Introduction. Chronic edematous-polypous laryngitis, Reinke – Gayek’s edema accounts for 5.5% of all benign diseases of the vocal folds. Surgical treatment of Reinke – Gayek disease consists in removing excess mucosa, or “stripping” – tearing off a strip of mucosa with forceps from the vocal fold. The principle of laryngeal surgery is to preserve the structures of the vocal fold, to obtain flexible vibration of the muscular-membranous part and the mucous membrane of the vocal fold.Purpose. Improving the effectiveness of the treatment of patients with Reinke – Hayek edema by developing sparing methods of surgical treatment using a carbon dioxide laser. To develop criteria for choosing a method of sparing surgical treatment of Reinke – Hayek edema using a carbon dioxide laser, depending on the type of edema according to the Yonekawa classification.Materials and methods. 80 patients with Reinke – Gayek’s disease, 59 women and 21 men, from 29 to 77 years old, divided into two subgroups, and a control group were treated. Preoperative examination included endoscopic examination, laryngostroboscopy. The type was determined according to the H. Yonekawa classification. In type II, subgroup 1 – aspiration technique, n = 30. In type III, subgroup 2 – M-shaped technique, n = 30. Control group, it includes patients with type II and III edema, resection technique, n = 20.Results. Patients in the preoperative period were surveyed with the SF-36 Health Status Survey questionnaire, the dysphonia severity index (DSI), as well as the time of maximum phonation. In the postoperative period, they were examined, 1 month after the operation and 6 months after the operation. There is an increase in indicators, an increase in the time of maximum phonation, an increase in SF-36 scores.Conclusion. The use of this technique made it possible to significantly accelerate the recovery of the voice, reduce the time spent in the hospital, minimally damaging the structure of the mucous membrane of the vocal folds.
Introduction. Viral infection is the main cause of damage to the ciliated epithelium of the nasal cavity mucosa, which in turn leads to disruption of mucociliary transport, increased viscosity and mucus hypersecretion in the sinuses and deceleration of its evacuation. Smokers suffer from chronic obstructive pulmonary diseases, in particular obstructive bronchitis. Their cough symptom complex sharply increases in acute respiratory viral infection (ARVI), especially when the mucociliary airway system is affected. The etiotropic treatment of this combined pathology is a therapy capable of affecting the entire mucociliary system of the upper and lower respiratory tract, including a drug based on ivy leaf extract, with the active ingredient of the saponin group.Aim of the study. To determine the effectiveness of phytopreparation in preventing exacerbation of chronic bronchitis of smokers in patients with acute viral rhinosinusitis.Materials and methods. Complex examination of 20 active smokers suffering from acute viral rhinosinusitis (AVR), including computed tomography of the lungs, was conducted. The randomized study included the use of phytopreparations in the complex therapy of acute rhinosinusitis in patients with obstructive bronchitis.Results and discussion. Use of medicines based on ivy extract in the complex treatment of acute rhinosinusitis in smokers allowed to achieve reduction of AVR symptom complex complicated by exacerbation of chronic bronchitis by the 5th day of the disease. Dynamics of cough complaints reduction in comparison groups reflects the beneficial effect of ivy extract in smokers with ARVI, complicated by AVR, and in the absolute majority of cases allows avoiding bacterial complications.Conclusion. The conducted study proved the effectiveness of Gedelix in the complex treatment of viral acute rhinosinusitis in smokers. In the absolute majority of cases (80% of the total number of patients in the group) it was possible to avoid long-term exacerbation of chronic bronchitis and bacterial complications.
Introduction. Laryngeal pathology occupies a leading place in the general structure of diseases of the upper respiratory tract, chronic edematous-polypous laryngitis, Reinke-Gayek edema accounts for 5.5% of all benign diseases of the vocal folds. The main method of treating Reinke-Gayek's disease is surgical treatment, which consists in removing excess mucosa, or “stripping” - tearing a strip of mucosa with forceps from the vocal fold. One of the main principles of laryngeal surgery is the maximum preservation of the structures of the vocal fold, obtaining a flexible vibration of the muscular-membranous part and the mucous membrane of the vocal fold.Purpose. The purpose of our work is to improve the effectiveness of treatment of chronic edematous-polypous laryngitis using a CO2 laser.Tasks. To develop a differentiated approach to the surgical treatment of chronic edematous-polypous laryngitis using a carbon dioxide laser.Materials and Methods. We treated 46 patients with Reinke-Gayek disease, including 35 women and 11 men. The age of the patients ranged from 40 to 67 years. Preoperative examination included endoscopic examination, laryngostroboscopy. The type was determined according to the classification of H. Yonekawa, for the choice of further surgical tactics. In type II, an incision of the mucosa, aspiration of gelatinous matter from the Reinke space, and laying of the mucosa were performed. With type III, it is made by forming M-shaped flap to close the defect.Results. All patients in the preoperative period were surveyed with the VOICE HANDICAP INDEX(VHI-30) questionnaire, laryn-gostroboscopy, and maximum phonation time. In the postoperative period, the examination was performed twice, 1 month after the operation and 3 months after the operation. There is a significant increase in indicators, an increase in the maximum phonation time, a decrease in VHI-30 points.Conclusion. The use of this technique allowed to significantly accelerate the recovery of the voice, reduce the time spent in the hospital, minimally damaging the structure of the mucous membrane of the vocal folds.
Введение. Яремно-барабанная параганглиома-достаточно редкая опухоль, которая возникает из клеток нехромаффинных параганглиев, называемых также гломусными тельцами. Параганглиомы могут быть обнаружены в различных органах и тканях, чаще всего это доброкачественные опухоли. Тем не менее, по данным литературы, даже через несколько лет после удачно проведенной операции в редких случаях может наблюдаться метастазирование. Практически все параганглиомы среднего уха или височной кости относятся к югулотимпанальным. Для верификации новообразований соответственно определенному гистологическому типу строения опухолей необходим сравнительный анализ данных морфологического исследования хирургических находок в сопоставлении с результатами лучевой диагностики. Цели исследования-определить клинико-морфологическую характеристику югулотимпанальных параганглиом, сравнить полученные результаты с данными лучевой диагностики и хирургическими находками. Материал и методы. За период с февраля 2015 по декабрь 2017 года на базе Научно-клинического центра оториноларингологии обследованы и прооперированы 33 пациента с параганглиомами височной кости (пятеро мужчин и 28 женщин) в возрасте от 33 до 82 лет (средний возраст-62 года). Всем пациентам хирургически удалена параганглиома, в ходе операции выполнен забор материала для гистологического исследования. Материал фиксировали в 10% забуференном формалине в течение 12 часов с последующим изготовлением парафиновых блоков и срезов. Срезы окрашивали по стандартному протоколу гематоксилином и эозином. Результаты. По данным лучевых методов исследования в зависимости от распространенности опухолевого процесса пациенты были разделены на три клинические группы по классификации U. Fisch. Параганглиома типа А была выявлена у шести пациентов, которые составили группу I. В группу II вошел 21 пациент с опухолями типа В. Группу III составили шесть пациентов, у которых была диагностирована параганглиома типа С. Морфологическое исследование операционного материала пациентов разных клинических групп в зависимости от количества и расположения гломусных клеток, сосудов, нервных стволиков и фиброзных прослоек позволило разделить опухоли на следующие морфологические типы: альвеолярный, аденомоподобный, ангиомоподобный, компактный и смешанный. Выводы. В зависимости от места локализации и степени распространения процесса каждому клиническому типу новообразований соответствовал определенный гистологический тип строения опухолей: для опухолей типа А (18,2%), ограниченных промонториумом, характерен аденомоподобный или компактный тип строения опухоли, для опухолей типа В (63,6%), характерны аденомоподобный, ангиомоподобный и смешанный тип, а у пациентов с опухолью типа С (18,2%) преобладал смешанный тип. Ключевые слова: параганглиомы височной кости, хирургическое лечение, клинико-морфологическая характеристика Для корреспонденции: Загорская Дарья Алексеевна.
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