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6SCIENTIFIC PROGRESS VOLUME 3 I ISSUE 5 I 2022 _ISSN: 2181-1601
Scientific Journal Impact Factor (SJIF 2022=5.016) Passport: http://sjifactor.com/passport.php?id=22257
EPIDEMIOLOGICAL CHARACTERISTICS OF EXUDATIVE OTITIS MEDIA IN CHILDREN INFECTED WITH THE HUMAN IMMUNODEFICIENCY
VIRUS
N. U. Narzullaev
Bukhara State Medical Institute
ABSTRACT
In the present article the data on investigation 79 HIV-infected children at the age from 3 till 14 years with a various pathology of a cavity of a nose, a nasopharynx and sinus paranasalis is cited. It is shown that at a HIV-infected of children disease exudative an otitis media (EOM) against an available pathology of LOR-organs increases, but is especially appreciable enlarged risk of disease EOM if they have a presence of two and-or more kinds of LOR-pathologies. All HIV-infected children, along with a general clinical examination, underwent examination of the ENT organs, digital examination, X-ray of the paranasal sinuses, audiological examination and impedancemetry.
Key words: a HIV-infected children, exudative an otitis media, a pathology of LOR- organs, audiometria, impedansometria, timpanogramma.
Diseases of the ENT organs are one of the most common and dangerous pathologies in childhood, arising as a complication of respiratory, bacterial and fungal diseases, as well as HIV infection. A frequent manifestation of HIV infection is various lesions of the upper respiratory tract, which occur in almost all clinical forms of the disease and have an important diagnostic and prognostic value. One of the formidable complications of childhood HIV infection is the defeat of the ENT organs. In HIV-infected children, in addition to purulent diseases, there are diseases of the middle ear of non-purulent genesis [1, 5, 8].
In recent years, among non-purulent pathologies of the middle ear, there has been a significant increase in the relative proportion of exudative otitis media (EOM) [3, 6, 7]. The high incidence of the disease, the low effectiveness of the treatment and the development of complications with the transition to chronic forms, often leading to the development of hearing loss, dictate the need for early detection of the disease, the development of timely diagnosis and adequate treatment of POE [2,4].
From the data of modern scientific literature, it follows that 90% of children under 5 years old experience POE at least once [3, 5, 6]. The peak incidence is usually between 2 and 4 years of age. The frequency of occurrence of ESO and the nature of hearing impairment are correlated on the state of the upper respiratory tract, the quality
SCIENTIFIC PROGRESS VOLUME 3 I ISSUE 5 I 2022 _ISSN: 2181-1601
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of diagnosis and treatment given diseases. In children with pathologies of the nasal cavity, near-sinuses and nasopharynx, the incidence of PES increases sharply. Purulent sinusitis in 24% of cases leads to the development of POE in children [5,7].
The aim of this study was to study the frequency of occurrence of EOM in HIV-infected children with pathology of the nasal cavity, nasopharynx and paranasal sinuses.
The work was carried out in accordance with the research plan of the Department of ENT Diseases of the Bukhara Medical Institute on the topic: "Modern approaches to the diagnosis and complex treatment of diseases of the ear, throat and nose" (State registration No. 01040019).
Object and methods of research. We examined 79 HIV-infected children aged 3 to 14 years with various pathologies of the nasal cavity, nasopharynx and paranasal sinuses. As a control group for comparison, 20 practically healthy children of comparable sex and age were selected. The examination was carried out in the ENT department of the Children's Multidisciplinary Medical Center of the Bukhara region. The majority of patients (68.3%) were aged 3-7 years. There were more male children (77.8%) than female children. Children diagnosed with purulent otitis media and/or with a history of purulent otitis media were not included in the study.
All HIV-infected children, along with a general clinical examination, underwent examination of the ENT organs, digital examination, X-ray of the paranasal sinuses, audiological examination and impedancemetry.
Tonal and threshold audiometry in children over the age of 4 years performed on Pracitronic MA-31 clinical audiometers (Germany) and Donac-22 (Germany) with a frequency range from 125 to 8000 Hz. Impedance-metry was performed on Welch Allyn Vision-4 (Germany) and Zo-diac-901 (Germany) devices, with ipsilateral stimulation with a probing tone frequency from 500 to 4000 with an air pressure of + 200 to - 400 mm water. Art. The received material was processed by conventional methods of statistics on the computer LG PENTIUM - IV.
Results and discussion. Prospective clinical studies have shown that of all diseases of the ENT organs - diseases of the nasal cavity, its paranasal sinuses and nasopharynx -4 main nosological forms have been identified:
1) 55 children were diagnosed with adenoid vegetations;
2) in 19 - curvature of the nasal septum;
3) 6 patients had vasomotor rhinitis, of which 4 had an allergic form, 2 had a neurovegetative form;
4) 38 - inflammation of the paranasal sinuses.
All of the above forms of diseases of the paranasal sinuses were combined into the concept of sinusitis.
SCIENTIFIC PROGRESS VOLUME 3 I ISSUE 5 I 2022 _ISSN: 2181-1601
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A combination of 2 or more diseases was diagnosed in 36 children. The most common combination of adenoid vegetation and purulent sinusitis was in 19 examined patients. Simultaneous presence of adenoid vegetation and curvature of the nasal septum was found in 7 children. A mixed disease in the form of deviated nasal septum and purulent sinusitis was diagnosed in 7 patients.
In 3 children, the simultaneous presence of three pathologies was revealed: diseases of the nasal cavity, its paranasal sinuses and nasopharynx - adenoid vegetation, purulent sinusitis and deviated septum.
All examined children with pathology of the nose and paranasal sinuses were divided into 2 groups:
1) Group 1 consisted of 43 children who had only one form of pathology of the ENT organs (pathology of the nasal cavity only, or its paranasal sinuses, or pathology of the nasopharynx;
2) The 2nd group consisted of 36 children who had a combination of 2 or more diseases.
Audiological studies made it possible to make an accurate diagnosis of OES in 58
HIV-infected patients. The nature of the tympanogram and the peculiarities of the otoscopic picture of the disease allowed us to distinguish 4 stages during EOM according to the classification of N.S. Dmitriev: a) catarrhal, b) serous, c) mucosal and fibrinous.
Otoscopy and audiological examination revealed signs of POE in 15 (34.9%) children of the 1st group.
ESO was detected in 8 out of 20 children with adenoids, which is 40% in relative terms. In addition, POS was diagnosed in 5 (38.5%) HIV-infected patients out of a total of 13 patients with purulent sinusitis, as well as in 1 patient (20%) out of 5 with deviated nasal septum.
A similar picture was observed in children with vasomotor rhinitis: EOM was diagnosed in 1 (20%) of 5 patients.
In group 2, PES symptoms were recorded in 34 (94.4%) HIV-infected children.
Among patients of the 1st group, the presence of the first or second stage of EOM was noted. In 6 (13.9%), the catarrhal stage of EOM was stated, in 9 (20.9%) - the secretory stage of EOM.
The opposite picture was observed in relation to children of the second group: 1 (2.8%) patient had catarrhal, 19 (52.8%) - secretory, 12 (33.3%) - mucosal and 2 -x (5.6%) - fibrinous stage.
The catarrhal stage of EOM was otoscopically characterized by retraction of the tympanic membrane, shortening of the light reflex, less often by infiltration of the tympanic membrane.
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Audiological studies of patients with the catarrhal stage of EOM showed that on the audiogram, the air conduction thresholds reached 20 dB, while the bone conduction thresholds remained within the normal range. In patients with impedancemetry, the C-type was predominantly noted, less often the B-type of tympanogram, which is typical for dysfunction of the auditory tube, and, consequently, negative pressure in the tympanic cavity. There were also no acoustic reflexes.
In patients with the serous stage of EOM inflammation, otoscopically noted retraction of the tympanic membrane, its turbidity (sometimes with a yellowish tinge), and the level of exudate was also determined. On the audiogram, the air conduction thresholds were within 20-30 dB, the bone conduction thresholds remained within the normal range. With impedancemetry, C- and B-types of tympanograms were equally often detected. The absence of acoustic reflexes was noted.
In patients with the mucosal stage of EOM, the otoscopic picture was characterized by retraction of the tympanic membrane of a cyanotic color, uneven infiltration, immobility, and sometimes swelling in the lower Zhnem quadrant. On the audiogram, the air conduction thresholds fluctuated within 30-40 dB, the bone thresholds - up to 10 dB at high hours totah. When impedance was determined mainly B-type tympanpanograms with the simultaneous absence of acoustic reflexes.
In 2 patients with the fibrous stage of EOM, otoscopically, the tympanic membrane looked pale, retracted, with cicatricial changes and the development of tympanosclerosis. On the audiogram, the thresholds of air sound conduction reached 3550 dB, the thresholds of bone - 15-20 dB. Impedancemetry revealed a type B tympanogram, acoustic reflexes were absent.
According to the author's data, the presence of diseases of the nasal cavities, paranasal sinuses and nasopharynx in a child significantly increases the risk of EOM. The results of our studies do not contradict, but, on the contrary, confirm the above conclusions.
So, for example, in contrast to the control group, in patients with adenoid vegetations, purulent sinusitis, vasomotor rhinitis, as well as deviated nasal septum, the risk of EOM significantly increases (p<0.05) and in 28.8% of cases leads to the development of EOM.
Statistically significant (p<0.01) is the position that the simultaneous presence (combination) of 2 or more of the above pathologies dramatically increases the risk of EOM formation (up to 95%).
The negative impact of the combination of several pathologies is not limited only to an increase in the risk of EOM. The second negative point is that in children with EOM against the background of a combination of diseases of the nasal cavity, its paranasal sinuses and nasopharynx, the degree of damage to the middle ear and hearing is
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significantly higher than in children with EOM against the background of just one disease.
With an increase in duration, its chronization occurs aggravation of the disease, i.e. there is a transition to the next stage of inflammation of the EOM, which, of course, significantly reduces the effectiveness not only conservative, but also surgical treatment. In this regard, it is difficult to overestimate the importance of early diagnosis of EOM in children.
Conclusion. Thus, the presence of several pathologies in the child at once from the ENT organs (diseases of the nasal cavity, its paranasal sinuses and nasopharynx) is a prerequisite for an additional study of hearing. The combination of 2 or more of these diseases dictates the need to include a hearing test in the mandatory examination algorithm. This will contribute to both early diagnosis and increase in the effectiveness of treatment of EOM in HIV-infected children, which will lead to a significant reduction in the number of complications, since EOM in HIV-infected children can be a source of persistent hearing loss, which has an adverse effect on speech formation. and overall development of the child.
In the future, we plan to continue research in this area. In the future, it is planned to study the state of the immune status and cytokine profile in HIV-infected children with diseases of the upper respiratory tract. It is planned to develop effective methods of treatment in patients with EOM using modern antibiotics.
REFERENCES
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2. Narzullaev .N.U., Hamidova N.K. Clinical and immunological study of the effect of different types of therapy on the course of allergic rhinitis in children with hymenolepiasis// Annals of the Romanian Society for Cell Biology 2021. pp.1900-1908.
3. Narzullaev .N.U. Immunological features of infectious mononucleosis Epstein-Barr virus etiology in children// International Journal of Pharmaceutical Research 2021, pp 2667-2671.
4. Raxmatov A.A., Narzullaev .N.U. Cytokine profile in children with acute inflammation of the middle ear on the background of chronic active hepatitis// Тиббиётда янги кун. №2 (34). Ташкент 2021г.-P.15-17.
5. Raxmatov A.A., Narzullaev .N.U. The role of chronic active hepatitis in children in the clinical course of acute otitis media// Тиббиётда янги кун. №2 (34). Ташкент 2021.-P.21-23.
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6. Narzullaev N.U.,Raxmatov A.A. Immunological aspects of diagnosis and treatment of sick children with chronic purulent medium otititis on the background of chronic hepatitis// Evropan journal of Molekular medicine.№2.2021.C.43-48.
7.Narzullaev .N.U. The characteristic of the immune status at hiv- infected children with acute rhinosinusitis . International scientific and practical conference.ADTI.2019.-P.223-231.
8.Narzullaev .N.U. Fregvency of occurrence of the exudative average otitis at the HIV-infected children. International scientific and practical conference.ADTI.2019. pp.232-240.
