ISSN 3083-7308 (Online) ISSN 3083-7308 (Print) Main title: ОТОРИНОЛАРИНГОЛОГІЯ Parallel title: OTORHINOLARYNGOLOGY Parallel title: OTORINOLARINGOLOGÌÂ The journal was founded in January 1924 and was published under the title ‘Journal of Ear, Nose and Throat Diseases’ until December 2018. Journal title: Журнал вушних, носових і горлових хвороб Alternative title (Trans): Žurnal vušnih, nosovih ì gorlovih hvorob ISSN: 0044-4650 ISSN: 1029-3515 ISSN: 2528-8253 Scope: Coverage of issues, achievements and prospects for the development of domestic and global otolaryngology, and ways of implementing scientific developments in healthcare practice Founders State Institution “Prof. O.S. Kolomiichenko Institute of Otorhinolaryngology of the National Academy of Medical Sciences of Ukraine” Public Organisation “Ukrainian Scientific Medical Society of Otorhinolaryngologists” Certificate of State Registration: Series KV No. 23640-13480P, issued by the Ministry of Justice of Ukraine on 20 December 2018 Publisher: VISTKA LLC, Kyiv, Ukraine Languages: Ukrainian, English Indexing/abstracting ¾ “Scientific Periodicals of Ukraine” (V.I. Vernadsky National Library of Ukraine) ¾ DOAJ ¾ Ulrich's Periodicals Directory ¾ WorldCat ¾ CrossRef (Cited-by-linking) ¾ Google Scholar The journal’s archive up to 2022 is available in open access at: https://archive.iol.com.ua/index.shtml - up to 2025 is available in open access at: https://journal.iol.com.ua/ Contact details Correspondence address: 03057, Ukraine, Kyiv, 3 Zoologichna St., State Institution ‘Prof. O.S. Kolomiichenko Institute of Otolaryngology of the National Academy of Medical Sciences of Ukraine’. Ukraine Telephone/fax: tel. +38 (044) 483-12-82 Email: amtc@kndio.kiev.ua Website: https://www.iol.com.ua/
TO THE BLESSED MEMORY OF VASYL VASYLIOVYCH KISHCHUK
ON THE 85th ANNIVERSARY OF ACADEMICIAN RICE KAZHENOVICH TULEBAEV
This anniversary article is dedicated to the 85th anniversary of the birth of the prominent scientist, Academician Rais Kazhkenovich Tulebayev. The paper highlights in detail his long-standing scientific, pedagogical, and public activities, as well as his fundamental contributions to medical science. Particular attention is paid to the professor's role as the founder of a unique research field – environmental otorhinolaryngology, alongside his significant achievements in reforming the healthcare system of Kazakhstan and training highly qualified scientific personnel.
COMBAT BLAST-INDUCED OTOLOGIC INJURY AND POSSIBILITIES OF SUPPORT WITH THE COMPOSITE AGENT COCHLEATON®
Background. Continuous hostile bombardments across Ukraine result in widespread blast injuries, with blast-induced acoustic barotrauma (ABT) serving as a frequent and critical component. The pathogenesis of inner ear damage in ABT involves interconnected mechanical, vascular (vasoconstriction and ischemia), and metabolic pathways, including oxidative stress, ionic imbalance, and glutamatergic excitotoxicity. Because emergency triage and evacuation protocols prioritize life-threatening somatic wounds, specialized otological care is routinely delayed. This delay facilitates the chronicity of sensorineural disorders, highlighting the urgent need to evaluate multi-component therapeutic agents capable of targeting these distinct pathogenic pathways. Objective. To evaluate the clinical efficacy of the composite agent Cochleaton® (comprising French maritime pine bark extract, the active form of folic acid, melatonin, and magnesium) in patients presenting with acute sensorineural hearing loss (ASNHL) and acute post-traumatic otitis media (APTOM) secondary to blast-induced acoustic barotrauma. Materials and Methods. The study involved 69 male patients (mean age 36–38 years) with ABT sustained during combat operations. Concomitant somatic injuries and cerebral concussion were present in 89.7% of cases. The patients were divided into two groups: Group 1 included 32 patients with ABT without tympanic membrane perforation; Group 2 consisted of 37 patients with tympanic membrane perforation who underwent type I tympanoplasty (the graft take rate was 94.6%). Cochleaton® was prescribed as a monotherapy for 30 days, starting on average 38–41 days after the injury. Efficacy was evaluated by the dynamics of bone conduction (BC) and air conduction (AC) hearing thresholds at frequencies of 500–4000 Hz, as well as by subjective symptoms (tinnitus, vertigo). Results. In Group 1 (without perforation), the use of Cochleaton® resulted in a reduction of BC hearing thresholds by more than 10 dB in 71.9% of patients (including 21.9% with an improvement exceeding 20 dB). The mean threshold improvement was 11.7±4.6 dB for BC and 10.8±5.8 dB for AC. In Group 2 (post-tympanoplasty), a BC threshold reduction of more than 10 dB was recorded in 56.8% of casualties (and more than 20 dB in 10.8%). An AC hearing improvement of more than 10 dB was reported by 91.9% of individuals (the mean AC gain was 19.7±5.6 dB due to the closure of the tympanic defect). Positive dynamics of subjective tinnitus (reduction in intensity, duration, and change in pitch) was noted by 100% of patients in both groups, with complete resolution of tinnitus achieved in 4 cases. Regression of vestibular disorders (dizziness, ataxia) was reported by the patients as early as the 10th day of administration. Conclusions. 1. The composite agent Cochleaton® demonstrates high therapeutic efficacy in restoring cochlear function in patients following blast-induced acoustic barotrauma, even when the initiation of therapy is delayed. 2. Integrating Cochleaton® into the postoperative regimen after tympanoplasty stimulates neuroprotective mechanisms and enhances cochlear perfusion, thereby mitigating additional surgical trauma to the inner ear. 3. The 100% response rate regarding tinnitus regression, combined with the rapid elimination of vestibular symptoms, supports the recommendation of Cochleaton® as an effective pathogenic intervention for blast-induced hearing damage in both military personnel and civilians.
EFFICACY OF A CO₂-ENRICHED EFFERVESCENT NASAL SPRAY FOR IRRIGATING-ELIMINATIVE THERAPY IN ACUTE BACTERIAL RHINOSINUSITIS
Background: Acute rhinosinusitis (ARS) is one of the most prevalent diseases of the upper respiratory tract. Bacterial rhinosinusitis (ABRS), as a distinct form of ARS, remains considerably common, accounting for approximately 0.5-2% of all ARS cases. Saline-based irrigating-eliminative therapy is currently recognised by a number of guidelines, including EPOS 2020, as a highly evidence-based component of rhinosinusitis management - both acute and chronic. A substantial body of publications exists addressing the optimal composition of aqueous saline solutions for nasal cavity irrigation, with investigations exploring the use of xylitol, menthol, various electrolytes, hyaluronic acid, and numerous other adjuvant agents. Nevertheless, no optimal combination has yet been established. The majority of studies remain focused exclusively on standard normal saline for nasal rinsing, while data concerning supplementary substances and their potential impact on the course of acute rhinosinusitis remain limited. Objective: To evaluate the efficacy of the nasal solution "Sparklin" (a solution supplemented with 0.4% CO₂) compared to standard isotonic saline as part of complex treatment for acute bacterial rhinosinusitis. Materials and methods: A prospective controlled study was conducted at the Svyato-Mykhailivska Clinical Hospital, Kyiv. Fifty-four adult patients (aged 18-60 years) with a verified diagnosis of ABRS were enrolled and allocated into two groups: a control group (n=28, irrigation with 0.9% sodium chloride solution) and a study group (n=26, irrigation with "Sparklin"). All patients received identical standard therapy: amoxicillin/clavulanate, phytotherapy, and xylometazoline. Severity of four cardinal symptoms (headache, facial pain/discomfort, nasal congestion, and nasal discharge) was assessed using a visual analogue scale (VAS, 0-10 points) at four time points: baseline, after the first irrigation, at day 7, and at day 14. Mucosal pH of the inferior nasal meatus was measured with Combur indicator test strips (Roche Diagnostics) at the same time points. All data obtained were subjected to statistical analysis. Results: Both groups demonstrated a statistically significant reduction in the severity of all symptoms by day 14 (p<0.001); however, effect sizes in the "Sparklin" group were substantially greater across all parameters (Cohen's d 7.51-8.26 vs. 5.43-6.83 in the control group). Already after the first irrigation, mucosal pH in the "Sparklin" group decreased from 7.52 to 6.63, whereas in the control group it remained at 7.52 (p<0.001). By day 14, the mean pH in the "Sparklin" group was 6.33±0.24 compared to 7.05±0.42 in the control group (p<0.001). At the end of the observation period, a statistically significant positive correlation was identified between residual mucosal pH and the severity of all four symptoms (r=0.468–0.591, p<0.001). Conclusions: The addition of the CO₂-enriched isotonic solution "Sparklin" to complex treatment of ABRS provides significantly greater reduction of clinical symptoms and more effective normalisation of nasal mucosal pH compared to standard isotonic nasal irrigation; accordingly, "Sparklin" may be recommended as an adjuvant irrigating agent in the management of ABRS in adult patients.
ETIOLOGICAL FACTORS AND CLINICAL FEATURES OF CHRONIC ADENOIDITIS IN CHILDREN AGED 2–10 YEARS
Background: Chronic adenoiditis is among the most common upper respiratory tract pathologies in children, associated with impaired nasal breathing, adenoid hypertrophy, and middle ear complications. Aim: To investigate the primary etiological factors and clinical characteristics of chronic adenoiditis in children aged 2–10 years. Methods: A comprehensive evaluation was conducted on 87 children treated at the Happy Life Clinic and the clinical base of Tashkent State Medical University between 2023 and 2025. Clinical, endoscopic, microbiological, allergological, and functional diagnostic methods were employed. Results: Bacterial infection was identified as the leading etiological factor, detected in 71.3% of cases. Herpesvirus infections played a significant role in younger children, whereas the impact of allergic sensitization increased with age. Grade II–III adenoid hypertrophy was identified in 75.9% of patients, and Eustachian tube dysfunction was detected in 24.1% of the examined children. Conclusion: These findings underscore the necessity of a comprehensive approach to the diagnosis and management of chronic adenoiditis, factoring in the predominant etiological triggers.
FOREIGN BODIES OF THE EAR, NOSE, AND THROAT IN CHILDREN: A RETROSPECTIVE ANALYSIS OF LOCALIZATION, TYPES, AND AGE DISTRIBUTION
Objective. To evaluate the anatomical localization, material types, and age-related distribution of ear, nose, and throat (ENT) foreign bodies in children requiring specialized medical care. Materials and Methods. A retrospective analysis was conducted on 101 cases of ENT foreign body removal in pediatric patients admitted to the emergency departments of the private clinic "Xayat Medical" and the Clinic of Tashkent State Medical University between January 2024 and May 2026. Data on patients' demographics, anatomical site, and type of foreign object were systematized and analyzed using descriptive statistics. Results. The patients' ages ranged from 12 months to 15 years, with a mean age of approximately 3.4 years. The study cohort included 58 boys (57.4%) and 43 girls (42.6%). ENT foreign bodies were most frequently detected in children younger than 7 years, accounting for 57.4% (n = 58) of all observations. The nasal cavity represented the predominant site of localization, identified in 71 cases (70.3%), followed by the external auditory canal in 21 children (20.8%) and the larynx in 9 patients (8.9%). Regarding material types, the most prevalent retrieved items were paper (18.8%), plastic objects (16.8%), and metallic items (13.9%). Conclusion. ENT foreign objects are most commonly encountered in infants, toddlers, and preschool-aged children under the age of 7, with a higher prevalence among boys. The nasal cavity remains the primary anatomical site of insertion, while common household items and small toys constitute the majority of retrieved objects, emphasizing the need for enhanced parental supervision and targeted preventive education.
PREVALENCE AND RISK FACTORS OF PROGRESSIVE SENSORINEURAL HEARING IMPAIRMENT
Background: Sensorineural hearing loss (SNHL) remains one of the key challenges in modern otorhinolaryngology due to its tendency toward chronicity and progression. Identifying prognostic factors and triggers of hearing deterioration is essential for developing effective prevention and treatment strategies for this pathology. Objective: To investigate the clinical features of chronic SNHL, determine the frequency of its progression, and identify the leading etiopathogenetic factors of auditory function decline. Results: It was established that approximately 20% of chronic SNHL cases follow a progressive course. Cardiovascular pathology exerts a decisive influence on hearing degradation and disease progression. Its manifestations include microcirculatory disorders, altered blood rheological properties, and other factors that destabilize the vascular bed, primarily cerebral hemodynamics. Adverse prognostic factors for SNHL progression include its vascular and acoustic traumatic genesis, comorbid somatic pathology (essential hypertension, atherosclerosis, heart failure, type 2 diabetes mellitus, varicose veins, hypercholesterolemia), and a history of acute cerebrovascular accidents. The primary triggers of acute hearing deterioration in progressive SNHL are hypertensive crises and sharp fluctuations in blood pressure, emotional and physical overstrain, stress conditions, acoustic barotrauma, and past infections (primarily COVID-19). In 84.2% of cases, the decline in auditory function is accompanied by subjective tinnitus (ear ringing). Conclusions: The findings confirm the high sensitivity of the cochleovestibular system to hemodynamic disturbances. Comprehensive consideration of the identified comorbidities and vascular risk factors allows for predicting the course of chronic SNHL and optimizing therapeutic strategies.
STABILOMETRIC ANALYSIS OF POSTURAL STABILITY IN CHILDREN WITH BILATERAL CHRONIC SENSORINEURAL DEAFNESS AFTER COCHLEAR IMPLANTATION
Background: Children with profound sensorineural hearing loss and deafness frequently exhibit concomitant vestibular dysfunction, which is due to shared embryogenesis and the anatomical and physiological proximity of inner ear structures. Cochlear implantation (CI) significantly affects the labyrinth; however, the pattern of postural control alterations in pediatric practice remains a subject of ongoing debate. Objective: To perform a stabilometric analysis of vestibular dysfunction characteristics in deaf children before and after cochlear implantation, and to evaluate its impact on patients' postural control and motor functions. Materials and Methods: The study included 30 children (19 boys, 11 girls) aged 4-9 years with bilateral chronic sensorineural hearing loss. All patients underwent CI: simultaneous bilateral implantation was performed in 10 cases, and unilateral implantation in 20 cases. Computerized stabilometry (using the "Stabilis" hardware and software system, Ukraine) was performed preoperatively, on the 3rd postoperative day, and 12 months after surgery to register the center of pressure (COP) microdeviation parameters at rest. The control group consisted of 30 healthy age-matched children. Statistical analysis was performed using IBM SPSS Statistics 26.0 with the paired t-test. Results: Pronounced orthostatic instability was detected in deaf children prior to surgery. On the 3rd postoperative day, an initial stage of vestibular adaptation was registered, accompanied by a moderate reduction in the statokinesigram area. At 12 months, a highly significant regression of stabilometric indices was observed (p < 0.01): the total trajectory length (Length) in children aged 4-6 years decreased from 8642.3 mm to 2567.6 mm, and in children aged 7-9 years from 4259.4 mm to 1007.3 mm; the average speed (AvgSpeed) decreased from 119.6 mm/s to 45.4 mm/s (4-6 years) and from 105.2 mm/s to 25.2 mm/s (7-9 years). The subgroup with simultaneous bilateral CI demonstrated maximum efficiency in balance recovery and deviation symmetry (RangeX parameter) due to the restoration of binaural stimulation. A weak negative correlation was found between the 12-month Length parameter and age at implantation (r = -0.32; p < 0.05). No statistically significant gender differences were found. Postoperative vertigo occurred in 5 patients and completely resolved within the first 3 months without pharmacological intervention. Conclusions: Cochlear implantation acts as an effective trigger for systemic sensorimotor integration and central compensation of vestibular deficits in deaf children. The most complete recovery of postural control is achieved with simultaneous bilateral implantation performed at an early age. Computerized stabilometry serves as a sensitive and objective method for monitoring the rehabilitation process.
DEPENDENCE OF CLINICAL MANIFESTATIONS ON THE LOCATION OF THE PATHOLOGICAL PROCESS IN LIMITED ORGANIC DISEASES OF THE LARYNX
Background. Voice disorders (dysphonia) represent a widespread symptom that significantly reduces patients' quality of life and poses a threat of professional disability for individuals in voice-and-speech professions. In cases of limited organic laryngeal lesions, clinical manifestations do not always correspond to the scale of structural changes, which complicates the choice of treatment strategy and requires a thorough study of subjective symptoms. Objective. To evaluate the nature of complaints, endoscopic features, and specific clinical manifestations of dysphonia in patients with small-volume organic laryngeal lesions. Materials and Methods. A total of 78 patients with limited organic laryngeal pathology were examined. Based on endoscopic laryngoscopy findings (using "Karl Storz" and "XION" equipment, Germany), the nosological structure of the group was established as follows: vocal fold nodules – 39.0%, polyps – 21.0%, papillomatosis – 13.0%, granulomas – 9.0%, cysts – 8.0%, and fibromas – 4.0%. The comprehensive examination included history taking, systematization of complaints, and measurement of maximum phonation time (MPT). Results. It was found that excessive vocal load was the primary anamnestic trigger for the development of pathology in the majority of patients, occurring against the background of concomitant inflammatory processes of the ENT organs, acute respiratory viral infections (ARVI), or psychoemotional stress. The evaluation of MPT across all nosologies revealed no specific features (results ranged within 14–18 s). The endoscopic picture expectedly differed by topography: nodules and polyps gravitated toward the medial edge of the vocal folds, granulomas toward the posterior regions, and papillomas toward the anterior commissure. The systematization of complaints demonstrated that the severity of dysphonia correlated not so much with the nosological form as with the anatomical location of the lesion. Conclusions. Despite the diversity of nosologies, patients with small organic laryngeal lesions present uniform complaints of persistent hoarseness, discomfort, and vocal fatigue, regardless of the specific diagnosis. The degree of voice function degradation clearly depends on the topical localization of the lesion: more significant impairments are recorded when the pathological process involves the medial edge of the vocal folds (especially in the anterior commissure region), whereas the location of lesions in the posterior compartments of the larynx has a minor impact on voice quality.
REGIONAL PATTERNS OF ACUTE TONSILLITIS AND PERITONSILLAR ABSCESS MORBIDITY IN 2025
Background: Acute tonsillitis (AT) and its complication, peritonsillar abscess (PTA), represent a substantial burden on the healthcare system. This issue has become increasingly acute in Ukraine due to post-pandemic COVID-19 dynamics, ongoing military actions, associated blackouts, widespread exposure to low temperatures, and constrained access to timely medical care. Objective: To identify the risk factors for the development of acute tonsillitis and peritonsillar abscess based on the analysis of clinical, demographic, and epidemiological parameters of regional morbidity. Materials and Methods: A retrospective cohort study was conducted for the year 2025 at the Non-Profit Utility Enterprise "Brovary Multidisciplinary Clinical Hospital." Data from 87 hospitalized patients were analyzed, including 42 individuals with verified AT and 45 patients with PTA. Statistical analysis was performed using R software. Descriptive statistics, Pearson's chi-square test (χ2), the Mann–Whitney U test, and both logistic and multiple linear regression models were applied. Results: The study confirmed a pronounced seasonal pattern of hospitalizations, peaking in the winter-spring period (February–March) and reaching a minimum in summer (p = 0.061). A strong correlation was found between both pathologies (r = 0.82; p < 0.001), with PTA accounting for an overall rate of 11.0% [6, 15]. The median age of patients with PTA was significantly higher than those with AT (35.0 vs. 28.0 years; p < 0.05). Logistic regression analysis revealed heterogeneity of risk factors depending on sex and age. In the subgroup of patients aged over 30 years, male sex was a significant risk factor for PTA development (OR = 1.30). Conversely, for female patients and the older age group in general, a history of recurrent tonsillitis served as the primary predictor (OR = 1.56 and OR = 1.49, respectively). The duration of hospitalization for PTA was significantly shorter compared to AT (6.0 vs. 7.0 bed-days; p = 0.001). According to the linear regression model, the presence of PTA was directly associated with a shorter hospital stay (β = -0.48), which can be attributed to the rapid regression of clinical symptoms following surgical incision and drainage. Conclusions: The findings confirm age-related and clinical differentiation in the epidemiological course of AT and PTA in the Brovary region. The obtained data are of practical importance for predicting peak periods of workload on the otolaryngology service, optimizing the allocation of inpatient resources, and refining the selection criteria for high-risk patients recommended for elective tonsillectomy.
STATE OF BIOELECTRICAL ACTIVITY OF THE BRAIN IN PATIENTS WITH SNORING
Background: Obstructive sleep-related breathing disorders (SRBD) and snoring represent a significant medico-social issue, substantially increasing the risk of traffic accidents and occupational injuries, while imposing a heavy economic burden. In clinical practice, the verification of central sleep apnea (CSA) – the genesis of which is directly linked to central nervous system pathology – poses particular challenges. Unlike routine diagnostics of obstructive events, CSA cases are often established solely through instrumental screening without a proper evaluation of the underlying pathophysiological mechanisms and neurofunctional changes driving this phenomenon. Objective: The aim of the study was to investigate the features of the neurofunctional state and bioelectrical activity of the brain using electroencephalography in patients with snoring complicated by episodes of central sleep apnea to elucidate the central mechanisms of this pathology. Materials and Methods: A total of 101 patients with snoring and 15 somatically healthy controls were examined. Depending on the nature of their respiratory disorders, the patients were divided into two groups: Group 1 (comparison group) comprised 53 individuals with isolated obstructive sleep apnea (OSA); Group 2 (main group) included 48 patients with a verified mixed form of apnea, in whom CSA episodes were recorded concurrently with obstructive ones. The respiratory status was evaluated via overnight cardiorespiratory monitoring using the Somnocheck Micro system (Löwenstein Medical, Germany). Electroencephalographic (EEG) examinations were performed using the "DX-Systems" complex (Ukraine) with qualitative (visual-graphic) and quantitative spectral analysis. Statistical analysis was carried out using Fisher's exact test via angular transformation (φ*). Results and Discussion: Expert evaluation of native EEGs revealed significant differences in cerebral bioelectrical activity in patients with snoring compared to the control group. In Group 2 (with a central apnea component), the following patterns were recorded with a statistically significant higher frequency: absence of the activation response to eye opening (56.3% vs. 37.7% in Group 1, (p < 0.05), diffuse desorganization and desynchronization of the main cortical rhythms (89.5% vs. 67.9%, (p < 0.05)), and hypersynchronization phenomena (37.5% vs. 22.6%, (p < 0.05)). The most pronounced intergroup differences (p < 0.01) were found in the rates of overall EEG amplitude reduction (54.1% in Group 2 vs. 28.3% in Group 1) and signs of diencephalic-brainstem structure irritation (68.8% vs. 45.3%). The hyperventilation test proved particularly indicative, provoking an exacerbation of pathological and paroxysmal activity in 77.1% of patients with central apnea compared to 34.0% in the isolated OSA group (p < 0.01). This underscores the extreme sensitivity of their limbic-diencephalic complex to fluctuations in blood gas composition amid chronic nocturnal hypoxia. The detection rate of "acute wave – slow wave" complexes in Group 2 was 43.8% versus 28.4% in Group 1 (p < 0.05). Concurrently, the prevalence of limbic-diencephalic irritation signs and flattened zonal differences was comparable between both groups (p > 0.05), proving the universal nature of these impairments under respiratory stress. Conclusions 1. Patients with snoring present with pronounced impairments in cerebral bioelectrical activity, manifested by a statistically significant (p < 0.05) increase in the frequency of rhythm desorganization, flattened zonal differences, suppression of the activation response, and an elevated slow-wave activity index with an amplitude accent in the frontal and occipital leads. 2. Neurofunctional impairments demonstrate a distinct pathogenic differentiation: in patients with a central sleep apnea component, destructive EEG changes are substantially deeper and more widespread than in patients with isolated obstructive sleep apnea. 3. The presence of diencephalic-brainstem irritation signs, a generalized reduction in EEG amplitude, exacerbation of pathological activity during the hyperventilation test, an increased slow-wave activity index, and the presence of "acute wave – slow wave" complexes serve as objective prognostic markers for the development of central sleep apnea.
THE STATE OF SYSTEMIC PRO-INFLAMMATORY IMMUNE FACTORS, AUTOIMMUNE REACTIONS TO NEUROANTIGENS, AND STRESS INDICATORS IN PATIENTS WITH FRONTOBASILAR INJURY IN THE IMMEDIATE PERIOD AFTER SURGICAL TREATMENT UTILIZING A BIOCOMPOSITE MATERIAL
Background: Surgical treatment of frontal bone injuries (FBI) involving skull defects requires meticulous monitoring of systemic inflammation and immunological response to evaluate the efficacy of the biocomposite materials utilized. Objective: To evaluate the dynamics of cortisol levels, pro-inflammatory cytokines (interleukin-1, interleukin-8, macrophage inflammatory protein-1 beta, and the intensity of autoimmune reactions to specific neuroantigens (myelin basic protein (MBP) and S100 protein) in the blood serum of patients with frontal bone injury at admission, on the 10th day, and 1 month post-surgery, depending on whether a standard technique or the "Syntekistka" biocomposite material was utilized. Materials and Methods: The study enrolled 30 patients aged 19-59 with frontal bone injuries (FBI). Depending on the surgical approach, the patients were divided into two clinical groups: Group 1 (n = 10) included patients treated via the conventional technique (removal of bone fragments followed by the application of cranioplastic materials); Group 2 (n = 10) comprised patients with FBI who underwent bone fragment repositioning combined with the application of the "Syntekistka" biocomposite material. The control group consisted of 10 practically healthy male individuals (blood donors). In all patients, cubital vein blood sampling was performed prior to treatment initiation to obtain serum for determining cortisol levels, pro-inflammatory cytokines, and the intensity of autoimmune reactions to specific neural tissue proteins. Results: Serum cortisol levels in patients with frontal bone injuries (FBI) from both groups were found to exceed control values throughout the entire monitoring period (up to 1 month). No signs of pronounced allergic reactions to neural tissue alloantigens were detected during follow-up. The level of the pro-inflammatory chemokine interleukin-8 remained elevated compared to the control group for 1 month. The content of macrophage inflammatory protein-1 beta was elevated on the 10th day of observation; however, subsequently, similarly to the interleukin-8 level, it approached the norm in patients of Group 2. Discussion: The impact of frontal bone injury (FBI) on blood serum cortisol levels as a stressor factor was identical in both groups regarding both dynamics and the duration of the elevation period. The decline in cortisol levels by the end of the first month post-injury in both groups may reflect characteristic features of the traumatic disease course, independent of the selected treatment approach. Allergic reactions to neural tissue alloantigens (MBP and S100 protein) were poorly pronounced, indicating a low rate of autoimmunity in this type of FBI, which fully aligns with published scientific data. Fluctuations in the levels of various pro-inflammatory cytokines over the 1-month period demonstrated a more favorable clinical and laboratory dynamics in Group 2 patients, particularly within the chemokine pathway. This serves as indirect evidence of the transition from cellular inflammatory responses toward regenerative processes. The utilization of the "Syntekistka" biocomposite material demonstrates superior efficacy in the surgical management of frontal bone injuries compared to conventional techniques.
"Syntekistka" biocomposite material, autoallergic reactions
HERNIATION OF TEMPOROMANDIBULAR JOINT STRUCTURES INTO THE TYMPANIC CAVITY: THE ROLE OF FORAMEN TYMPANICUM IN PATHOGENESIS AND DIAGNOSIS
Background: Herniation of temporomandibular joint (TMJ) structures through the tympanic foramen (foramen tympanicum, foramen of Huschke) is a rare anomaly caused by the persistence of an embryonic defect in the tympanic part of the temporal bone. This pathology establishes a communication between the TMJ and the external auditory canal (EAC) or the middle ear, frequently mimicking otolaryngological diseases. Objective: To analyze the role of the persistent foramen tympanicum in the development of TMJ structure herniation, to determine its specific prevalence within the spectrum of temporal bone pathology, and to evaluate the capabilities of and develop an algorithm for CT/MRI diagnosis of this anomaly. Materials and Methods: Between January 2024 and May 2026, 150 patients (80 males, 70 females) aged 25–55 years presenting with temporal bone pathology were examined at the State Institution "O. S. Kolomiychenko Institute of Otolaryngology of the National Academy of Medical Sciences of Ukraine". All patients underwent multidetector computed tomography (slice thickness 0.5–0.6 mm). When necessary, 1.5 T TMJ MRI with dynamic maneuvers (open- and closed-mouth views) was performed. Results: Within the structure of the detected pathology, the most prevalent conditions were: chronic otitis media – 43.3% (n = 65), mastoiditis – 16.7% (n = 25), fenestral otospongiosis – 12.0% (n = 18), cholesteatoma – 10.0% (n = 15), labyrinthitis ossificans – 9.3% (n = 14), and EAC exostoses – 3.3% (n = 5). No pathological changes were found in 4.0% (n = 6) of cases. Herniation of TMJ structures through the foramen of Huschke was diagnosed in 2 female patients (1.3% of the total sample and 2.9% within the female cohort). The primary complaints included TMJ pain, masticatory tinnitus, and a foreign body sensation in the EAC. CT clearly visualized a defect in the anterior EAC wall (4.5 × 5.0 mm), while MRI confirmed the joint origin of the prolapsed retrodiscal tissues in dynamics. A step-by-step CT/MRI diagnostic workflow was developed and implemented to differentiate herniation from neoplasms and granulation tissue. Conclusions: Herniation of TMJ structures through the foramen of Huschke is a casuistically rare pathology (1.3%) requiring multidisciplinary awareness. CT is the method of choice for the morphometry of the bony defect, whereas dynamic MRI is crucial for verifying the soft-tissue substrate. The proposed CT/MRI algorithm optimizes the diagnostic process, prevents erroneous and hazardous biopsies of prolapsed tissues, and ensures the selection of an appropriate conservative or surgical management strategy. Keywords: temporomandibular joint, foramen of Huschke, foramen tympanicum, herniation, computed tomography, magnetic resonance imaging, differential diagnosis
temporomandibular joint, foramen of Huschke, foramen tympanicum, herniation, computed tomography, magnetic resonance imaging, differential diagnosis.
90 YEARS OF THE NATIONAL PIROGOV MEMORIAL MEDICAL UNIVERSITY (VINNYTSYA) ENT DEPARTMENT
The paper presents historical data on the emergence and development of the Department of ENT Diseases of Vinnytsia National Medical University named after M.I. Pirogov. The article presents basic data on the employees of the department, areas and achievements of pedagogical, medical, scientific and social work.
PATHOGENETIC AND CLINICAL ASPECTS OF PHYTOTHERAPY IN ACUTE RHINOSINUSITIS
Introduction: The success of a treatment strategy for acute rhinosinusitis (ARS) is determined not only by the correct choice of pharmacological agent, but also by the overall quality of medical care. An essential condition is comprehensive patient counseling regarding the specific mechanism of action of the medication, the regimen of its administration (routes of introduction, dosing intervals, dosage schedule, and total duration of therapy), as well as the prevention of adverse reactions and assessment of interactions with other drugs or dietary factors. The classification of medicines into "effective" and "ineffective" is to some extent relative. Even a pharmacological agent with a solid evidence base may demonstrate poor clinical outcomes in cases of misdiagnosis or insufficient knowledge of its proper use. Addressing these factors makes it possible to substantially enhance therapeutic success and improve the safety profile in the management of ARS. Relevance of the Problem: Modern otorhinolaryngology is actively incorporating phytoengineering agents into evidence-based treatment protocols for ARS. According to the provisions of the EPOS 2020 international consensus, specific herbal formulas have been integrated into the management algorithms for viral and post-viral forms of rhinosinusitis, with an evidence level of 1b according to GRADE criteria. In this context, the Sinus Herbal Stick product line from the domestic manufacturer "Georg Biosystems" is of particular scientific interest. This product is based on a standardized complex of eleven phytoextracts: dry extract of St. John's wort (50 mg), licorice (50 mg), nettle leaf (40 mg), calendula (40 mg), sorrel herb (36 mg), verbena (36 mg), elderflower (36 mg), primrose (36 mg), plantain (36 mg), stevia (25 mg), and gentian (12 mg). The therapeutic potential of each component has been verified by long-standing practice, and their synergistic interaction has substantial scientific justification. Pathogenetic Rationale: Through the accumulation of biologically active nutrients, Sinus Herbal Stick exerts a multi-vector effect aimed at disrupting the "vicious cycle" of rhinosinusitis pathogenesis. The pharmacodynamic activity of the preparation encompasses secretolytic, anti-inflammatory, anti-infective, and immunomodulatory vectors. The use of this agent makes it possible to avoid excessive polypharmacy — a situation in which several duplicative drugs are prescribed to address the same symptom. This issue is particularly acute with regard to irrational antibiotic therapy, which drives the global development of antimicrobial resistance. Conclusions: Given the available compelling evidence-based data, the Sinus Herbal Stick product line may be considered as an alternative treatment option for patients with uncomplicated acute rhinosinusitis.
FOREIGN BODIES OF THE LARYNGOPHARYN AND ESOPHAGUS WITH DIFFERENT CLINICAL COURSE AND TREATMENT TACTICS
Foreign bodies of the laryngopharynx and esophagus are a complex problem of practical otolaryngology. Untimely diagnosis and removal of foreign bodies often lead to the development of severe and life-threatening complications. The clinical picture depends on the type of foreign body, shape, size, level of its retention, and the nature of the damage to the esophagus. The article describes three cases of foreign bodies of the laryngopharynx in the area of ​​the first narrowing of the esophagus with a different clinical picture from minor discomfort and inconvenience when swallowing to severe pain and dysphagia, hyperthermia, inspiratory dyspnea. Two patients are women 68 and 71 years old and a man 42 years old. By nature, the foreign bodies are represented by chicken bones, in one case - a cervical vertebra of a chicken. In one patient, the foreign body occurred with a typical clinical picture without complications, and in two cases – complicated foreign bodies with damage to the laryngopharyngeal wall, cervical esophagus and jugular vein with the development of phlebitis. In one case, to confirm the foreign body, a lateral Zemtsov radiography of the cervical esophagus and contrast radiography were performed, and in two cases, a CT scan of the neck organs was performed. In terms of treatment tactics, direct hypopharyngoscopy under anesthesia was used to remove the foreign body in one case, in the second – esophagoscopy with cervical esophagotomy on the left, and in the third – the foreign body of the soft tissues of the neck was removed by external access with ligation of the internal jugular vein. The presented clinical cases indicate that foreign bodies of the laryngopharynx and esophagus are a complex problem in otolaryngology, and early diagnosis and immediate removal of foreign bodies using modern methods of anesthesia lead to recovery and form the basis for the prevention of complications.
VOCALIZATION ACTIVITY OF PET PARROTS AS A POTENTIAL FACTOR OF SENSORINEURAL HEARING LOSS: PATHOPHYSIOLOGICAL ANALYSIS AND CLINICAL OBSERVATION
Relevance: Sensorineural hearing loss (SNHL) remains one of the most prevalent auditory disorders among adults, with etiologies encompassing both endogenous and exogenous factors. While the deleterious effects of occupational and impulse noise have been extensively studied, the role of domestic acoustic sources—particularly loud vocalizations of companion birds—remains largely overlooked. Results: This study presents a comprehensive analysis of the potential auditory impact associated with vocalizations of pet parrots, especially larger species from the Cacatuidae and Psittacidae families, whose calls can exceed 120-140 dB. The article outlines the pathophysiological mechanisms underlying cochlear damage due to chronic noise exposure, including outer hair cell apoptosis, oxidative stress, and synaptopathy. A clinical case of high-frequency SNHL in a long-term owner of a Senegal parrot (Poicephalus senegalus) is described, which served as the basis for the initial research hypothesis. Additionally, behavioural and environmental factors contributing to increased vocal activity in parrots are examined. Preventive strategies are proposed to mitigate auditory risks for individuals living in close proximity to loud bird species. The findings underscore the need for further interdisciplinary research at the intersection of otology, animal behaviour, and residential acoustic hygiene.
MULTIFACTORIAL ANALYSIS OF THE CAUSES OF INEFFECTIVENESS OF CLOSED-TYPE TYMPANOPLASTY
Topicality: Closed-type tympanoplasty is one of the leading methods of reconstructive surgery of the middle ear, aimed at restoring the anatomical integrity of the tympanic membrane and improving sound-conducting function in chronic middle ear diseases. Despite significant progress in the development of otologic methods and the improvement of surgical techniques, the proportion of unsatisfactory outcomes remains relatively high, which makes the study of factors affecting surgical efficacy particularly relevant. Objective: To determine the complex of factors leading to the ineffectiveness of closed-type tympanoplasty in patients with chronic middle ear diseases. Materials and Methods: The study included 41 patients who underwent closed-type tympanoplasty during the period 2020-2024. In 67% of patients, the primary surgery was performed in various clinics of the Republic of Uzbekistan. Revision surgeries and comprehensive examinations were carried out at the multidisciplinary clinic “Bakhtli Hayot” and included clinical-morphological, functional, and systemic analyses of factors influencing the outcomes of surgical treatment. Results: Revision surgeries revealed a complex of morphological changes reflecting a combi-nation of chronic inflammation, impaired ventilation of the middle ear, and secondary tissue remodeling processes. The most frequent pathological finding was cicatricial-adhesive disease, observed in 25 patients (61%). In 61% of patients, diseases of the nasal cavity and paranasal sinuses were identified, including chronic rhinitis and rhinosinusitis, nasal septum deviation, hypertrophy of adenoid tissue, and allergic conditions. These disorders impaired middle ear ventilation and contributed to graft retraction. Conclusion 1. Ineffectiveness of closed-type tympanoplasty is due to a combination of morphological changes, impaired Eustachian tube function, and technical aspects of the surgery. 2. The main factors of unfavorable out-comes are: scarring – 61%, rhinosinus pathology – 61%, cholesteatoma – 37%, recurrent perforation – 29%, and prosthesis instability – 24%. <span lang="EN-US" style="font-size: 10.0pt; mso-bidi-font-size: 11.0pt; line-height: 107%; font-family: 'Calibri',sans-serif; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: minor-bidi; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: AR-SA;">3. Comprehensive preoperative diagnostics and timely correction of diseases of the nasal cavity and paranasal sinuses improve the effectiveness of reconstructive surgery
USE OF PLATELET-ENRICHED FIBRIN FOR CLOSING POST-TRAUMATIC PERFORATIONS OF THE EARDRUM IN PATIENTS WITH EXPLOSION INJURIES AMONG CONTEMPORARY VARIATIONS OF MYRINGOPLASTY
Perforations of the tympanic membrane are accompanied by hearing loss and an increased risk of complications, which justifies the search for minimally invasive and effective methods for their closure. Aim: to evaluate the anatomical and functional results of myringoplasty using platelet-rich fibrin (PRF). Materials and methods: The study included 36 patients aged 20-58 years with post-traumatic perforations of the tympanic membrane. All patients underwent myringoplasty with a PRF patch, followed by clinical, endoscopic, and audiometric monitoring. Results: Complete anatomical engraftment of the PRF patch was achieved in 33 (91.7%) cases. The mean reduction in the bone-air interval was 24.3±3.1 dB (p<0.001). The results showed that PRF myringoplasty is an effective and safe method for closing tympanic membrane perforations, providing a high level of anatomical healing and a significant improvement in hearing function.
EFFECTIVENESS OF TREATMENT CHRONIC SINUSITIS IN CHILDREN WITH THE PARISINUS 2 INHALER
The clinical features, pathogenesis, and efficacy of local aerosol therapy using the Parisinus 2 inhaler for chronic sinusitis in children are discussed. The results of a clinical study involving 60 pediatric patients aged 7-14 years showed that therapy using the Parisinus 2 inhaler rapidly alleviated symptoms of inflammation, restored mucociliary clearance, and prolonged remission. This method was found to be safe, effective, and physiologically acceptable in children.
APPLICATION OF SPARKLIN NASAL SPRAY IN THE TREATMENT OF RHINITIS MEDICAMENTOSA AND ADENOIDITIS
The relevance of the study lies in the need for further improvement of treatment strategies based on current protocols for adenoiditis and medication-induced rhinitis, aimed at rapid restoration of the physiological structure and function of the nasal cavity and nasopharyngeal mucosa. Objective: To optimize the treatment of patients with medication-induced rhinitis and adenoiditis. Materials and Methods: This was a post-marketing comparative study evaluating the clinical efficacy and tolerability of the seawater nasal spray "Sparklin" as part of complex therapy, conducted in parallel groups. The study included 100 patients with medication-induced rhinitis and adenoiditis. To assess mucociliary clearance during treatment, patients in both groups underwent a saccharin test and rhinocytogram (microscopic examination of a nasal smear). Additionally, nasal mucus pH was measured using a pH probe. Conclusions: The nasal spray "Sparklin" is an effective component of complex therapy for medication-induced rhinitis and adenoiditis. Its use accelerates the restoration of mucociliary clearance, normalizes nasal mucosal pH, and improves rhinocytological findings in patients with medication-induced rhinitis and grade II-III adenoid hypertrophy.
ZINC LEVELS, LACTATE DEHYDROGENASE ACTIVITY, AND INSULIN BINDING IN LARYNGEAL SQUAMOUS CELL CARCINOMA TISSUES
Introduction: Laryngeal squamous cell carcinoma of the larynx (LSCC) and hypopharyngеal region is the significant diagnostic and therapeutic problem in the world. Early diagnosis of LSCC and the mechanisms of its development are the important factors for the successful treatment of disease. The recent COVID-19 (SARS-CoV-2) pandemic has created a global health crisis that has long-lasting consequences. Potentially affecting categories of the population were patients with other diseases, including cancer. Aim: Determination of the changes in markers of LSCC development: the activity of lactate dehydrogenase, the strength of insulin receptors and changes in zinc levels due to COVID-19 infection and morphological subtypes of LSCC. Materials and methods: Tissue samples from 52 patients diagnosed with laryngeal squamous carcinoma were studied. The tissue was selected directly after surgical resection of the tumor. Histological sections were prepared on a microtome-cryostat (10 μm) and stained with N-(6-methoxy-8-quinolinyl)-4-methylenebenzenesulfonamide. They used for determination of zinc levels and FITC-insulin to assess insulin binding. Besides, the catalytic identification of lactate dehydrogenase (LDH) activity was performed in a medium of lactate, NAD+, and nitrotetrazolium blue to contrast the enzymatic reaction. Results and discussion: The generalized data of zinc levels in malignant LSCC epithelium and tumor stroma do not differ from non-malignant laryngeal epithelium and healthy connective tissue. An increase in zinc content and LDH activity was found in non-keratinizing LSCC tumors relative to non-malignant laryngeal epithelium and connective tissue underneath. An increase in LDH activity was found in the stroma of LSCC tumors relative to healthy connective tissue. A decrease in the ratio of LDH activity of malignant epithelium/stroma was found in patients with keratinizing and non-keratinizing LSCC. Insulin binding by malignant LSCC epithelial tissues did not differ from that of non-malignant epithelium. No statistically significant difference in insulin binding by tumor stromal tissues and healthy connective tissue was found. The connective tissue surrounding the tumor had a large number of cells with a significant presence of insulin binding receptors. The influence of COVID-19 and vaccination on zinc levels, LDH activity, and the number of insulin receptors in LSCC tumors was not found. Conclusions: Indicators of zinc content in malignant LSCC epithelium do not statistically differ from non-malignant epithelium, but in the connective tissue of non-keratinizing LSCC it tends to decrease. In the stroma of LSCC, LDH activity is significantly higher compared to healthy connective tissue. The level of insulin binding by non-malignant and malignant epithelium does not differ, and therefore the metabolic pathways associated with this ligand operate at the same level. In the stroma and in the tissues around the tumor, single or clusters of cells were found that have a significant presence of insulin-binding receptors on their surface. COVID-19 disease and vaccination do not affect the indicators of zinc levels, LDH activity and insulin binding by LSCC tissues.
ALGORITHM FOR SELECTING AUTOLOGOUS CARTILAGE TRANSPLANT IN SECONDARY RHINOPLASTY
Relevance: Secondary rhinoplasty is one of the most complex and technically demanding procedures in nasal reconstructive surgery. Traditionally, the choice of the type of autologous cartilage graft is based on the surgeon's subjective assessment of anatomical structures. However, modern studies demonstrate significant advantages of using objective research methods for planning complex reconstructive interventions such as radiological methods, including CT. Therefore, preoperative assessment of the state of the residual cartilage support of the nose becomes relevant in the context of planning the scope of the reconstructive intervention and choosing the optimal donor material. Objective: To develop an objective algorithm for choosing the type of autologous cartilage graft for secondary rhinoplasty based on radiological and clinical data. Materials and methods: The prospective study included 54 patients aged 18 to 60 years who underwent secondary rhinoplasty using autologous cartilage grafts between January 2022 and January 2025. All patients underwent preoperative multispiral CT of the nasal septum. Based on the obtained CT data in combination with clinical assessment of the condition of the nasal septum, upper lateral nasal cartilages and greater alar cartilages and the nasal bony pyramid, a cartilage support score developed by us was calculated on a scale from 0 to 9 points. Results: The mean age of the subjects was 37.5 years with a range from 22 to 52 years, and women accounted for 81.5% of the sample. Costal cartilage was used in 37 patients (68.5%), septal cartilage in 9 patients (16.7%), and auricular cartilage in 8 patients (14.8%). The distribution of patients according to the level of cartilage support was clinically significant. Critical loss of support, corresponding to scores from 0 to 2, was observed in 5 patients (9.3%), which corresponded to the most severe cases with multiple previous interventions. Moderate support with scores from 3 to 5 was diagnosed in 37 patients (68.5%), and adequate support with scores from 6 to 9 was maintained in only 12 patients (22.2%). Conclusions: The nasal cartilage support score is the most informative prognostic factor for the choice of cartilage graft type with an importance of 0.68 in the decision tree model, with patients with a support score below 3 requiring the mandatory use of costal cartilage, while with a score above 7 even fragments of septal cartilage can be used if available. Despite the statistically significant difference in cartilage support score between groups, all three types of autologous cartilage grafts provide satisfactory functional and aesthetic results twelve months after surgery.
EFFECTIVENESS OF ETHMOID NASALIZATION IN PATIENTS WITH POLYPOUS RHINOSINUSIS
Chronic rhinosinusitis with nasal polyps (CRSwNP) remains a challenging clinical condition characterized by a high recurrence rate after conventional surgical treatment. Increasing attention has recently been paid to ethmoidal nasalization, a more radical surgical approach targeting inflamed mucosa as a potential source of type‑2 inflammation. Objective: To evaluate the effectiveness of modified ethmoid nasalization compared to classical functional endoscopic sinus surgery (FESS) in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) and type 2 inflammation. Materials and methods: Twenty patients with CRSwNP, bronchial asthma, and eosinophilic inflammation (100% type 2) were enrolled. Patients were divided into two groups (n=10 each): group 1 – classical FESS with maximal mucosal preservation; group 2 – modified ethmoid nasalization with complete removal of ethmoid mucosa followed by free mucosal flap coverage from the nasal floor. Quality of life was assessed using the SNOT-22 questionnaire and reverse visual analog scale (VAS, 0-10, higher scores indicate better condition) preoperatively and at 3, 6, and 12 months postoperatively. Statistical analysis was performed using the independent samples t-test. Results: Groups were comparable at baseline (Lund-Mackay score: 22 vs 20; SNOT-22: 60.2 vs 62.6). At 12 months, mean reverse VAS score was 2.1 (95% CI 0.67-3.53) in the FESS group versus 7.1 (95% CI 5.67-8.53) in the nasalization group (p<0.001). SNOT-22 scores at 12 months were 21.4 (95% CI 8.52-34.28) versus 11.1 (95% CI -1.78-23.98), respectively (p=0.217). The most pronounced difference was observed at late follow-up time points, indicating more sustained improvement after nasalization. Conclusions: Modified ethmoid nasalization provides significantly better long-term subjective outcomes in quality of life compared to classical FESS in patients with eosinophilic CRSwNP. The technique appears promising for reducing recurrence rates and the need for systemic corticosteroids and biologic therapy. Keywords: chronic rhinosinusitis with nasal polyps, ethmoid nasalization, functional endoscopic sinus
chronic rhinosinusitis with nasal polyps
DIFFERENTIATION OF MUC1 AND MUC5AC MUCIN EXPRESSION IN PALATINE TONSIL TISSUE IN CHRONIC TONSILLITIS
Aim: To investigate the expression patterns of MUC1 and MUC5AC mucins in palatine tonsil tissue in chronic tonsillitis and assess their potential as biomarkers of disease activity. Materials and methods: Palatine tonsil tissue samples obtained during tonsillectomy from 31 patients with chronic tonsillitis (compensated form – DG1, n=12; decompensated form – DG2, n=19) and 29 control subjects (CG n=19, CG2 n=10) were examined. Mucin expression was determined by Western blotting followed by densitometry, normalized to β-actin (arbitrary units, a.u.). Results: Gel-forming MUC5AC expression was significantly elevated in both tonsillitis groups compared to controls (DG1: 6.83 ± 2.14; DG2: 9.67 ± 2.41; controls: 2.18–2.94; p < 0.001). Transmembrane MUC1 showed a biphasic pattern: 70–90% increase in the compensated form and 38–42% decrease in the decompensated form (p < 0.001). Conclusions: Elevated MUC5AC expression indicates mucus hypersecretion and impaired mucociliary clearance. Differentiated MUC1 changes reflect distinct disease phenotypes. MUC5AC holds promise as a biomarker of inflammatory activity in chronic tonsillitis.
IMMUNOLOGICAL ASSESSMENT IN CHRONIC NASOPHARYNGITIS WITH DIFFERENT VARIANTS OF COMORBIDITY IN THE NASOPHARYNGEAL ZONE
Topicality: Understanding the immunological features of chronic nasopharyngitis with or without pharyngeal hypertrophy makes it possible to prescribe treatment based on individualization according to the specific pathophysiological situation and concomitant conditions of the nasopharyngeal area and the child's immune status, which allows for precision pharmacotherapy. Objective: 1) To study the immunological profile of different variants of chronic nasopharyngitis in children with various associated conditions of the nasopharyngeal zone for further substantiated modulation of the activity of the nasopharyngeal immune system using a mucosal vaccine. 2) The full spectrum of changes in all indicators of local immunity in oropharyngeal secretions in patients with MG III - increased IL-1β, decreased IFN-α, decreased sIgA - most likely ensure the chronicity of infectious inflammation of the nasopharynx in this category of subjects. Conclusions: The greatest changes in both local and systemic immunity are shown by representatives of MG I (without comorbidity) and MG III (chronic nasopharyngitis on the background of allergic rhinitis). However, such indicators of systemic immunity in patients with MG III as the absence of a decrease in T-lymphocytes CD3+, a decrease in T-lymphocytes CD8+, an increased IPI, a decrease in T-lymphocytes CD16+, an increase in T-lymphocytes CD19+, a decrease in T-lymphocytes CD25+, an increase in Ig M (monomer), an increase in Ig E indicate an immunological profile of an allergic person. Representatives of MG II (chronic nasopharyngitis with hypertrophy of the pharyngeal tonsil) showed a high level of bacterial load in the form of dysbiosis grade 3 with serum leukocytosis and nasal mucus against the background of systemic immunity within normal limits with a noticeable deterioration of local immunity - increased IL-1β, decreased sIgA in oropharyngeal secretion. 3) Differences in indicators of systemic and local, humoral and cellular immunity against the background of quantitative and qualitative changes in the microbiome of the nasopharyngeal zone in representatives of different MG indicate the need for further study of the effectiveness of immunorehabilitation with a differential approach for each variant of chronic nasopharyngitis.
RESEARCH OF THE DIFFERENT TYPES PRO-INFLAMMATORY CYTOKINES AND GROWTH FACTORS STATE IN THE DYNAMICS OF OBSERVATIONS IN THE CASE OF EXPERIMENTAL INJURY OF THE RABBIT’S ILIUM USING THE BIOCOMPOSITE "SYNTEKISTKA"
Relevance: In recent decades, much attention has been paid to the use of experimental models of various pathological processes to determine the main mechanisms of their pathogenesis and to study the effect of new pharmacotherapeutic agents. Sufficiently complex models include models of traumatic lesions of the bone apparatus and, especially, those that are accompanied by a significant reaction of nervous tissue and its structures, for example, traumatic brain injury (TBI). We created a rabbit iliac bone injury model without damage to the bone marrow structures and carried out experimental therapy of the locally affected area using the "Syntekistka" biocomposite with dynamic morphological control of the injury state during up to 12 months of observation and established the positive effect of surgical treatment with the use of hydroapatite biocomposite. Aim: In order to determine the pathophysiological basis of effective experimental therapy of bone trauma in animals and repair mechanisms, it seemed appropriate to find out the state of growth factors and pro-inflammatory cytokines based on their quantitative content in the blood serum of rabbits. Material and methods: Research of pro-inflammatory cytokines according to their quantitative content in the blood serum of rabbits at the research points: "0" – the baseline before the start of the experiment before the start of the experiment; "1" – 1 month after the injury without using a biocomposite; "2" – 1 month after the injury with the use of a biocomposite; "3" – after six months without using biocomposite; "4" – after six months with the use of biocomposite. Simulation of traumatic damage to the iliac bone in rabbits, as well as the treatment regimen after the injury, was carried out as previously described. Growth factors and pro-inflammatory cytokines were studied at the indicated sampling points from 0-4. Blood was obtained from the ear vein at a fixed time. The serum content of transforming growth factor (TGF-1β), fibroblast growth factor, interleukins-6 and 1β, immunoglobulin class G was studied. The study was conducted on two groups of rabbits, 7 in each. The animals were bled from the ear vein before modelling the iliac bone. Serum was obtained and stored in a refrigerator at - 200C for no more than 3 months. Trauma modelling was performed according to recommendations. In the control group, the treatment was carried out by fixing parts of the bone with a metal plate followed by fixing the limb. Surgical treatment with the use of BCS "Sintekost" was performed according to recommendations. All the indicated factors of immunity were determined by the immunoenzymatic method using the Stat Fax 2100 analyzer (US) and sets of reagents from «Hema» (Ukraine), «Elabscience» (USA), «Euroimmun» (Belgium). We followed the recommendations of the statistical programs Biostat-6 and Win-Pepi. Results and discussion: Almost all investigated immune factors underwent the same profile of changes: increased levels of both growth factors and pro-inflammatory interleukins. The so-called "normalization" of the studied factors content factors was noticeable during the observation period of six months, mainly in the group of animals where a biocomposite material of the "Syntekistka". type was applied locally in the trauma zone. As for the content of immunoglobulin class G in blood serum, no significant deviations compared to the starting level ("0") were detected (there were none). Analyzing experimentally obtained data and facts indicated in literary sources on the problem of using biocomposite materials with a conventional designation such as "Syntekistka". for bone repair in case of different localization injuries, the following generalizing assumptions can be made: - the use of hydroapatite-based biocomposite materials in the surgical treatment of bone injuries is more pathogenetically justified method than metal osteosynthesis; - the use of the biocomposite is accompanied by systemic changes in the cytokine profile, in particular, TGF-1β, fibroblast growth factor, IL-6, interleukin-1β and the approach of these indicators to the normal level, which was noted in the group with the use of the biocomposite at the end of the observation period in more effective trauma therapy and indicates the pathogenetic nature of this approach to the treatment of bone injuries; - a further thorough study of the state of both systemic and, especially, local (in the wound) immunity is necessary before carrying out the treatment process with the use of biocomposite materials "Syntekistka" type. Conclusions: Considering the peculiarities of natural reparation of damaged bone tissue, the use of "Syntekost" type biocomposite is a promising method for ensuring full regeneration in case of bone injuries.