[Epidemiology and modern methods of treatment of non-traumatic nosebleeds]

Data on the detection incidence of nosebleeds (NBs) of non-traumatic origin in the population show considerable variability in statistical indicators, and NBs treatment and consequences depend on the localization of hemorrhage source, the volume of blood loss, patient's general condition, the presence and nature of comorbid pathology and a number of other factors. There are some differences in the choice of NBs treatment options, evaluation of their clinical and economic efficiency, which indicates the need to analyze and systematize the results of such studies.

OBJECTIVE

To analyze data on prevalence and current treatment approaches of non-traumatic nosebleeds.

MATERIAL AND METHODS

The search for publications (articles and related abstracts) on the subject of the study, presented in the PubMed database, has been conducted. The choice of material was made according to the following key words: non-traumatic nosebleeds, causes, incidence, methods of stopping nosebleeds.

RESULTS

The literature data show a significant prevalence of NBs in the population, their potential hazard to the life of patient and the importance of clinical and demographic characteristics of persons for determining treatment tactics in each case. In practical terms, primary and secondary NBs should be distinguished. In case of primary NB, the use of coagulation and nasal packing is recommended after determining the place of bleeding. In secondary NB it is necessary to establish its cause in order to assess risk factors and apply appropriate topical or systemic drug therapy. The so-called difficult (difficult-to-treat) NBs deserve special attention. As a rule, these cases involve bleeding from the posterior parts of nose. The analysis of publications shows a high (90%) efficacy of surgical interventions, used as first-line treatment. Effectiveness of embolization in such cases was 75% and of anterior/posterior nasal packing was 62%.

CONCLUSION

The literature data show a significant prevalence of nosebleeds in the population and their potential hazard to the life of patient. The existing differences in the assessments of treatment options for this pathology, their clinical and economic efficiency are the basis for further research, in particular, to clarify the causes of nosebleeds' occurrence and recurrence, the impact of treatment methods on quality of patients' life.

[Treatment of chronic eczematous otitis externa]

Otitis externa is a common disease. The article discusses the anatomical and physiological features of the structure of the outer ear, the epidemiology of otitis externa. Acute inflammation is characterized by the presence of significant microflora, and most often it is preceded by the impact of various physical factors. With chronic inflammation, more changes from the skin are recorded, while the microflora is not always isolated. The authors consider the problem of chronic inflammation of the outer ear. They provide their own data on the etiology of inflammation. Particular attention is paid to local treatment, including their own experience of using the combined drug Candiderm. As a result of the treatment, the skin changes of the external auditory canal were completely resolved in all patients by day 28, the itching in the ears completely stopped after 10-14 days of therapy. Stable remission was achieved in 89% of patients.

[External otitis: clinical diagnostics and treatment tactics]

OBJECTIVE

To summarize modern data about the epidemiology, etiology, clinical course and diagnosis of otitis externa.

MATERIAL AND METHODS

Materials of scientific publications included in the Cochrane Library, information bases of the RSCI, MEDLINE, PubMed were used as a data source. The choice of material was carried out according to the keywords: otitis externa, etiology, diagnosis, treatment, local treatment.

RESULTS

The role of combined drugs in the main etiopathogenetic mechanisms of the external ear inflammatory process is shown.

CONCLUSION

Analysis of published data from clinical trials indicates the importance of a fixed antibacterial agents and anesthetic combination in increasing the effectiveness of topical therapy for otitis externa.

[Diaphanoscopy palatal tonsils with use of the diode laser]

For the purpose of decrease in intraoperative blood loss during a tonsillectomy the technique of a laser diaphanoscopy (DS) of the palatal tonsil (PT) and paratonsil space is developed. In the conditions of a transillumination of tissues of throat vessels paratonsil space which are preventively coagulated by the holmium laser are visualized. In carrying out DS of structures of a throat the 'pilot' red laser of the surgical laser LUMENIS Versa Pulse Power Suite 20W system was used. In a research there were 60 patients with chronic tonsillitis. Laser DS was carried out before tonsillectomy, at the same time 120 PT were subjected to raying. As result of the conducted research established that 60% of PT (n=72) anatomic were deeply shipped in a sidewall of a throat, 44,2% of PT (n=53) - had the expressed top pole, 0,8% of PT (n=1) - an additional segment. Also it was established that laser transillumination of paratonsil space is possible in the conditions of infiltration of fabrics isotonic physiological NaCl solution of 0,9%. Carrying out preventive coagulation of vessels of paratonsil space of Ho:YAG laser in the conditions of DS allows to reduce the volume of intraoperative blood loss to 4,17±0,37 ml that is 10,1 time less in comparison with the tonsillectomy which is carried out on traditional techniques.

[Presbyacusis]

In the world, the spread of hearing loss due to age is an important socio-medical problem. Age-related hearing loss is the result of the biological process of aging of the tissue elements of the auditory analyzer. Changes in hearing develops by a complex of factors associated with both genetic, environmental and social aspects. Presbycusis is one of the causes of human cognitive disorders. Recent studies on hearing impairment prove a correlation with cognitive processes that increase the risk of dementia in the elderly. Timely rehabilitation of hearing with the use of hearing aids allows you to delay the processes of inhibition of cognitive function, and allows older people to prolong active longevity. Patients require consistent auditory and cognitive training for better socialization.

[Retention cysts: a new approach to treatment]

In 2017-2018, the authors examined and operated on 35 patients aged 20 to 39 years (19 women, 16 men) with cystic maxillary sinusitis. The study included patients who were diagnosed with retention cyst of the maxillary sinus, located on the lower walls of the maxillary sinus and dealing with no more than ²/₃ of the maxillary sinus volume, according to CT of the paranasal sinuses. The operation was performed using the following method: two punctures of the sinus were performed simultaneously in a typical place in the lower nasal passage - using a Kulikovsky needle and using a 2.8 mm trocar. The fiber of the Ho-laser was inserted into the Kulikovsky needle, and an endoscope was inserted into the trocar in parallel with the 0, 30 or 45°. Then, under the control of the endoscope, the fiber was inserted into the cyst and given a series of impulses before its 'explosion'. The parameters Ho:YAG-radiation had the following values: power - 14.4 W, pulse energy - 1.2 Jol, pulse frequency - 12.0 Hz. All patients were discharged from the hospital on the 2^nd day. In the long-term period (up to 14 months), according to the endoscopic examination, an objective examination and CT of the paranasal sinuses showed no recurrence of the cyst in any patient, no pathological changes were recorded in the area of the lower nasal passage.

[Etiopathogenetic treatment of professional singers with vocal nodules]

The article deals with optimization of treatment policy for professional singers. The survey sample is 67 singers with vocal nodules of the age from 24 to 42 and the length of time worked from 3 to 28 years. The following methods are used: questionnaire survey (professional anamnesis, voice evaluation according to Visual Analog Scale (VAS), Spielberg-Hanin test), microlaryngoscopy, video endolaringostroboscopy, voice acoustic analysis (MDVP Kay Pentax system). The algorithm and evaluation criteria of vocal nodules treatment efficiency for the singers taking into account the specific character of their professional activity are proposed.