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Despite the long-term study of exudative otitis media, the disease is not well understood. The wide prevalence of exudative otitis media in children and the increase in the incidence during recent decades explain the interest of specialists in the etiology of the disease. The article presents current views on the role of premature birth, gastroesophageal reflux, systemic and local immunodeficiency, disorders in the antioxidant defense system, mucopolysaccharidosis, genetic predisposition, and other factors in otitis media development. Unfortunately, the cause of exudative otitis media cannot always be established, and it requires further experimental and clinical studies in order to develop effective approaches to etiopathogenetically justified, timely and successful treatment of the disease and its implementation in clinical medicine.

Otitis media, including exudative otitis, is one of the most common childhood diseases. Almost asymptomatic course in children of early and preschool age leads to undiagnosed hearing loss. In such cases the minimal auditory deficit significantly affects the auditory-speech development and the formation of higher cortical functions in children. It is pediatricians who are the first to deal with the manifestations of exudative otitis media. Consequently, their knowledge and understanding of the disease, including the most common causes and risk factors, is important. The first part of the literature review considers the theories of the exudative otitis media formation, the role of viral and bacterial flora in the development of the disease, the effect of obstruction of the auditory tube against the background of nasopharyngeal neoplasms, craniofacial anomalies (including chromosomal aberrations), allergic diseases, rhinosinusitis and adenoiditis.

Amyloidosis rarely occurs in the head and neck region and is extremely rare in the nasopharynx (3%). We encountered a case of nasopharyngeal amyloidosis discovered because of exudative otitis media. The patient presented to a local otolaryngology department with complaints of hearing loss, right exudative otitis media, and a nasopharyngeal mass. She was referred to our department for consultation. A diagnosis of AA type amyloidosis was made based on a biopsy of the mass. In a detailed systemic examination in internal medicine, there were no findings suggestive of systemic amyloidosis or the presence of a primary disease, leading to a diagnosis of localized nasopharyngeal amyloidosis. Surgical resection was difficult. However, in outpatient follow-up, no signs of a change to the systemic type were observed. If amyloid deposition is discovered in a particular organ, the prognosis is good if it is localized. It is however imperative to check whether it has a systemic nature through a detailed systemic examination. In addition, as the AA type may be secondary to rheumatoid arthritis or collagen disease, it is important to determine if there is a primary disease through a detailed examination. Since the transformation of localized amyloidosis to the systemic type has been reported, stringent follow-up is important.

Early diagnosis is crucial for an effective cancer management. Cancers of the head and neck, and the ENTorgans in particular, are among the top ten most common human malignancies. The human upper respiratorytract is most affected by squamous cell carcinomas, lymphomas, and adenoid cystic carcinomas. Nasopharyngealneoplasms are characterized by mild and non-specific manifestations, especially at the initial stages of development.Mild symptoms and the localization peculiarities result in the delayed diagnosis of these tumors. Lymphomaslocalized in the pharynx can cause several pathological conditions: postnasal congestion syndrome, auditorytube dysfunction, recurrent inflammatory processes in the middle ear, snoring. MALT-lymphoma is a low-gradeB-cell non-Hodgkin lymphoma. It is necessary to remember MALT-lymphoma can transform into diffuse largeB-cell lymphoma, which belongs to aggressive lymphomas.The article describes a clinical case of MALT-lymphoma localized in the pharynx and parapharyngeal spacein a 63-year-old patient. The patient was observed on an outpatient basis for more than 3 years for recurrentotitis media and complaints of difficulty in nasal breathing, snoring and mucus trickling down the back wallof the pharynx. Due to the ineffectiveness of conservative treatment (topical corticosteroid drugs, intranasaldecongestants, ear drops), the patient was referred to the L. I. Sverzhevsky RCIO. Endoscopic examinationof the nasopharynx revealed a tumor of the nasopharyngeal arch passing to the area of tori tubarii. Audiologicalexamination confirmed the concomitant diagnosis - exudative otitis media. According to contrast-enhancedcomputer tomography of the pharynx, the formation spread into the parapharyngeal space, without signs ofbone invasion. After X-ray examination, a biopsy was taken from three tumor foci: the middle of the posterior wallof the nasopharynx and the paratubar region. Considering the morphological picture, an additional immunohistochemicalstudy of the material was performed on Ventana Benchmark XT (universal staining system) using anti-CD20(clone L26 Ventana), ultra View Universal DAB Detection Kit (Ventana). The morphological pattern correspondedto a small B-cell non-Hodgkin lymphoma; more likely, to the lymphoma of the marginal zone of the mucosa-associated lymphoid tissue (MALT-lymphoma). For further treatment, the patient was referred to an oncologicalinstitution.The clinical case demonstrates that only the complex implementation of modern endoscopic, radiological,and morphological methods helps in verifying the diagnosis in order to choose the correct treatment and reacha favorable outcome for such a serious disease. The article presents a diagnostic algorithm for suspectedmalignant neoplasm of the pharynx. Lymphomas have the following radiological features: they spread onlywithin the prestyloid space; they do not affect bone structures; they have a smooth, free surface; the contrastagent is evenly accumulated; as a rule, there are no calcifications, hemorrhages, necrotic and cystic changesin the structure of the lymphoma; pharyngeal lymphoma rather obstructs the lumen of the respiratory tract thaninvades the underlying tissues. A biopsy of a neoplasm at the stage of examination by an otorhinolaryngologistcan accelerate the referral of a cancer patient to a specialist. Multifocal tumor biopsy increases the probabilityof a correct diagnosis based on the results of a pathomorphological examination., Вопросы ранней диагностики играют ключевую роль в эффективном лечении онкологических заболеваний.Злокачественные новообразования головы и шеи, и ЛОР-органов в частности, входят в первую десяткунаиболее часто встречающихся опухолей человеческого организма. Верхние дыхательные пути человеканаиболее часто поражаются при плоскоклеточных карциномах, лимфомах и аденоидно-кистозных кар-циномах. Новообразования носоглотки характеризуются слабовыраженными и неспецифическими про-явлениями, особенно на начальных этапах развития. Скудная симптоматика и особенности локализациипредопределяют позднюю диагностику опухолей этого типа. Лимфомы, локализующиеся в глотке, могутбыть причиной ряда патологических состояний: синдрома постназального затека, дисфункции слуховойтрубы, рецидивирующих воспалительных процессов в среднем ухе, храпа. MALT-лимфома является В-кле-точной неходжинской лимфомой низкой степени злокачественности. Необходимо учитывать тот факт, чтовозможна трансформация MALT-лимфомы в диффузную В-крупноклеточную лимфому, которая относитсяк агрессивному классу злокачественных лимфом.В статье описан клинический случай MALT-лимфомы, локализующейся в глотке и окологлоточном про-странстве у пациента 63 лет, который более 3 лет наблюдался амбулаторно по поводу рецидивирующихсредних отитов и жалоб на затруднение носового дыхания, храп и стекание слизи по задней стенке глотки.В связи с неэффективностью консервативного лечения (топические глюкокортикостероидные препараты,интраназальные деконгестанты, ушные капли) пациент был направлен в НИКИО им. Л.И. Свержевского.При эндоскопическом осмотре носоглотки определили объемное образование свода носоглотки, переходя-щее на область трубных валиков. Аудиологическое исследование подтвердило сопутствующий диагноз –экссудативный средний отит. По данным компьютерной томографии глотки с контрастированием, обра-зование распространялось в парафарингеальное пространство без признаков костной инвазии. Послерентгенологического исследования была выполнена биопсия новообразования из трех локусов: серединазадней стенки носоглотки и паратубарная область. С учетом морфологической картины дополнительнопроводилось иммуногистохимическое исследование материала на Ventana Benchmark XT (universal stainingsystem) с использованием anti-CD20 (clone L26 Ventana), ultra View Universal DAB Detection Kit (Ventana).Морфологическая картина соответствовала мелкоклеточной В-клеточной неходжинской лимфоме, болеевероятно – лимфоме маргинальной зоны лимфоидной ткани, ассоциированной со слизистыми оболочка-ми (MALT-лимфома). Для дальнейшего лечения пациент был направлен в учреждение онкологическогопрофиля. Описанный нами клинический случай подтверждает, что только комплексное применение со-временных методов эндоскопической, лучевой и морфологической диагностики помогает в верификациидиагноза с целью выбора дальнейшего правильного лечения и благоприятного прогноза столь тяжелогозаболевания. В статье представлен диагностичекий алгоритм при подозрении на злокачественное новообразование глотки. Лимфомы имеют следующие рентгенологические особенности: распространяютсятолько в пределах прешиловидного пространства; не поражают костные структуры; имеют гладкую сво-бодную поверхность; равномерно накапливают контрастный препарат; как правило, в структурах лимфо-мы отсутствуют кальцинаты, кровоизлияния, некротические и кистозные изменения; лимфома глотки нестолько прорастает подлежащие ткани, сколько обтурирует просвет дыхательных путей. Биопсия новообра-зования на этапе обследования врачом-оториноларингологом может ускорить маршрутизацию пациентасо злокачественным новообразованием к профильному специалисту. Биопсия образования из несколькихлокусов увеличивает вероятность корректной установки диагноза по результатам патоморфологическогоисследования., Head and neck. Russian Journal, Выпуск 4 2021

The purposeTwo clinics was parallel conducted a cytological examination of exudate of the middle ear in children. The first group consisted of 30 patients aged 2 to 17 years with EOM without CCLP (n=54 ears). The 2nd group included 17 patients aged 1 year 4 months to 10 years with EOM with CCLP (n=34 ears).In the 1st group, in 61% of cases (n=33), an inflammatory-regenerative type of cytogram was detected, in 39% (n=21) - a regenerative, inflammatory type of cytogram was not detected. In the 2nd group, in 82.4% of cases (n=28), an inflammatory type of cytogram was observed, in 14.7% (n=5) - an inflammatory-regenerative type, in 2.9% (n=1 ear) - a regenerative type.With CCLP, the inflammatory nature of the cytogram of the resulting exudate from the middle ear is more common, which is characterized by signs of destruction of the mucous membrane, decay and degradation of the basal and cell membranes. Patients with CCLP often suffer from EOM. They are more likely to development of chronic purulent otitis media, including with cholesteatoma. Destructive changes in the mucous membrane of the middle ear are found in children of different ages. Taking into account the analysis of cytograms of the exudate of the middle ear with CCLP, the imposition of long-term ventilation tubes is justified.Сравнение типов цитограмм экссудата из среднего уха между пациентами с экссудативным средним отитом (ЭСО) с врожденными расщелинами губы/нёба (ВРГН) и без ВРГН, определение стадий хронического заболевания и значимость хирургического вмешательства на среднем ухе.Две клиники параллельно проводили цитологическое исследование экссудата среднего уха у детей. Первую группу составили 30 пациентов в возрасте от 2 до 17 лет с ЭСО без ВРГН (В 1-й группе в 61% случаев (При ВРГН чаще встречается воспалительный характер цитограммы получаемого экссудата из среднего уха, для которого характерны признаки деструкции слизистой оболочки, разрушение и деградация базальных и клеточных мембран. Пациенты с ВРГН часто болеют ЭСО, в большей степени склонны к развитию хронического гнойного среднего отита, в том числе с холестеатомой. Деструктивные изменения в слизистой оболочке среднего уха встречаются у детей разного возраста. С учетом анализа цитограмм экссудата среднего уха при ВРГН оправданно наложение вентиляционных трубок длительного ношения.

To increase the effectiveness of treatment of children with catarrhal and secretory stages of exudative otitis media (EOM) through the development of a therapeutic and diagnostic algorithm for the management of children with this condition.From 2008 to 2017, 346 children (682 ears) aged from 3 to 13 years with exudative otitis media were examined and treated. Two groups of patients were formed: Group 1 (150 children, 298 ears) - with a catarrhal stage of EOM, group 2 (196 children, 384 ears) - with a secretory stage of EOM. Diagnosis and treatment algorithm was created for such patients based on the results of the examination.Depending on the treatment, 3 groups of patients were formed: Group I - 150 children with a catarrhal stage of EOM who received conservative and surgical treatment for upper respiratory tract conditions; Group II - 146 children with an a secretory stage of EOM, who underwent conservative and surgical treatment: myringotomy / installation of a shunt in the eardrum simultaneously with surgical removal of the block of the auditory tube ostium, a course of conservative treatment for children who did not require surgical treatment; Group III - 50 children with a secretory stage of EOM and grade III adenoids, whose parents, contrary to the doctor's advice, refused the proposed myringotomy / installation of a shunt in the eardrum simultaneously with surgical removal of the block of the auditory tube ostium. These children underwent only adenotomy.The developed treatment algorithm for children with EOM, depending on the stage of the disease, demonstrated high clinical efficacy and made it possible to achieve stable positive results in 94.7% of cases in patients with the catarrhal stage of ESO and in 84.8% of cases in patients with the secretory stage of ESO, which makes it possible for us to recommend it as an integrated method that improves the quality of treatment for children with EOM.Цель исследования - повышение эффективности лечения детей с катаральной и секреторной стадиями экссудативного среднего отита (ЭСО) посредством разработки лечебно-диагностического алгоритма ведения детей с данной патологией. Пациенты и методы. С 2008 по 2017 г. обследовано и пролечено 346 детей (682 уха) с ЭСО в возрасте от 3 до 13 лет. Сформировано 2 группы больных: 1-я (150 детей, 298 ушей) - с катаральной стадией ЭСО, 2-я (196 детей, 384 уха) - с секреторной стадией ЭСО. На основании результатов обследования этих групп пациентов разработан лечебно-диагностический алгоритм ведения данных категорий больных. Результаты и обсуждение. В зависимости от проводимого лечения сформировано 3 группы больных: I группа - 150 детей с катаральной стадией ЭСО, получавших консервативное и хирургическое лечение по поводу патологии верхних дыхательных путей; II группа - 146 детей с секреторной стадией ЭСО, которым проведено консервативное и хирургическое лечение: миринготомия/установка шунта в барабанную перепонку одномоментно с хирургическим устранением блока устья слуховой трубы, курс консервативного лечения для детей, не требующих оперативного лечения; III группа - 50 детей с секреторной стадией ЭСО и аденоидами III степени, родители которых, вопреки совету врача, отказались от предложенного проведения миринготомии / установки шунта в барабанную перепонку одномоментно с хирургическим устранением блока устья слуховой трубы. Этим детям была выполнена только аденотомия. Заключение. Разработанный алгоритм лечения детей с ЭСО в зависимости от стадии заболевания продемонстрировал высокую клиническую эффективность и позволил добиться стойких положительных результатов в 94,7% случаев у больных с катаральной стадией ЭСО и в 84,8% случаев у больных с секреторной стадией ЭСО, что позволяет рекомендовать его как комплексный метод, повышающий качество лечения детей с ЭСО.

Tagunova I. K., Andreev A. V., Drahniev M. I., Padalka S. P., Gushcha S. G., Zukow W. Features of the treatment of exudative otitis media in children of the Black Sea region (Odessa and Chernomorsk, Ukraine). Journal of Education, Health and Sport. 2020;10(2):27-34. eISSN 2391-8306. DOI http://dx.doi.org/10.12775/JEHS.2020.10.02.003 https://apcz.umk.pl/czasopisma/index.php/JEHS/article/view/JEHS.2020.10.02.003 https://zenodo.org/record/3634892 The journal has had 5 points in Ministry of Science and Higher Education parametric evaluation. § 8. 2) and § 12. 1. 2) 22.02.2019. © The Authors 2020; This article is published with open access at Licensee Open Journal Systems of Nicolaus Copernicus University in Torun, Poland Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author (s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non commercial license Share alike. (http://creativecommons.org/licenses/by-nc-sa/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. The authors declare that there is no conflict of interests regarding the publication of this paper. Received: 02.01.2020. Revised: 25.01.2020. Accepted: 03.02.2020. Features of the treatment of exudative otitis media in children of the Black Sea region (Odessa and Chernomorsk, Ukraine) I. K. Tagunova1, A. V. Andreev2, M. I. Drahniev1, S. P. Padalka1, S. G. Gushcha1, W. Zukow3 1State Institution "Ukrainian Research Institute of Medical Rehabilitation Therapy of Ministry of Health of Ukraine", Odessa, Ukraine 2Odessa national medical university, Odessa, Ukraine 3Faculty of Earth Science, Nicolaus Copernicus University, Torun, Poland Summary. Among non-purulent inflammatory diseases of the ear in children, exudative otitis media is in second place. The purpose of the work is the development of algorithms to increase the effectiveness of treatment of children with exudative otitis media of various age groups. Practical conclusion: therapeutic tactics have their own characteristics; conservative treatment is advisable for two weeks, while maintaining the exudate beyond the specified period, an operation is indicated - shunting of the tympanic cavity. Key words: respiratory diseases, exudative otitis media, tactics of treatment of exudative otitis media.

The article presents the published data about pathology of the middle ear: acute and chronic, modern methods of the medical therapy and features of surgical tactics choice.

Actuality: A thorough sanation of the nasopharynx is essential for successful treatment of the exudative otitis media (EOM). The literature describes in detail the state of the nasopharynx after different types of adenoidectomy. The classifications of the location of the remnants of lymphoid tissue and the extent of scarring in the nasopharynx are given.The subject of this work is to trace the relationship of postoperative nasopharyngeal changes with recurrent EOM. Objective: To study the immediate and long-term results of different methods of surgical treatment of hypertrophy of the nasopharyngeal lymphoid tissue in children with exudative otitis media. Materials and Methods: This paper presents information on the results of treatment of 62 children of 5–7 years suffering from exudative otitis media. Observations were carried out in two groups of patients. The first group included 28 children previously undergone adenoidectomy, with the signs of recurrent exudative otitis. The second group included 34 children with exudative otitis previously untreated surgically. The task of the investigation is to study the effectiveness of endonasal and extranasal methods of surgical removal of nasopharengeal lymphoid tissue with a minimum probability of scar obliteration of the mouth of the Eustachian tube. Results and discussion: The priority method in nasopharengeal surgery in children is extranasal access with shaver technology in conjunction with cold plasma surgery. The using of these methods gives a clear visualization of the operating field under conditions of moderately bleeding wound. On the other hand, endonasal approach is associated with traumatization of the nasal mucosa with incomplete volume visualization of the surgical field. This combination can result in a longer healing of the surgical wound, the formation of adhesions of the nasal cavity and scarring in the nasopharynx. Complete visualization of the operating field significantly affects the long-term results of EOM treatment in childhood. Conclusions: The use of cold plasma surgery combined with shaver gives the possibility to achieve in the long term a stable cure in 93% of children with exudative otitis media with minimal (less than 6%) traumatic changes in the nasopharynx.

The study objective was to assess the levels of VEGF-A and TGF-β cytokines in the children with adenoid hypertrophy concomitant with exudative otitis media (OME) and in children with adenoid hypertrophy (HA) alone.The study material consisted of hypertrophic adenoids removed during adenoidectomy from 39 children (20 girls and 19 boys), aged 2-7 years suffering from OME. The reference group included 41 children (19 girls and 22 boys), aged from 3 to 9 years with adenoid hypertrophy. The levels of VEGF-A and TGF-β were determined in supernatants obtained from phytohemagglutinin-stimulated cell cultures of the adenoids using a commercial enzyme-linked immunosorbent assay kit.The median VEGF-A and mean TGF-β concentrations in the study group were significantly higher than those in the reference group (503 pg/mL versus 201 pg/mL, P 0.001 and 224 pg/mL versus 132 pg/mL, P 0.001, respectively). ROC analysis revealed that the area under the curve (AUC) for VEGF-A was 0.952 with diagnostic sensitivity and specificity of 95%, whereas for TGF-β it was 0.902 with 60% sensitivity and the same specificity as for VEGF-A. There was no significant difference between the AUC for VEGF-A and TGF-β (P = 0.573).The changes in the levels of VEGF-A and TGF-β may indicate bacterial pathogen as one of the causes of exudative otitis media in children. Determination of VEGF-A and TGF-β could be used as additional and objective tests to confirm the clinical diagnosis.

INTRODUCTION. A conductive hearing loss is a very common problem in childhood. It is possible to indicate many reasons for the problem, but most of the times it is caused by the infectious process, as well as the typical adenoid hypertrophy in children. Very often this disease is associated with obstruction of the eustachian tube.OBJECTIVE. In this study, the authors present the results of the hearing tests of patients who underwent the treatment of the eustachian tube obstruction by pneumotherapy with otovent. The aim of the work was to monitor the effectiveness of this method of OME treatment.RESEARCH GROUP AND METHODOLOGY. The research group consisted of 54 children aged 4 to 15 years, including 23 girls and 31 boys. The control group consisted of 16 children. Pure tone audiometry and impedance audiometry were performed before and after the therapy, for all of the participants.RESULTS. Obtained results of the study showed improvement in hearing in children correctly using the Otovent set. Hearing improvement was recorded both in the results of pure tone audiometry and impedance audiometry.CONCLUSIONS. The obtained results showed the effectiveness of the pneumotherapy method. In the case of the research group, 81.4% of children achieved the auditory norm (44 people). In the case of the control group, after a fixed period of application of the Otovent set, this value was 0%. The intergroup comparative analysis clearly shows that the research group obtained significantly better results within all of the parameters assessed, than the control group.

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.Цель работы - продемонстрировать клиническую значимость и возможности диагностики и лечения кистозных образований носоглотки на примере собственного клинического наблюдения. Кистозные образования носоглотки редко проявляются клинически и имеют неспецифическую симптоматику. В НИКИО им. Л.И. Свержевского доля пациентов, госпитализированных для хирургического лечения по поводу кисты носоглотки, составила 0,05%. Представлено клиническое наблюдение двух крупных интрааденоидных кист носоглотки у одного пациента, осложненных двусторонним экссудативным средним отитом. Успешное хирургическое лечение было проведено путем эндоназальной марсупиализации кист под эндоскопическим контролем с лазерной ассистенцией и одновременным шунтированием барабанных полостей с двух сторон.

The article considers the efficacy of antireflux therapy in the treatment of exudative otitis media in the infants with gastroesophageal reflux. The authors have analyzed the efficacy of the tympanic cavity shunting in children with exudative otitis media against the background of gastroesophageal reflux disease, in the absence of the effect of antireflux therapy.

In this study the authors evaluated the possibilities of the advanced surgical correction of Eustachian tube dysfunction in children with exudative otitis media, including the new method of treatment of persistent tube dysfunction – the balloon tuboplasty. The study is based on the data obtained in the process of examination and treatment of 190 patients with exudative otitis media aged from 3 to 13 years. It has been found that the main cause of chronic exudative otitis media was the obsturative dysfunction of Eustachian tube, related to the presence of degree 3–4 adenoid vegetations, degree 2 adenoid vegetations combined with the hypertrophy of Eustachian cushion cartilage tissue, degree 2 adenoid vegetations combined with the Eustachian tonsil hypertrophy, stenosis of Eustachian tube cartilage area in children. Based on the data obtained during the treatment session including the endoscopically controlled isolated adenotomy or isolated adenotomy in combination with myringotomy, tympanic cavity shunting, instrumental correction of Eustachian cushion, Eustachian tonsil destruction, the authors have drawn a concussion about efficacy of the treatment applied (84.7%), however, they have singled out a group of children with persistent Eustachian tube dysfunction who need the application of balloon tuboplasty method, which has proven a high efficacy in most patients (76%) of this study.

Modern methods for diagnosis of exudative otitis media (EOM) have great potential, however, the problem of diagnosis of EOM is still relevant. The article describes the methods of modern diagnostics that are widely used in the daily practice of an otolaryngologist. The basic principles, advantages and disadvantages of generally accepted diagnostic methods for EOM are presented. The method of optical coherence tomography (OCT) is described as a method of studying biological tissues, which is used in many fields of medicine. Information is provided on the possibilities of OCT in the diagnosis of diseases of the ENT organs and, in particular, of the middle ear. The results of studies of the tympanic cavity structures in various inflammatory conditions, the possibilities of intrasurgery use of OCT, as well as the possibilities and perspectives of introducing OCT into the practice of an otorhinolaryngologist in the diagnosis of exudative otitis media are described.Современные методы диагностики экссудативного среднего отита (ЭСО) обладают широкими возможностями, однако проблема диагностики ЭСО все еще актуальна. В работе описаны методы современной диагностики, получившие широкое распространение в ежедневной практике оториноларинголога. Представлены основные принципы, преимущества и недостатки общепринятых методов диагностики ЭСО. Метод оптической когерентной томографии (ОКТ) описан как метод исследования биологических тканей, применяющийся во многих сферах медицины. Представлена информация о возможностях ОКТ в диагностике заболеваний лор-органов, в частности среднего уха. Описаны результаты исследований структур барабанной полости при различных воспалительных состояниях, возможности интраоперационного использования ОКТ, а также возможности и перспективы внедрения ОКТ в практику оториноларинголога при диагностике экссудативного среднего отита.

Objectives The aim of the current study was to assess the levels of MMP-8, MMP-9 and TIMP-1 in the group of children with adenoids who suffered from exudative otitis media. Methods The study included 20 patients (10 females and 10 males) with adenoid hypertrophy coexisting with otitis media with effusion. The reference group included 24 patients (10 females and 14 males) with adenoid hypertrophy without otitis media. The levels of MMP-8, MMP-9 and TIMP-1 were determined in supernatants obtained from phytohemagglutinin (PHA)-stimulated cell cultures of the tonsils, using commercial enzyme-linked immunosorbent assay kits (R@D Systems, USA). Results The median MMP-8, MMP-9 and TIMP-1 concentrations (220.8 ng/mL, 311.1 ng/mL, 53.5 ng/mL, respectively) in the study group were significantly higher (p = 0.000, p = 0.000, p = 0.048, respectively) than those in the reference group (93.5 ng/mL, 112.5 ng/mL, 36.95 ng/mL, respectively). ROC analysis revealed that the area under a curve (AUC) for both metalloproteinases MMP-8 and MMP-9 was 1 with a diagnostic sensitivity of 100% and diagnostic specificity of 95.8%, as compared to 0.690 for TIMP-1. Significant differences were found between the AUC for MMP-8 and TIMP-1 and MMP-9 and TIMP-1 (p Conclusions The changes in the concentrations of MMP-8, MMP-9 and TIMP-1 may indicate an increased remodeling of the extracellular matrix in children with adenoid hypertrophy and otitis media with effusion. The findings can have clinical as well as diagnostic utility. Determination of MMP-8 and MMP-9 may help qualify a child for adenoidectomy and differentiate pediatric patients affected by adenoid hypertrophy with and without otitis media.

Study design clinical results of A STROBE-compliant retrospective study OBJECTIVE:: To achieving adequate pharyngeal closure and improve the pharyngeal function by a modified two-flap palatoplasty. Summary of background Excessive tension in soft palate is the main factor causing the dysphonia after cleft palate. The tension-free suture of the soft palate is the key to achieving adequate pharyngeal closure. In this paper, a modified two-flap palatoplasty improved the pharyngeal function METHODS:: From August 2016 to December 2017, 20 patients with cleft palate were treated with a modified two-flap palatoplasty of the posterolateral symmetrical mucosal relaxation incision. The mucosal relaxation incision was performed on both posterolateral sides of the soft palate. Results All cases had good healing of mucosal flap and the palate. All patients underwent endoscopic examination at 6 months after operation. The postoperative results were satisfactory, with no complications. Twelve patients had bilateral exudative otitis media before operation, 4 patients returned to normal postoperatively, and 8 patients underwent bilateral tympanic membrane catheterization; 2 patients had abnormal function of bilateral eustachian tube before operation and returned to normal postoperatively; 3 patients had unilateral exudative otitis media before operation, and all of them returned to normal; the acoustic impedance test was normal in 3 children before operation. Most children begin to learn to speak, parents are satisfied with their pronunciation, and 3 children are in speech rehabilitation due to unclear pronunciation. Conclusions We propose a technique to improve the function of the velopharyngeal closure which effectively reduces the incidence of pharyngeal insufficiency and occurrence of operative correction of pharyngeal closure dysfunction. The modifed two-flap palatoplasty with posterior lateral symmetric mucosal relaxation incision is beneficial for better velopharyngeal closure.

Actuality: A thorough sanation of the nasopharynx is essential for successful treatment of the exudative otitis media (EOM). The literature describes in detail the state of the nasopharynx after different types of adenoidectomy. The classifications of the location of the remnants of lymphoid tissue and the extent of scarring in the nasopharynx are given.The subject of this work is to trace the relationship of postoperative nasopharyngeal changes with recurrent EOM.Objective: To study the immediate and long-term results of different methods of surgical treatment of hypertrophy of the nasopharyngeal lymphoid tissue in children with exudative otitis media.Materials and Methods: This paper presents information on the results of treatment of 62 children of 5–7 years suffering from exudative otitis media. Observations were carried out in two groups of patients. The first group included 28 children previously undergone adenoidectomy, with the signs of recurrent exudative otitis. The second group included 34 children with exudative otitis previously untreated surgically. The task of the investigation is to study the effectiveness of endonasal and extranasal methods of surgical removal of nasopharengeal lymphoid tissue with a minimum probability of scar obliteration of the mouth of the Eustachian tube.Results and discussion: The priority method in nasopharengeal surgery in children is extranasal access with shaver technology in conjunction with cold plasma surgery. The using of these methods gives a clear visualization of the operating field under conditions of moderately bleeding wound. On the other hand, endonasal approach is associated with traumatization of the nasal mucosa with incomplete volume visualization of the surgical field. This combination can result in a longer healing of the surgical wound, the formation of adhesions of the nasal cavity and scarring in the nasopharynx. Complete visualization of the operating field significantly affects the long-term results of EOM treatment in childhood.Conclusions: The use of cold plasma surgery combined with shaver gives the possibility to achieve in the long term a stable cure in 93% of children with exudative otitis media with minimal (less than 6%) traumatic changes in the nasopharynx.Key words: adenoidectomy, exudative otitis media, children., Цель: изучение ближайших и отдаленных результатов различных методов хирургического лечения гипертрофии лимфоидной ткани носоглотки у детей с экссудативными средними отитами (ЭСО).Пациенты и методы. Изучались результаты лечения ЭСО у 62 детей 5–7 лет. Первую группу составили 28 детей, ранее перенесшие аденотомию, с признаками рецидива экссудативного отита. Вторую группу составили 34 ребенка с экссудативным отитом, которые ранее хирургическому лечению не подвергались. Сравнивалась эффективность эндоназальных и экстраназальных методов хирургического удаления лимфоидной ткани носоглотки с минимальной вероятностью рубцовой облитерации устья слуховой трубы.Результаты. Приоритетным методом в хирургии носоглотки в детском возрасте является экстраназальный доступ с использованием шейверной техники в сочетании с холодно-плазменной хирургией. Использование этих методов позволяет четко визуализировать границы операционного поля в условиях умеренной кровоточивости раны. Эндоназальный подход связан с травматизацией слизистой оболочки носа в условиях неполной объемной визуализации операционного поля. Подобное сочетание может приводить к более длительному заживлению операционной раны, образованию синехий полости носа и рубцов в носоглотке. Полноценная визуализация операционного поля достоверно сказывается на отдаленных результатах лечения ЭСО в детском возрасте.Выводы. Использование холодно-плазменной хирургии в сочетании с шейверной техникой в отдаленной перспективе позволяет достичь стойкого излечения у 93% детей с экссудативными средними отитами с минимальными (не болем 6%) травматичными изменениями в носоглотке.Ключевые слова: дети, аденоидные вегетации, экссудативный отит, хирургическое лечение., Мета: вивчення найближчих та віддалених результатів різних методів хірургічного лікування гіпертрофії лімфоїдної тканини носоглотки у дітей з ексудативними середніми отитами (ЕСО).Пацієнти і методи. Вивчалися результати лікування ЕСО у 62 дітей 5–7 років. Першу групу склали 28 дітей, що раніше перенесли аденотомию, з ознаками рецидиву ексудативного отиту. Другу групу склали 34 дитини з ексудативним отитом, які раніше хірургічного лікування не отримували. Порівнювали ефективність ендоназальних і екстраназальних методів хірургічного видалення лімфоїдної тканини носоглотки з мінімальною ймовірністю рубцевої облітерації вічка слухової труби.Результати. Пріоритетним методом у хірургії носоглотки в дитячому віці є екстраназальний доступ з використанням шейверної техніки в поєднанні з холодно-плазмовою хірургією. Застосування цих методів дозволяє чітко візуалізувати межі операційного поля в умовах помірної кровоточивості рани. Ендоназальний підхід пов'язаний із травматизацією слизової оболонки носа в умовах неповної об'ємної візуалізації операційного поля. Подібне поєднання може призводити до більш тривалого загоєнню операційної рани, утворення синехій у порожнини носа та утворення рубців у носоглотці. Висновки. Використання холодно-плазмової хірургії у поєднанні із шейверною технікою у віддаленій перспективі дозволяє досягти стійкого одужання у 93% дітей з ЕСО з мінімальними (не більше 6%) травматичними змінами в носоглотці.Ключові слова: діти, аденоїдні вегетації, ексудативний отит, хірургічне лікування.

Francesco Di Pierro,1 Daniele Di Pasquale,2 Maurizio Di Cicco2 1Velleja Research, Milan, Italy; 2ORL Department, Ospedale Maggiore Policlinico Ca’ Grande IRCCS, Milan, Italy Abstract: Secretory otitis media (SOM) remains a common disease among children. Although its cause is not yet perfectly established, the pathology, often a sequel of acute otitis media (AOM), is mainly characterized by persistent fluid in the middle ear cavity. Twenty-two children with a diagnosis of SOM were treated daily for 90 days with an oral formulation containing the oral probiotic Streptococcus salivarius K12 (Bactoblis®). After treatment, the children were evaluated for AOM episodes and subjected to tone audiometry, tympanometry, endonasal endoscopy, otoscopy, and tonsillar examination. Subject compliance and probiotic tolerability and side effects have also been evaluated. Our results indicate a good safety profile, a substantial reduction of AOM episodes, and a positive outcome from the treatment for all of the clinical outcomes tested. We conclude that strain K12 may have a role in reducing the occurrence and/or severity of SOM in children. From our perspective, this study constitutes a starting point toward the organization of a more extensive placebo-controlled study aimed at critically appraising our preliminary observations. Keywords: BLIS K12, Bactoblis®, acute otitis media, exudative otitis media

The objective of the present study was to improve the effectiveness of medicamental therapy of exudative otitis media in the children with recurrent and chronic adenoiditis. It was shown that the use of fluifort (carbocysteine lysine salt) for the treatment of exudative otitis media in the children presenting with chronic adenoiditis is a more effective approach in comparison with the expectant management. It is concluded that the application of carbocysteine lysine salt in combination with the mometasone furoate nasal spray ensures the rapid elimination of the symptoms of adenoiditis and significantly accelerates the resolution of exudative otitis media compared with the monotherapeutic treatment.Цель исследования - повышение эффективности медикаментозной терапии экссудативного среднего отита у детей с рецидивирующими и хроническими аденоидитами. Показано, что использование карбоцистеина лизиновой соли (флуифорт) в терапии экссудативного среднего отита у детей с рецидивирующим и хроническим аденоидитом является более эффективным методом лечения по сравнению с выжидательной тактикой. Применение карбоцистеина лизиновой соли в комбинации с назальным спреем мометазона фуроата позволяет достичь быстрого купирования симптомов аденоидита и значительно ускоряет разрешение экссудативного среднего отита по сравнению с монотерапевтическим подходом.

When a tympanic membrane tube is inserted in an infant with otitis media with effusion, the procedure is often performed under general anesthesia. In such cases, hospitalization for a few days is generally required. The health expenditure increases with general anesthesia and hospitalization. Recently a one-day operation has been widely performed and demonstrates merits such as reduction of health expenditures and patient burden. Therefore, we attempted intravenous anesthesia using ketamine hydrochloride for one-day procedure. With respect to 41 cases of infant exudative otitis media, profitability was compared in the hospitalization under general anesthesia group and the one-day procedure with ketamine hydrochloride group. Tube insertion was completed in a very short time under ketamine anesthesia. In the ketamine group, there were no major complications and the health expenditure was limited. Ketamine is a very suitable anesthesia for tympanic membrane tube insertion in an infant.

Cleft lip palate is a congenital anomaly that requires surgical reconstruction, and patients rarely develop tongue edema after palatoplasty. We describe a 1-year-and-8-month-old boy who underwent palatoplasty for left-sided cleft lip palate accompanied by exudative otitis media. Although previous reports have described that tongue edema usually sets in early after surgery, the symptoms of edema persisted more than 4 hours postoperatively in our case. We suggest that careful observation for edema is necessary for 24 hours at least after palatoplasty.

Inflation of the eustachian tube is often applied in the treatment of exudative otitis media and obstruction of the eustachian tube. However, complications following treatment have been occasionally reported and we encountered a rare case which developed a swelling in the neck, dyspnea, and hemorrhage in the deep neck, following application of inflation of the eustachian tube. A finding suggestive of bleeding was obtained by CT and MRI of the neck. Nasopharyngeal fiberscopy revealed extensive submucosal hemorrhage near the tubal orifice.Treatment with steroids, antibiotics and hemostypic was based on initiated immediately. The symptoms remitted on the next day. Anatomical relationships and earlier reports of similar cases, the internal carotid artery and its branches were considered to be the source of hemorrhage. The route of out flow was estimated accordingly. Although such a complication often results from carelessness in treatment, this patient had diabetes mellitus and osteoporosis as underlying diseases. A diabetic vascular disorder was suspected to be involved in the development of extensive hemorrhage. This case was presented to point out the importance of recognizing the coexisting basic disease, in cases such as this.

Exudative otitis media is a widespread pathological condition in the human population. In the recent years, the treatment with the electric current having the frequency up to 3.8 MHz has found the increasingly frequent application, in addition to shunting and laser myringotomy, for the perforation of the tympanic membrane to facilitate removal of exudate. The objective of the present study was to evaluate the effectiveness of the application of the electric current with the frequency up to 4 MHz for myringotomy in the patients presenting with exudative otitis media under the experimental conditions and in the clinical practice. The experimental studies were carried out with the use of the isolated temporal bones (ex vivo) and laboratory animals (in vivo). The clinical studies included the surgical treatment of 41 patients presenting with exudative otitis media using the electric current with the frequency of 4 MHz and laser irradiation with the subsequent evaluation of the inflammatory manifestations in the tympanic membrane tissues during the early post-operative period. It was shown that the method of myringotomy with the application of the electric current having the frequency of 4 MHz is safe and causes no complications. Moreover, it is accompanied by the development of the minimally active inflammatory processes in the tympanic membrane tissues during the early post-operative period.Экссудативный средний отит - часто встречающаяся патология в человеческой популяции. Наряду с распространенным шунтированием и лазерной миринготомией в последние годы для создания перфорации барабанной перепонки с целью удаления экссудата из барабанной полости применяется электроток частотой до 3,8 Мгц. Цель исследования - изучение применения тока частотой 4 МГц для выполнения миринготомии у больных экссудативным средним отитом в условиях эксперимента и в клинической практике. Проведено экспериментальное исследование на выделенных височных костях (ex vivo) и животных (in vivo), представлен опыт хирургического лечения 41 пациента с экссудативным отитом с помощью тока частотой 4 МГц и лазерного излучения с последующей оценкой воспалительных явлений в тканях барабанной перепонки в раннем послеоперационном периоде. Метод миринготомии с помощью тока частотой 4 МГц является безопасным, не вызывает каких-либо осложнений, а также сопровождается минимальными воспалительными процессами тканей барабанной перепонки в раннем послеоперационном периоде.Экссудативный средний отит — часто встречающаяся патология в человеческой популяции. Наряду с распространенным шунтированием и лазерной миринготомией в последние годы для создания перфорации барабанной перепонки с целью удаления экссудата из барабанной полости применяется электроток частотой до 3,8 Мгц. Цель исследования — изучение применения тока частотой 4 МГц для выполнения миринготомии у больных экссудативным средним отитом в условиях эксперимента и в клинической практике. Проведено экспериментальное исследование на выделенных височных костях (ex vivo) и животных (in vivo), представлен опыт хирургического лечения 41 пациента с экссудативным отитом с помощью тока частотой 4 МГц и лазерного излучения с последующей оценкой воспалительных явлений в тканях барабанной перепонки в раннем послеоперационном периоде. Метод миринготомии с помощью тока частотой 4 МГц является безопасным, не вызывает каких-либо осложнений, а также сопровождается минимальными воспалительными процессами тканей барабанной перепонки в раннем послеоперационном периоде.

The objective of the present study was to elucidate the anatomical features of the structure of the middle ear and eustachian tube in the breast-fed infants of different gestational age that may be responsible for the formation of exudates (fluids). We have examined 150 temporal bones obtained from the children's cadavers that were allocated to three groups as follows: 50 temporal bones obtained at weeks 26-30 weeks of gestation (group 1), 44 bones 31-36 weeks of gestation (group 2), and 37-40 weeks of gestation (full-term babies, group 3),The analysis of the data obtained on an individual bases revealed either increase or decreases in the selected characteristics of the eustachian tube in comparison with the respective average values as well as the well apparent predominance of a single change or a combination of alteration of several parameters in one case in 26-30 weeks and 31-36 weeks groups. No significant changes were found in group 1. It is concluded that the presence of a single change or a combination of two or three abnormal changes in the parameters of the bone structures of the eustachian tube can affect the development of the secretory process in the middle ear especially in the children born after 36 weeks of pregnancy.Цель исследования: выявление анатомических особенностей строения барабанной полости и слуховой трубы у детей грудного возраста, которые могут привести к формированию экссудата. Исследовано 150 кадавровых височных костей детей. Полученный материал был объединен в три группы: 26-30 нед - 50 височных костей, 31-36 нед - 44 височные кости, 37-40 нед (доношенные) - 56 височных костей. При индивидуальной обработке данных выявлено уменьшение или увеличение значений некоторых параметров слуховой трубы по сравнению со средними значениями во всех группах, а также достоверное преобладание одного изменения или сочетания двух абнормальных параметров в одном случае в группах 26-30 нед и 31-36 нед. В группе 37-40 нед достоверных различий выявлено не было. Таким образом, изменение одного параметра или комбинации двух или трех индивидуальных абнормальных параметров костного отдела слуховой трубы может повлиять на формирование экссудативного процесса в среднем ухе, в особенности у детей, рожденных после 36-й недели гестации.