Speech intelligibility in patients of different ages with chronic sensorineural hearing loss

Deterioration in speech intelligibility, the most common complaint of people with hearing loss, leads to social isolation and dramatically reduces the quality of life. The correction of peripheral hearing loss by hearing aid fitting does not always solve this problem in patients with chronic sensorineural hearing loss (SNHL). That is why in the process of audiological examination of patients with complaints of hearing loss, it is necessary to include methods of speech audiometry, which make it possible to comprehensively assess the functioning of the auditory system. The aim of the study: assessment of speech intelligibility in patients of different ages with SNHL. 94 people from 20 to 74 years of age were examined: 54 patients with SNHL (14 young and 40 elderly) and 40 people with normal hearing thresholds (20 young and 20 elderly). Besides the standard audiological examination, speech audiometry testing was conducted: evaluation of monosyllabic words intelligibility in quiet, binaural rapidly alternating speech test, dichotic digits test, Russian matrix sentence test (RuMatrix). Results: Speech intelligibility in elderly patients with SNHL was shown to be significantly worse than in young patients with a similar degree of hearing loss. The RuMatrix test in noise was proved to be the most sensitive test for comprehensive evaluation of the hearing system functioning.

Clinical efficacy of the drug 200 mg silver proteinate in the complex therapy of acute infectious rhinitis in children, which occurred as part of an acute respiratory infection

The effectiveness of pharmacotherapy of acute infectious rhinitis in children by means of drugs from the list of medicines of the J00 Standard and in addition to this pharmacotherapy with the drug silver proteinate – 200 mg nasal spray Sialor® (manufacturer of JSC «Production Pharmaceutical Company “Obnovlenie”, Russia) was evaluated in a multicenter randomized comparative study. A higher quality of treatment was demonstrated when using 200 mg silver proteinate (Sialor®) in the form of a nasal spray in complex therapy. The article presents evidence of the feasibility of including the drug 200 mg silver proteinate in the list of medicines of the J00 Standard.

Prevalence of acute inflammatory otorhinolaryngological diseases in hematopoietic stem cell transplant recipients

The article presents the results of a study of the prevalence of acute (exacerbation of chronic) otorhinolaryngological pathology at the stages of hematopoietic stem cell transplantation (HSCT). The frequency of the studied pathology was assessed at the stage of pre-transplant screening, at the stage before graft engraftment and at the stage after graft engraftment up to 180 days. The study included 1129 cases of HSCT performed at the Raisa Gorbacheva Memorial Research Institute of Pediatric Oncology, Hematology and Transplantation from January 2017 to December 2019. The median age of the patients was 27 years (min – 0,36, max – 73,22). Allogeneic HSCT was performed in 784 (69,4%) cases, autologous HSCT in 345 (30,6%) cases. The power of the study was 0,95. A comparative analysis using the Pearson χ2 criterion revealed that infectious complications were significantly more frequent with allo-HSCT than with auto-HSCT, both at the stage before engraftment (χ2 = 21.8 at p <0.0001) and at the stage after graft engraftment (χ2 = 224,78 at p < 0.0001). It was also shown that acute symptoms of rhinosinusitis prevailed at all stages of HSCT, reaching 5,3% (95% CI 5.0% – 5,6%) at the stage before transplantation, 3,01% (95% CI 2, 8% – 3,2%) at the stage before engraftment, and 8,13% (95% CI 7,67% – 8,60%) at the stage after engraftment. At the stage before engraftment, rhinosinusitis competed with the diagnosis of acute pharyngitis, with a frequency of 34 (36,17%) and 33 (35,11%), respectively. Acute rhinosinusitis, acute rhinitis, and strep throat were the most common diagnoses at all three stages assessed. The rest of the acute inflammatory otorhinolaryngological diagnoses were observed in less than 2% of cases each. Establishing the frequency of acute otorhinolaryngological pathology at the stages of HSCT; understanding the most relevant nosologies. This allows us to focus on further study of the factors of their development, prevention and treatment.

Odontogenic sinusitis as a multidisciplinary problem

Chronic focal infection is pathologically closely associated with internal pathology and is a serious factor in its aggravation. Systemic inflammatory reactions are associated with metabolic changes, such as oxidative stress, impaired regulatory participation of macro- and microelements with an imbalance in their distribution in biological media. The resulting homeostatic imbalances cannot be ignored by the attraction of chronic foci of infection, such as odontogenic sinusitis. The aim of the study was to substantiate complex approaches to the supervision of patients with chronic odontogenic sinusitis against the background of comorbid multiple chronic focal infection (MCFI). Materials and methods. In patients with chronic odontogenic sinusitis against the background of multiple chronic foci of infection, the activity of systemic inflammatory factors was studied. Levels and ratio of pro- and anti-inflammatory cytokines – interleukins 2, 6, 10, TNF alpha, C-reactive protein in comparison with the oxidation activity of lipids, proteins, low molecular weight thiols, assessment of Zn, Cu, Fe parameters in biological media and hepcidin in blood. In patients with chronic odontogenic sinusitis against the background of MCFI, an increase in the level of pro-inflammatory (TNF alpha, interleukin 6) was found with an imbalance in the distribution of Zn, Cu, Fe with a deficiency of these elements in the intracellular media. Expressed correlations of these changes with the activity of lipid peroxidation and free radical oxidation of thiol compounds were revealed. The data obtained serve as a rationale for the use of antioxidant and mineral replacement therapy in the complex treatment of patients with MCFI.

Model of development of the regional system of medical, psychological and pedagogical assistance to infants with hearing impairment

The study provides an analysis of medical and psychological and pedagogical assistance to children with hearing impairment at an early age in St. Petersburg in accordance with the modern standard «1-3-6». It was found that only 19% of children with hearing impairment registered at the Audiology Center were diagnosed with hearing loss before the age of 3 months, at the age of 6 months. 5,4% of children had hearing aids. A model for the development of a system of comprehensive care for young children with hearing impairment in St. Petersburg has been developed. The model includes 5 stages, for each of which a system of organizational measures is presented, aimed at improving the effectiveness of comprehensive care using a family-centered approach. The implementation of the model made it possible to increase the proportion of children diagnosed before the age of 3 months and to reduce the average age of hearing aid in young children. Expansion of the range of services in the Audiology Center (a course of classes on adapting a child to hearing aids during primary hearing aids, group deaf pedagogical and musical classes with children and parents, a school for parents, parental counseling by a psychologist), as well as the introduction of remote forms of support contributed to an increase in the competence of parents in matters of hearing aids, development of infant with hearing loss and parental activity in the classroom with the child. Remote forms of work made it possible to continue the rehabilitation of children during the COVID-19 pandemic. The developed model for the development of comprehensive care for young children with hearing impairment and their families may be useful for other regions of the Russian Federation.

Prevention and conservative treatment of nasopharyngeal tonsil hypertrophy

The aim of this work is to draw the attention of otorhinolaryngologists to the advantages of early conservative treatment of children with hypertrophy of the nasopharyngeal tonsil - adenoids. In childhood, a significant part of the protective and informational functions lies on the pharyngeal tonsil, since it is in the path of inhaled air. Unfavourable environmental conditions exacerbate its functional failure. Pathology of the lymphopharyngeal ring is highly prevalent and occupies a leading place among ENT diseases in children. Each person has a certain own microflora on the nasal mucosa from birth. In most cases, monoflora is determined on the mucous membrane of the nasal cavity, and only 2-3% is due to the combination of two types of microbial and fungal flora. For more than twenty years, we have been using the tactics of a sparing effect on the mucous membrane when using medicinal mixtures on a protective basis. Conservative treatment of 245 children aged 3 to 6 years with grade 1 – 2 adenoiditis was carried out, which made it possible to avoid surgical intervention in this group of children. When choosing a drug mixture, the sensitivity of the microflora of the patient’s nasal cavity was considered according to the results of a smear from the mucous membrane. Adenoidectomy is an operation with potentially undesirable consequences for the whole body, therefore, effective timely conservative therapy can reduce the risks and harms of surgery for pediatric patients.

Features of external auditory canal anatomy

The external auditory canal is not only a part of the external ear, but also an integral part of the human auditory system, which conducts and amplifies the sound wave. In the field of otosurgery, it is often the priority access to the tympanic cavity, and therefore it is necessary to clearly understand the features of its anatomy. The dimensions and anatomy of the external auditory canal are extremely variable: the length is 2–3,5 cm, the diameter ranges from 5-9 mm, it is somewhat curved in the horizontal and frontal planes and consists of a membranous cartilaginous part and a bony part, between which there is the most the bottleneck – the isthmus. The ear canal is covered with skin, the thickness and structure of which depends on the section of the ear canal. The membranous cartilaginous section contains sebaceous and sulfur glands. Studies identify several forms of the bony part of the ear canal: conical, hourglass-shaped, ovoid, reverse conical, and cylindrical. The endoscopic scale (CES) for the visibility of the tympanic membrane was also proposed for the convenience of assessment. It has been suggested that the shape of the external auditory canal is an etiological factor in chronic otitis externa. Unambiguous interpretations of the relationship between ear diseases and the shape of the external auditory canal have not yet been obtained, but modern developments tend to consider its importance in the development of ear diseases. Clinical observations show that certain anatomical forms of it may be involved in the pathogenesis of chronic inflammation, since they interfere with proper self-cleaning.

Case report of von willebrand disease after tonsillotomy and adenotomy in a child

The authors present a clinical case of von Willebrand disease detected after tonsillotomy and adenotomy in a child. The peculiarity of this observation lies in the rare occurrence of von Willebrand disease in clinical practice, as well as the manifestation of the clinical manifestations of this pathology against the background of surgical treatment in a child.

Odontogenic Sinusitis Index (OSI)

The criteria for «odontogenic sinusitis» (OS) with the highest values of specificity and sensitivity were identified. An integral odontogenicity sinusitis index (OSI) was developed based on the identified criteria. To measure the sensitivity and specificity of the criteria, a group of 261 patients was selected (113 women (43.29%), 148 men (56.70%), the average age of the patients was 36 years), consisting of 150 known to have OS and 111 patients who were known to be without OS. As a result of data analysis, the values of sensitivity and specificity were obtained for all 13 criteria. Based on the sensitivity and specificity values, all criteria were combined into an odontogenicity sinusitis index (OSI) and divided into «minor» and «major». The “large” criteria were assigned a significance point of 2, and for the “small” criteria, a significance point of 1. The determination of the odontogenic nature of sinusitis was carried out by a simple summation of the points assigned to patients during the survey, examination, and analysis of CT criteria. An odontogenic cause of sinusitis is recognized if there is a minimum of 4 points of significance, for example, one “large” (2 points) and two “small” (1 point each) criteria. The general sensitivity of the integral OSI index was 93%, the general specificity was 94%. These rates are high enough that OSI can be used to determine the «odontogenic» nature of sinusitis.

Exposure of weak magnetic fields on auditory nerve of patients with moderate to severe sensorineural hearing loss

The article shows that one of the alternative methods of treating moderate to severe sensorineural hearing loss can be the use of an external weak magnetic field. The proposed method is based on the coincidence of the effects caused by the exposure of an external electromagnetic field of certain parameters on the auditory nerve, and natural acoustic exposure. The similarity of reaction allows using of external magnetic fields as an artificial stimulator of the auditory system’s neural part. Induction of applied magnetic fields does not exceed 300 µT, which means that under the current legislation such fields are classified as posing no health hazard. This method was tested at Saint Petersburg Research Institute of Ear, Throat, Nose, and Speech based on relevant Ethics Committee approval and complied with informed consent standards of volunteers. 15 patients aged 18 to 45 with III and IV levels of sensorineural deafness without concomitant pathologies were tested. Threshold pure-tone audiometry was performed on each patient at 500, 1000, 2000, 3000, and 4000 Hz before and after the procedure. The results of the experiments showed that electromagnetic stimulation of auditory neurons allows increasing hearing sensitivity. The proposed procedure may not yield a tangible result in patients with auditory deprivation. Patients with hearing aids showed the most significant results. At the same time, the measurements have shown that the sound thresholds among them became 10 dB lower on the average. The non-invasiveness of the exposure provided additional comfort for the patient.