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Acute bacterial rhinosinusitis (ABRS) is one of the most common diseases in outpatient practice with a steady tendency to increase of complicated forms in recent years. The risk of antibiotic resistance makes it necessary to search for effective pathogenetic methods of ABRS treatment.To evaluate the efficacy of inhalation therapy with compressor nebulizer using Fluimucil Antibiotic IT in the treatment of ABRS and acute laryngotracheitis in outpatient practice.Patients with ABRS were divided into two sex- and age-matched groups of 26 people each. The first group was treated with 250 mg of Fluimucil Antibiotic IT inhalations by the use of Norditalia HI-NEB compressor nebulizer once a day. The second group was treated with amoxicillin/clavulanate 875 mg + 125 mg orally two times a day.In the first group, the cough disappeared significantly earlier (on day 5-6) than in the second group (on day 7-8). In the first group, nasal congestion also disappeared significantly earlier (on day 3-5) than in the second group (on day 4-6). There was no significant difference in the reduction of intoxication syndrome and nasal secretions in both groups.Local antibacterial and mucolytic therapy in the initial stages of ABRS and acute laryngotracheitis reduces rhinological symptoms and coughing, similar to systemic antibacterial therapy. The use of Fluimucil Antibiotic IT in the early stages of the treatment provides an opportunity to avoid systemic antibiotics, which reduces the risk of antibiotic resistance as well as side effects in patients.Острый бактериальный риносинусит (ОБРС) является одним из самых распространенных заболеваний в амбулаторной практике с тенденцией в последние годы к стойкому увеличению числа больных с осложненными формами его течения. Нарастающий риск развития антибиотикорезистентности требует поиска эффективных методов патогенетической терапии ОБРС. Цель исследования - провести оценку эффективности ингаляционной терапии с помощью компрессорного небулайзера с применением препарата Флуимуцил-антибиотик ИТ в лечении ОБРС в сочетании с острым ларинготрахеитом в амбулаторных условиях. Материал и методы. Пациенты с ОБРС были разделены на две равные по полу и возрасту группы по 26 человек в каждой. В 1-й группе проводилось лечение Флуимуцилом-антибиотиком ИТ в виде ингаляций на компрессорном небулайзере Norditalia HI-NEB по 250 мг 1 раз в сутки ежедневно, во 2-й группе была назначена системная антибитикотерапия амоксициллином/клавуланатом 875 мг + 125 мг 2 раза в сутки. Результаты. В 1-й группе достоверно раньше купировались кашель (5-6-й день в 1-й группе, 7-8-й день во 2-й группе) и заложенность носа (3-5-йдень в 1-й группе, 4-6-й день во 2-й группе) при отсутствии достоверной разницы регресса интоксикационного синдрома и выделений из носа в обеих группах. Заключение. Местная антибактериальная и муколитическая терапия, назначаемая на начальных этапах лечения ОБРС в сочетании с острым ларинготрахеитом, в отношении ринологических симптомов и кашля дает эффект, аналогичный системной антибактериальной терапии. Своевременное использование Флуимуцила-антибиотика ИТ обеспечивает возможность избежать приема системных антибиотиков, что снижает риск развития антибиотикорезистентности и вероятность возникновения побочных эффектов.

A review of the current problems of nasal polyposis has been presented. The results of an analysis mainly of foreign literature have been given, which is reflected in EPOS 2012.Представлен обзор по проблеме полипозного риносинусита. Приведены результаты анализа преимущественно зарубежной литературы, отраженной в EPOS 2012.

The objective of the present study was to upgrade the rhinological simulator employed as a tool for the teaching of the basic technical skills in endoscopic sinus surgery (ESS). The new ESS simulator providing a model of the nasal cavity consists of the replaceable cylinders and the adaptable table stand. It includes a set of 3D printed nasal models. Each of them is the elliptical tube of a specific size. The participants of the study performed different tasks depending on the structural properties of the tubes. A wide variety of surgical instruments and esndoscopes could be fitted to the simulator. 16 otorhinolaryngologists having no previous experience with ESS were recruited into the study to evaluate the effectiveness of the training procedures. After a brief tutorial, the participants practiced an one hour-long exercise per day during 5 days. The pre-training and post-training performances were videotaped. The task-performance time and the number of technical errors made by the operators were estimated immediately before and after the training session. To assess the subjective attitudes of the operators toward the new technology, the participants of the study were asked to complete the model questionnaire soon after the termination of the training course. The questionnaire contained 34 items. The correctness of the answers was assessed based on the 5-point Likert scale, with score 1 meaning 'totally disagree' and score 5 - 'totally agree'. The statistically significant reduction of the performance time and the number of technical mistakes was documented within the first 5 hours after the onset of teaching (p0.05) which suggests the effectiveness of the training procedures. The questionnaire study has demonstrated the positive attitude of the trainees toward the proposed technology. The average score based on the Likert scale was higher than 3 for all kinds of questions. It is concluded that the results of this study give evidence of the positive assessment of the upgraded rhinological simulator as an effective tool for the teaching of the basic skills necessary to operate various surgical instruments and endoscopes by the novice surgeons in the field of endoscopic sinus surgery .Цель работы - совершенствование ринологического симулятора, применяемого в обучении оториноларингологов практическим навыкам в эндоназальной эндоскопической хирургии (ЭЭХ). В новом ринологическом симуляторе в качестве модели полости носа используют эллиптические цилиндры определенных размеров, которые изготовлены с применением 3D-печати и имитируют разные этапы ЭЭХ. В ходе обучения используется широкий набор хирургических инструментов и эндоскопов. Для оценки эффективности занятий на новом симуляторе было проведено исследование, в котором приняли участие 16 врачей без опыта выполнения ЭЭХ. Занятия проходили по 1 ч в день в течение 5 дней. Все этапы исследования фиксировали методом наружной видеосъемки. Объективную оценку практических навыков проводили до и после тренинга на основании времени выполнения упражнений и количества технических ошибок. Сразу после обучения испытуемые заполнили анкету для субъективной оценки тренинга, содержащую 34 утверждения с применением шкалы Лайкерта от 1 до 5, где 1 - полностью не согласен, 5 - полностью согласен. При сравнении полученных данных через 5 ч обучения наблюдалось статистически значимое уменьшение времени выполнения упражнений и количества технических ошибок (р0,05), что свидетельствует об эффективности тренинга. По результатам анкетирования средний балл по шкале Лайкерта был выше 3 для всех утверждений, что демонстрирует положительную оценку тренинга обучающимися.

Acute rhinosinusitis is a challenging clinical problem due to its high prevalence. The overwhelming majority of the cases of acute rhinosinusitis (ARS) have viral etiology. Clinical manifestations of viral and bacterial rhinosinusitis can be very similar. Similar expert communities have proposed their recommendations on diagnostics and treatment of acute rhinosinusitis in the recent decade. These recommendations are underlain by the principles of evidence-based medicine, take into consideration the result of reliable investigations, and reflect the opinions of leading specialists in otorhinolaryngology, allergology and immunology. The present review contains the analysis of consensus documents and recommendations. The results of ongoing research provide convincing evidence of the effectiveness of intranasal application of corticosteroids in the patients presenting with acute rhinosinusitis. Antibacterial therapy of acute rhinosinusitis is indicated only in the case of severe or complicated clinical course of the disease.

The objective of the present study was to estimate the efficacy, safety, and tolerability of protracted therapy with sinuforte for 15 days in 40 patients presenting with medicamental rhinitis (MR). The secondary objective was to evaluate the long-term results of this treatment. The results of the study indicate that the efficacy of sinuforte therapy in the patients using nasal decongensants during 12 months amounts to 80.7%. This observation gives reason to recommend sinuforte as the product of choice for the treatment of the patients with medicamental rhinitis.

A new computer program has been developed designed to simulate all possible variants of nasal septum deformation and anatomical malformation of turbinate bones. Moreover, the program makes it possible to analyse approaches to surgical correction of these problems. Implications of this model for the practical treatment of patients with these disorders are discussed. The program provides a qualitatively new tool for obtaining a deeper insight into a given surgical intervention and facilitates mutual understanding between the surgeon and the patient. Also, it may be used as a teaching aid in the training of young ENT specialists.

The objective of the present work was to evaluate potential of otoendoscopy for the diagnosis of chronic middle ear diseases. A total of 195 patients (274 ears) with this pathology were examined. The group included 87 men (114 ears) and 108 women (160 ears) aged from 16 to 72 (mean 43.5) years. All of them underwent rigid video-otoendoscopy. The proposed method is suitable for the use in outpatient clinics with the help of endoscopes 4.0 and 2.7 mm in diameter and an angle of vision 0 and 30 degrees respectively. Analysis of the results of the study was used to develop criteria for the evaluation of the endoscopic picture. The study allowed the agreement between the diagnoses established before and after otoendoscopic examination to be estimated and expressed in percentage terms. It is concluded that the above diagnostic algorithm of otoendoscopy permits to evaluate and systematize results of otoendoscopic examination and to make decision on the necessity of referring the patient for further treatment in a hospital.

The present work was designed to evaluate the influence of certain nasal decongestants (oxymethazoline hydrochloride and oxymethazoline hydrochloride used in combination with eucalyptol) for the treatment of acute purulent rhinosinusitis. Results of the study give evidence of high therapeutic effectiveness of these preparations. It for the first time provided exact data on locomotor activity of the ciliary apparatus of nasal mucosa in the periods of exacerbation and during reconvalescence after the disease.

The influence of different temperatures (22 degrees capital ES, Cyrillic, 30 degrees capital ES, Cyrillic, 37 degrees capital ES, Cyrillic) of 2% saline solution and isotonic saline solution on the breathing function of the nasal cavity and transport function of the nasal mucosa in nasal shower with these solutions was studied in healthy volunteers. Nasal shower technique with application of the device Rhinolife is described. It was found that nasal shower with isotonic saline solution at temperature of 37 degrees C is optimal as it does not depress a nasal breathing function and is comfortable for the patient.

A transport function and motor activity of the ciliary system (MACS) of the nasal mucosa was studied in 10 patients with chronic polypous rhinosinusitis (CPRS). A complex examination included optic endoscopy of the nasal cavity for assessment of nasal polypous process, timing of the saccharine test (ST) according to standard technique, and ciliary beat rate (BR) by V.S. Kozlov method. For estimation of ciliary BR epithelium was taken from five zones: inferior and middle turbinated bones, nasal septum, base and top of the polyp growing from the median nasal passage. ST time in CPRS is much higher (28.3+/-0.34 min) than normal age-specific values. Ciliary BR in different nasal anatomic zones in CPRS is not similar. MACS on the inferior turbinated bone and nasal septum was absent, none of the samples contained cells with functioning cilia. Ciliary BR remained rather high, despite the pathological process, at the site of the top and base of the polyps as well as on the middle turbinated bone (8.7+/-1.07, 8.1+/-1.02, 6.5+/-0.35 Hz, respectively).

A nasal cycle was studied in 10 healthy children (5 boys and 5 girls) aged 11-17 years (mean age 14.1+/-1.9 years). Registration of the nasal cycle was conducted for 7 hours by means of long-term nasal monitoring with Rhinocycle rhinoflowmeter (Interacoustics, Denmark). The nasal cycle was presented as a graphic image of fluctuations of a relative volumetric flux (RVF) in the relative units in accordance with linear dependence of pressure in the air flow to its volume. The nasal cycle in all healthy children was irregular, with mean fluctuation rate 1.3+/-0.6 h. There were no significant differences by RVF between the right and left parts of the nose in 8 children. In girls the nasal cycle most often was partially coinsiding, partially fluctuating while in most boys (in 4 of 5) the nasal cycle was irregular bilateral and fluctuating. It was found that the cycle was not longer or regular with the child's growth.

Acute rhinosinusitis is leading in frequency of antibiotic prescribing all over the world. At the same time the problem of antibiotic resistance and safety of antimicrobial drugs becomes more relevant and international. The article describes the basic mechanisms of bacterial resistance and growth of side effects when using macrolides, respiratory fluoroquinilones and β-lactam antibiotics of different types. Formation of IgE-mediated cephalosporin allergy is associated with the side R1 chain. The R1 structure of cephalosporins I and II generations is similar to penicillins, thus creating conditions for cross-allergy progression. R1 of cephalosporins III and IV generations is represented by a qualitatively different chemical compound (aminothiazol-oxime group) that increases the level of tolerance to these antibiotic types. The data of surveillance study are given to evaluate the efficacy and safety of the new drug Spectracef (active substance is cephalosporin of III generation Cefditoren) when treating acute bacterial rhinosinusitis on an outpatient basis.Острый риносинусит занимает лидирующее положение по частоте назначения антибиотиков во всем мире. Одновременно актуальность проблемы антибиотикорезистентности и безопасности применения антибактериальных препаратов приобретает межнациональные масштабы. В статье приведены основные механизмы устойчивости бактерий и развития побочных явлений при применении макролидов, респираторных фторхинолонов и разных классов β-лактамных антибиотиков. Формирование IgE-опосредованной аллергии на цефалоспорины связано с боковой R1 цепью. Строение R1 имеет сходство с пенициллинами только у цефалоспоринов I и II поколений, тем самым создавая условия для развития перекрестной аллергии. У цефалоспоринов III и IV поколений R1 представлена качественно другим химическим соединением (аминотиазол-оксим группой), что повышает уровень толерантности к этим классам антибиотиков. Приведены данные наблюдательного исследования по оценке эффективности и безопасности нового препарата спектрацеф, действующим веществом которого является цефалоспорин III поколения цефдиторен, при лечении острого бактериального риносинусита в амбулаторной практике.Острый риносинусит занимает лидирующее положение по частоте назначения антибиотиков во всем мире. Одновременно актуальность проблемы антибиотикорезистентности и безопасности применения антибактериальных препаратов приобретает межнациональные масштабы. В статье приведены основные механизмы устойчивости бактерий и развития побочных явлений при применении макролидов, респираторных фторхинолонов и разных классов β-лактамных антибиотиков. Формирование IgE-опосредованной аллергии на цефалоспорины связано с боковой R1 цепью. Строение R1 имеет сходство с пенициллинами только у цефалоспоринов I и II поколений, тем самым создавая условия для развития перекрестной аллергии. У цефалоспоринов III и IV поколений R1 представлена качественно другим химическим соединением (аминотиазол-оксим группой), что повышает уровень толерантности к этим классам антибиотиков. Приведены данные наблюдательного исследования по оценке эффективности и безопасности нового препарата спектрацеф, действующим веществом которого является цефалоспорин III поколения цефдиторен, при лечении острого бактериального риносинусита в амбулаторной практике.

An open, randomized, comparative trial of the drug bioparox was made in 50 patients. Nasal cavity function and its changes in response to bioparox administration were studied with the saccharin test and measurement of ciliary motor activity (CMA) using a special computer program. Significant suppression of the transport function and CMA in all the patients with catarrhal rhinosinusitis was observed. SMA on the inferior turbinated bone and septum was minimal, being low on the middle turbinated bone. After 7 days of bioparox administration mean value of CMA rose 2-fold. Thus, it is demonstrated that bioparox inhalations have no negative effect on nasal ciliated epithelium. On the contrary, it enhances its recovery.

The article describes design characteristics of a new adenotome model for surgery under anesthesia. The results of adenotomy under anesthesia were analysed for 53 patients aged 3 to 14 years made with Beckman's adenotome and the new device. Surgical anatomy of the nasopharynx before the intervention, variants of correlations between adenoid vegetations and other anatomic formations are described. Individual adjustment of the size of the adenotome currete by the distance between Eustachian cushins of the nasopharynx is discussed. The new design of adenotome improves visualization of the operative field during the operation and visual control of the course of surgery.

Potentialities of a new design of sinus-catheter YMIK-3 are considered in the treatment of 68 patients with acute sinusitis. Essential details of the procedure are described. A mechanism of action of controlled pressure on nasal mucosa edema is specified. The use of YMIK-3 catheter has the advantage of reduced duration of the procedure, low traumaticity for patients, wide adjustment range for the patient's size. In the block of the sinus shunt the delayed procedure is recommended.

Sinus catheters (RMNK) create positive and negative pressure in the nasal cavity. With control of this pressure, it is possible to remove abnormal secretion from different paranasal sinuses and to insert diagnostic and therapeutic medicines. Saccharine tests performed prior to and after the catheterization in patients with acute and chronic sinusitis confirmed inhibition of transport function of nasal ciliated epithelium (TF) in these affections. Intermittent pressure, insertion of drugs into the nasal cavity and paranasal sinusitis suppress TF significantly in chronic but insignificantly in acute sinusitis. Within 3 hours after the procedure the pressure recovered.

A trocar of a novel design for maxillary surgery reduces to minimum operative injury of the cheek soft tissue and bone wall of the sinus providing an effective approach to sinus lesions. It enables widening of the sinus anastomosis by means of the diamond drill and forceps under microscope and endoscope control. The design of the instrument allows the surgeon to operate without the assistant's help. The duration of the operation is reduced, postoperative period runs uneventfully, with minimal negative responses of the cheek soft tissue and sublabial wound. Postoperative complications (subcutaneous emphysema and blood accumulation in the sinus) are corrected by irrigation or disappear spontaneously. The experience gained in operations on 180 patients and 248 sinuses provided the efficacy of the trocar in the removal of the polyps, foreign bodies, fungal masses and cysts both in children and adults.

A new modification of sinus-catheter RMNK-5 is proposed enabling simultaneous irrigation of the nasal cavity and evacuation of the discharge from the paranasal sinuses. Details of the technique are provided. A positive effect consisting in attenuation of the inflammation, prolongation of the remission improvement of life quality is illustrated in the analysis of 6 cases.

Endoscopy with fiber endoscope Olimpus FNL-10 was performed to study the effects of controlled pressure on nasal mucosa. In 15 patients with aggravated chronic purulent sinusitis maxillary mucosa alterations were assessed using sinus-catheter and maxillary microsinusotomy. 12 patients with the same diagnosis underwent nasal mucosa examination with sinus catheter . The experiments with controlled pressure in the nasal cavity and paranasal sinuses demonstrate that the above pressure causes no damage to the mucosa, though it enhances hyperemia and diminishes edema in the area of osteomeatal complex as a result of changing the pressure (+) and (-).

A new method for the diagnosis and treatment of PNS has been designed. The devices are named sinus-catheters YAMIK and consist of elongated flexible body with two inflatable vessels and three passages. Two of the passages have separate outlets into the vessel cavities and serve for their inflation. The third, working passage, opens on the body surface between the vessels and has an adaptor on the other end. Also a glass model of nasal sinuses has been developed. On the model YAMIK the procedure performs as follows: sinus catheter is inserted into the nasal cavity, the nostril and rhinopharynx are sealed off by inflating the vessels, a syringe is connected to the adaptor of the working passage. It creates controlled negative pressure in the nasal cavity, and this makes pathological secretion come out of the paranasal sinuses through their natural openings. After the evacuation of the pathological contents, medicine is introduced into the sinuses. This glass model is helpful in understanding the principle of YAMIK procedure which provides a good opportunity to evacuate pathological secretion from PNS through natural ostia and introduce medicine into the PNS.