronic inflammatory diseases of the upper respiratory tract of both sexes who were not vaccinated for 1 year before the study were examined. Among these patients, 11 were diagnosed with chronic rhinosinusitis, 9 with chronic tonsillitis, and 12 with chronic pharyngitis. All patients with chronic inflammatory diseases of the upper respiratory tract underwent a complete otolaryngological examination prior to influenza vaccination and were monitored for another 36 weeks thereafter. Attention was paid to their general clinical condition, cases of exacerbations of chronic inflammatory diseases of the upper respiratory tract and the number of episodes of acute respiratory viral infections during the year before vaccination according to the anamnesis and for the observation period during the post-vaccination period. Samples of serum venous blood of donors, as well as persons with chronic inflammatory diseases of the upper respiratory tract were obtained at the initial examination, and in vaccinated patients 3, 12 and 36 weeks after vaccination and stored at -20°C (Ardo, Italy) until the simultaneous detection of antibodies (Ab) to influenza A and B viruses by hemagglutination inhibition reaction with human erythrocytes 0 group. Trivalent influenza inactivated split vaccine Vaxigrip (France) was used both for vaccination and in the determination of Ab in the blood for influenza viruses. In all examinations, the titer of anti-influenza Ab and the content of immune complexes were determined in the sera of patients, and the content of total IgE was measured in patients with chronic inflammatory diseases of the upper respiratory tract before and after 12 and 36 weeks. Statistical processing of the obtained results was performed in accordance with the recommendations of Glantz. Results: In 41% of those examined protectively significant titers of antibodies to hemagglutinins of vaccine strains of influenza virus vaccine Vaxigrip were detected in the blood. Parenteral vaccination of patients with chronic inflammatory diseases of the upper respiratory tract against influenza helped to improve the course of their underlying clinical disease and reduce their incidence of acute respiratory viral infections within 36 weeks after vaccination. The effect of increasing the level of antibodies to hemagglutinins of influenza virus remained at the limit of 3 months and decreased. Influenza vaccination in patients with chronic inflammatory diseases of the upper respiratory tract with the presence of most of them at the time of vaccination of clinically significant protective titers of antibodies to hemagglutinins vaccine strains of viruses led to an increase in blood in the long term of the vaccination process levels of immune complex and total IgE relative to their initial level, while these indicators did not exceed the limits of their physiological values. Conclusion: Single parenteral influenza vaccination leads to a short-term increase in the blood of specific projective antibodies, improving the clinical condition of patients with inflammatory diseases of the upper respiratory tract, increasing the level of immune complexes and total IgE.

Tuberculosis otitis media: problem relevance

Aim: currently clarification of the course characteristics, diagnosis and treatment principles of tuberculosis otitis media. Materials and methods: The study included 6 cases (8 ears) of tuberculosis otitis media and mastoid process from 2015 to 2020. Clinical, radiological, bacteriological, pathomorphological studies were used for diagnostics. Results: Primary localization of tuberculosis in the middle ear was found in 2 patients. In 4 patients tuberculosis middle otitis associated with lung affection. The disease manifested in the form of purulent perforated otitis media with a polymorphic otoscopic picture in all examined patients. The terms of the diagnosis were from 6 months to 1.5 years since the onset of the disease. This indicates the complexity of diagnosing the tuberculous etiology of the middle ear disease.

Some aspects of conservative treatment of patients with laryngeal cancer

Topicality: According to the National Cancer Registry of Ukraine, the incidence of laryngeal cancer is 4.1%. The treatment of patients with laryngeal cancer depends on the stage of the tumor. The conservative therapy includes both radiation therapy and chemotherapy. Material and methods: The conservative treatment of 93 patients with laryngeal cancer was performed. All patients are divided into two groups according to the localization of cancer: glottis (n=57) and supraglottis (n=36). The course of radiation therapy was conducted in oncology centers. The course of chemotherapy was induction or combined with radiation therapy. The outcome of therapy was evaluated one month after its completion. Tumor response after therapy was assessed by RECIST 1.1. Statistical processing of the obtained results was performed in accordance with the recommendations of Glantz. Results: It was found that metastases to the lymph nodes of the neck were significantly more common in cancer of the supraglottic (χ2=16.074; φ=0.00012; р<0.05). The greater number of recurrences of the tumor of the glottis after conservative therapy (χ2=6.718; φ=0.01345; р<0.05). Three-year recurrence-free survival and overall survival of patients after conservative treatment of laryngeal cancer patients were the same in both groups. Conclusion: The treatment of 93 patients with laryngeal cancer gave an objective tumor response in 96% of patients. The conservative treatment of patients with laryngeal cancer revealed a lower number of tumor recurrences in the supraglottis cancer (20 of 36 patients) compared with the glottis (37 of 57) (χ2= 6.718; φ = 0.01345; p <0.05).

The level of peripheral myelin protein and vitamin D in blood serum among patients suffering diabetes mellitus type II and hearing impairment

Topicality: While diabetes mellitus is often observed hearing impairment, including sensorineural hearing loss (SNHL). On the other hand, metabolic changes, disorders of the hemostasis system, lack of vitamins and minerals can lead to the development of SNHL. Aim: to examine the level of peripheral myelin protein (PMP) and vitamin D in patients with diabetes mellitus type II with hearing impairment. Materials and methods: Were examined 43 patients with diabetes mellitus type II, who, according to subjective audiometry, revealed SNHL of the I-II degree according to the International Classification. We divided patients into two groups: group 1st included 22 patients without complications, group 2nd – 21 patients with complications of diabetes mellitus and sudden changes in blood sugar levels in the anamnesis. As a comparison group were examined 15 patients with SNP without high blood sugar. The control group consisted of 15 healthy individuals. Results and discussion: When analyzing the results of the study, it was found that in patients with diabetes mellitus and SNHL (groups 1st and 2nd) there was a significant increase of the level of PMP comparing with the control and the comparison group. Moreover, in group 2nd (with complicated diabetes mellitus) the increase of the level of PMP in the blood serum was reliably more significant than in group 1st. In patients with diabetes mellitus group 1st the level of PMP was from 2.3 to 9.8 ng/ml (average value of 7.2±0.5 ng/ml), in group 2 PMP had a level of 8.5 to 37.2 ng/ml (average value of 24.3±1.7 ng/ml). This is significantly (P<0.01) more than in the control group. Elevated levels of PMP in patients with diabetes mellitus may indicate the processes of demyelination, damage of neural structures, which are more pronounced in the complicated course of diabetes, which, obviously, have some significance in the development of SNHL in diabetes mellitus type II. As for the content of vitamin D, certain reductions in its level were observed in all groups of examined patients with SNHL. However, in patients with SNHL without diabetes mellitus, this decrease was not differing significantly from the control values. But in both groups of patients with SNHL on the background of diabetes mellitus, this difference was significant, especially in group 2nd. Decreasing the level of vitamin D in blood serum, more expressed at the complicated course of diabetes mellitus in patients with SNHL testifies of a certain role of this vitamin in deepening of metabolic disturbances at such patients, and consequently – faster and more expressed development of complications. While the analysis of the distribution of patients with deviation of PMP level and vitamin D, it was found that in groups of patients with diabetes, especially in group 2nd with a complicated course, in blood serum there was significantly more often than in the comparison group a lack of vitamin B and increasing of PMP. Moreover, in group 2nd deviations from the norm in the level of PMP were also significantly more often than in group 1st. In the group of SNHL without diabetes mellitus (group 3rd) vitamin D deficiency was observed only in 13.3% of cases. A deficiency of vitamin D in group 2nd occurred significantly more often not only comparing with the control and comparison group, but also relatively to group 1st, with a milder course of diabetes. Thus, in group 2nd in patients with diabetes and SNHL, the lack of vitamin D occurred in 26.6% and its deficiency – in 73.3% of cases. In general, a decrease of vitamin D levels occurred in 100% of patients in group 2nd and in 80% in group 1st, while in group 3rd – 30%. Thus, researches have shown that in all studied groups of patients with SNHL on the background of diabetes mellitus type II there are deviations from the norm in the content of PMP and vitamin D in the blood serum. Moreover, the most pronounced disorders were found in the examined, who also had a complicated course of diabetes mellitus type II, the episodes of hypoglycemia in the anamnesis. This indicates the possible role of a complicated course of diabetes mellitus type II on the development of disorders (including demyelinating processes) in the neural structures of the auditory analyzer. Conclusions: In patients with diabetes mellitus type II and sensorineural hearing loss there is a significant increase in the content of PMP in blood serum, more pronounced in complicated diabetes, which may indicate the processes of demyelination and damage of neural structures. In patients with sensorineural hearing loss on the background of diabetes mellitus type II there is a significant (P <0.01) reduced levels of vitamin D compared with the control, the severity of reducing indicates its lack and even deficiency, especially occurred on the background of complications of diabetes mellitus. Patients with diabetes mellitus type II with sensorineural hearing loss, who have a complicated course, polyneuropathy, episodes of a severe changes of sugar levels in anamnesis, there is a significant (P<0.05) more pronounced increasing levels of PMP and decreasing of vitamin D than in patients with milder course of disease. The obtained data may indicate an important role of demyelinating processes and vitamin D deficiency in the development of sensorineural hearing impairment among patients with diabetes mellitus type 2.

A new approach to the treatment of allergic rhinitis

The growth of allergic morbidity, as well as certain limitations in traditional therapy, sets the task of finding new means and methods of treating this pathology. Antihistamines and leukotriene receptor blockers traditionally belong to drugs that affect the symptoms of inflammation and control the course of diseases of allergic genesis. Substances of natural origin, whose effectiveness and safety have been proven for centuries, have similar properties. The article analyzes the data of the available scientific literature concerning the experience of using macromycetes of the genus Ganoderma in clinical practice. Our clinical study showed that the inclusion of the drug "Astmagan", based on Ganoderma lucidum, in the complex therapy of seasonal and year-round allergic rhinitis, increased the effectiveness of treatment. The authors consider that this will allow a more differentiated approach to the choice of the optimal scheme of complex therapy for allergic rhinitis.