“Periodontal prevention” - Medical examination. Containing herbal preparations. Eliminating bad habits. Toothbrushes. Gingivitis. Pastes containing enzymes. Patients with gingivitis. Abrasive action. Complex of proteolytic enzymes. Salt toothpastes. Toothpastes. Hygienic toothpastes. Dental floss. Prevention measures.

"Forensic Medicine" - Dentistry. General clinical examination. List of lecture topics. Name of the discipline section. Preparation and conduct of a business game. Final control. Analysis of the quality and effectiveness of your work. Young couple. On the implementation of work programs. Conducting practical classes. At-risk groups. Link of domestic healthcare.

"Dermatoglyphics" - Establishing kinship. Functional module on dermatoglyphics. Basics of the flow identification method. Composition of the research group. Dermatoglyphics. Prerequisites for the flow identification method. Dermatoglyphic identification of the dead. Special tool kits. Realities of dermatoglyphic identification.

"Disaster Medicine" - Disaster Medicine. Separation and maneuver of forces. Modes. First aid. Emergency warning. Elimination of emergencies. Tasks of the disaster medicine service. Epidemiology of disaster. Death toll. Factors of emergency severity. Command center. Classification of emergency situations. Additional expanded medical institutions. VSMK. Emergency situation (ES).

"Dentistry" - Methods of examining a patient. Pulpitis. The purpose and objectives of dentistry. Serological study. Pathogenesis. Microflora of the oral cavity. Treatment methods for pulpitis. The main tasks of the dental clinic. Periodontal examination. Luminescent diagnostics. Black's classification. Dentistry. Following the oral cavity, the mucous membrane of the gums is examined.

“Artificial organs” - Biological xenoaortic prosthesis “LABCOR” (USA). Development stage: preparation of experiments on humans. One of the most high-tech types of medical equipment is the pacemaker. Development stage: clinical trials are underway. Pacemakers and sports. A pacemaker is a device designed to maintain the rhythm of the heart.

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Methods of examination and research of ENT organs

Methods of closure of ENT organs
ZAPORIZA STATE MEDICAL UNIVERSITY
Faculty: PISSLYADIPLIMNOI OSVITI
Department: CHILDREN'S ILLNESS
assistant of the department Shamenko V.O.
2016

Methods of examination and examination of ENT organs have a number of general principles.
The subject sits so that the source
there was light and a table with tools
to his right.
The doctor sits opposite the patient,
placing your feet on the table; legs
the subject should be outward.
The light source is placed at the level
right auricle of the subject in
10 cm from her.

1) Inspection of the external nose and projection sites of the paranasal sinuses
on the face.
2) Palpation of the external nose: index fingers of both hands
placed along the back of the nose and lightly massaging
movements palpate the area of ​​the root, slopes, back and
tip of the nose.
3) Palpation of the anterior and lower walls of the frontal sinuses: large
place the fingers of both hands on the forehead above the eyebrows and gently
press on this area, then your thumbs
moved to the area of ​​the upper wall of the orbit to the inner
corner and also press. The first exit points are palpated
branches of the trigeminal nerve (n. ophthalmicus). Palpation is normal
the walls of the frontal sinuses are painless (Fig. 1.2).
4) Palpation of the anterior walls of the maxillary sinuses: large
the fingers of both hands are placed in the area of ​​the canine fossa on
anterior surface of the maxillary bone and slightly
press. The exit points of the second branches are palpated
trigeminal nerve (n. infraorbitalis). Palpation is normal
the anterior wall of the maxillary sinus is painless.
Palpation of the walls of the frontal sinuses

5) Palpation of the submandibular and cervical lymph nodes:
submandibular lymph nodes are palpated at several
with the head of the person being examined tilted forward with light massaging
movements of the ends of the phalanges of the fingers in the submandibular region in
direction from the middle to the edge of the lower jaw.
The deep cervical lymph nodes are palpated first from one
side, then on the other. The patient's head is tilted forward (with
tilting the head posteriorly, anterior cervical lymph nodes and main
the vessels of the neck are also displaced posteriorly, which makes them difficult to feel).
When palpating the lymph nodes on the right, the doctor’s right hand lies on
crown of the subject, and with the left hand they massage
movements with soft deep immersion into the tissue by the ends of the phalanges
fingers in front of the anterior edge of the sternocleidomastoid
muscles. When palpating the lymph nodes on the left, the doctor’s left hand
is located on the crown, palpation is performed on the right.

Examination of the nasal cavity is carried out when
artificial lighting (frontal
reflector or stand-alone
light source) using the nasal
speculum - nasal dilator,
which must be held in the left
hand as shown
Anterior rhinoscopy:
a - correct position of the nasal dilator in the hand;
b - position of the nasal dilator during examination

Rhinoscopy can be anterior, middle and posterior.
1) Inspection of the nasal vestibule (first position during anterior rhinoscopy).
Using the thumb of the right hand, lift the tip of the nose and inspect
vestibule of the nose. Normally, the vestibule of the nose is free and there is hair.
2) Anterior rhinoscopy is performed alternately - one and the other half
nose A nasal dilator is placed on the open palm of the left hand with its beak down;
the thumb of the left hand is placed on top of the nasal dilator screw,
index and middle fingers - outside under the jaw, IV and V should
be between the branches of the nasal dilator. Thus, fingers II and III
close the jaws and thereby open the beak of the nasal dilator, and IV and V
the fingers spread the jaws and thereby close the beak of the dilator.
3) The elbow of the left hand is lowered, the hand with the nasal dilator should be
mobile; The palm of the right hand is placed on the parietal area of ​​the patient so that
give the head the desired position.

4) The beak of the nasal dilator in a closed form is inserted 0.5 cm into the vestibule of the right half of the nose
sick. The right half of the nasal dilator beak should be in the lower inner corner
vestibule of the nose, left - on the upper third of the wing of the nose.
5) Using the index and middle fingers of the left hand, press the branch of the nasal dilator and
open the right vestibule of the nose so that the tips of the beak of the nasal dilator do not touch
mucous membrane of the nasal septum.
6) Examine the right half of the nose with the head in a straight position; the color of the mucous membrane is normal
the shell is pink, the surface is smooth, moist, the nasal septum is in the midline. Normal
the nasal turbinates are not enlarged, the common, lower and middle nasal passages are free. Distance
between the nasal septum and the edge of the inferior turbinate is 3-4 mm.
7) Examine the right half of the nose with the patient’s head slightly tilted downwards. At
This clearly shows the anterior and middle sections of the lower nasal passage and the bottom of the nose. Normal
the lower nasal passage is free.
8) Examine the right half of the nose with the patient’s head slightly tilted back and to the right.
In this case, the middle nasal meatus is visible.
9) With fingers IV and V, push back the right branch so that the nose of the beak of the nasal dilator does not
closed completely (and did not pinch the hairs) and remove the nasal dilator from the nose.
10) Inspection of the left half of the nose is carried out in a similar way: the left hand holds the nasal dilator, and
the right hand rests on the crown of the head, while the right half of the nasal dilator beak is in
the upper inner corner of the vestibule of the nose on the left, and the left one in the lower outer corner.

1) There are a large number of methods for determining
respiratory function of the nose. The simplest method is V.I. Vojacek,
at which the degree of air permeability through
nose. To determine breathing through the right half of the nose
press the left wing of the nose to the nasal septum
index finger of the right hand, and with the left hand they bring
a fluff of cotton wool to the right vestibule of the nose and ask the patient
take a short breath and exhale. Nasal is determined similarly
breathing through the left half of the nose. According to the deviation of the fleece
The respiratory function of the nose is assessed. Breathing through each
half of the nose may be normal, obstructed or
absent.

2) The determination of the olfactory function is carried out in turn for each
half of the nose with odorants from the olfactometric kit
or using a device - an olfactometer. To determine
olfactory function on the right is pressed with the index finger
with the right hand the left wing of the nose to the nasal septum, and with the left hand
take a bottle of odorous substance and bring it to the right vestibule
nose, ask the patient to inhale with the right half of the nose and
determine the smell of a given substance. The most commonly used substances
with odors of increasing concentration - wine alcohol, tincture
valerian, acetic acid solution, ammonia, etc.
The sense of smell is determined through the left half of the nose
similarly, only the right wing of the nose is pressed with the index
finger of the left hand, and with the right hand bring the odorous substance to the left
half of the nose. The sense of smell may be normal (normosmia),
decreased (hyposmia), absent (anosmia), perverted
(cocasmia).

Radiography. She is one of the most
common and informative methods
examination of the nose and paranasal sinuses.
The following methods are most often used in the clinic.
With a nasofrontal projection (occipito-frontal) in
the patient's head is placed in a lying position
so that the forehead and tip of the nose touch the cassette. On
the resulting image best shows the frontal and
at least ethmoid and maxillary sinuses

With a nasomental projection (occipitomental)
the patient lies face down on the cassette with his mouth open, touching
nose and chin towards her. In this photo you can clearly see
frontal, as well as maxillary sinuses, cells of the ethmoid
labyrinth and sphenoid sinuses (Fig. 1.4 b). In order to
see on the x-ray the level of fluid in the sinuses,
use the same styling, but in a vertical position
patient (sitting).
With lateral (bitemporal), or profile, projection of the head
the subject is placed on the cassette in such a way that
the sagittal plane of the head was parallel to the cassette,
The X-ray beam passes in the frontal direction slightly
anterior (1.5 cm) from the tragus of the auricle.

Most common
x-ray placements,
used for
study of paranasal
sinuses:
a - nasofrontal (occipital-frontal);
b - nasomental
(occipitomental)

c - lateral (bitemporal,
profile);
g - axial
(chin vertical);
d - computer
tomogram of the paranasal
sinuses

With the axial (chin-vertical) projection of the patient
lies on his back, throws his head back and the parietal part
placed on the cassette. In this position, the chin
the area is in a horizontal position and the X-ray
the beam is directed strictly vertically to the thyroid notch
larynx. In this arrangement wedge-shaped
sinuses separately from each other (Fig. 1.4 d). In practice, like
Typically, two projections are used: nasomental and
nasofrontal, if indicated, other styling is prescribed.
In the last decade, widespread
methods of computed tomography (CT) and magnetic nuclear
resonance imaging (MRI), which have much larger
resolving capabilities.

These methods are the most informative
modern diagnostic methods with
the use of optical visual systems
control, rigid and flexible endoscopes with
different viewing angles, microscopes.
The introduction of these high-tech and
expensive methods has significantly expanded
horizons of diagnostics and surgical
capabilities of an ENT specialist.

1. Examine the neck area and the mucous membrane of the lips.
2. Regional lymph nodes of the pharynx are palpated: submandibular, in
retromandibular fossae, deep cervical, posterior cervical, supra- and
subclavian fossae.
Stage II. Endoscopy of the pharynx. Oroscopy.
1. Take the spatula in your left hand so that your thumb supports the spatula
from below, and the index and middle (possibly ring) fingers were on top. Right
the hand is placed on the crown of the patient.
2. Ask the patient to open his mouth, use a spatula to pull the left and
right corners of the mouth and examine the vestibule of the mouth: mucous membrane, excretory
ducts of the parotid salivary glands located on the buccal surface at the level
upper premolar.
3. Examine the oral cavity: teeth, gums, hard palate, tongue, excretory ducts
sublingual and submandibular salivary glands, floor of the mouth. The floor of the mouth can be
examine by asking the person being examined to lift the tip of the tongue or by lifting it
with a spatula.

MESOPHARINGOSCOPY
4. Holding a spatula in your left hand, press the front 2/3 of the tongue downwards without touching it
root of the tongue. The spatula is inserted through the right corner of the mouth, the tongue is not pressed flat
spatula, and its end. When you touch the root of the tongue, an vomiting sensation immediately occurs.
movement. Determine the mobility and symmetry of the soft palate by asking
the patient pronounce the sound “a”. Normally, the soft palate is well mobile, the left and
the right sides are symmetrical.
5. Examine the mucous membrane of the soft palate, its uvula, anterior and posterior
palatal arches. Normally, the mucous membrane is smooth, pink, and the arches are contoured.
Examine the teeth and gums to identify pathological changes.
The size of the palatine tonsils is determined by mentally dividing them into three parts.
distance between the medial edge of the anterior palatine arch and the vertical
a line passing through the middle of the uvula and soft palate. The size of the tonsil,
protruding up to 1/3 of this distance is classified as I degree, protruding up to 2/3 - to II
degrees; protruding to the midline of the pharynx - to the III degree.

6. Examine the mucous membrane of the tonsils. Normally it is pink
moist, its surface is smooth, the mouths of the lacunae are closed, discharge in
there are none.
7. Determine the contents in the crypts of the tonsils. To do this, take two
spatula, in the right and left hands. Press down with one spatula
tongue, the other gently presses through the anterior arch onto the tonsil
in the area of ​​its upper third. When examining the right tonsil, the tongue
squeeze with a spatula in the right hand, and when examining the left tonsil with a spatula in the left hand. Normally, there is no content in crypts or it is
scanty, non-purulent in the form of minor epithelial plugs.
8. Examine the mucous membrane of the posterior pharyngeal wall. She's normal
pink, moist, smooth, on its surface rare, sized
up to 1 mm, lymphoid granules.

EPIPHARYNGOSCOPY (POSTERIOR RHINOSCOPY)
9. The nasopharyngeal speculum is strengthened in the handle, heated in hot water to 40-45 ° C,
wipe with a napkin.
10. Using a spatula, taken in the left hand, press down the anterior 2/3 of the tongue. Asking for a patient
breathe through your nose.
11. The nasopharyngeal speculum is taken in the right hand, like a pen for writing, and inserted into the oral cavity,
the mirror surface should be directed upward. Then they put the mirror behind the soft
palate, without touching the root of the tongue and the back wall of the pharynx. Direct a beam of light from the frontal
reflector on the mirror. With slight turns of the mirror (1-2 mm), the nasopharynx is examined
(Fig. 1.5).
12. During posterior rhinoscopy, you need to examine: the vault of the nasopharynx, the choanae, the posterior ends of all three
turbinates, pharyngeal openings of the auditory (Eustachian) tubes. Normal vault of the nasopharynx
in adults, free (there may be a thin layer of pharyngeal tonsil), mucous membrane
pink membrane, free choanae, midline vomer, posterior mucosa
the ends of the nasal conchas are pink in color with a smooth surface, the ends of the conchas are not
protrude from the choanae, the nasal passages are free.

Posterior rhinoscopy (epipharyngoscopy):
a - position of the nasopharyngeal mirror; b - picture of the nasopharynx during posterior rhinoscopy: 1 - vomer;
2 - choanae; 3 - posterior ends of the lower, middle and upper nasal concha; 4 - pharyngeal opening
auditory tube; 5 - tongue; 6 - pipe roller

FINGER EXAMINATION
Nasopharynx
13. The patient sits, the doctor stands up
behind to the right of the subject.
Left index finger
hands gently press the left
the patient's cheek between the teeth
open mouth Index
right hand finger quickly
pass beyond the soft palate into
nasopharynx and feel the choanae,
nasopharyngeal vault, lateral walls
(Fig. 1.6). At the same time, the pharyngeal
the amygdala feels like the end
back of index finger
finger
Digital examination of the nasopharynx:
a - the position of the doctor and the patient; b - finger position
doctor in the nasopharynx

Stage I. External examination and palpation.
1. Examine the neck and the configuration of the larynx.
2. Palpate the larynx and its cartilages: cricoid, thyroid;
determine the crunch of the cartilage of the larynx: with the thumb and forefinger
with the right hand they take the thyroid cartilage and gently move it into one, and
then in the other direction. Normally, the larynx is painless, passive
movable in the lateral direction.
3. Regional lymph nodes of the larynx are palpated:
submandibular, deep cervical, posterior cervical, prelaryngeal,
pretracheal, paratracheal, in supra- and subclavian fossae. IN
Normally, the lymph nodes are not palpable (cannot be felt).

Stage II. Indirect laryngoscopy (hypopharyngoscopy).
1. The laryngeal mirror is strengthened in the handle, heated in hot water or over an alcohol lamp in
for 3 s to 40-45 °C, wipe with a napkin. The degree of heating is determined
by applying a mirror to the back of the hand.
2. Ask the patient to open his mouth, stick out his tongue and breathe through his mouth.
3. Wrap the tip of the tongue from above and below with a gauze napkin, take it with your left fingers
hands so that the thumb is on the upper surface of the tongue, the middle finger on the lower surface of the tongue, and the index finger lifts the upper lip. Slightly
pull the tongue towards you and downwards (Fig. 1.7 a, c).
4. The laryngeal mirror is taken in the right hand, like a pen for writing, and inserted into the oral cavity
mirror plane parallel to the plane of the tongue, without touching the root of the tongue and the back wall
throats. Having reached the soft palate, lift the tongue with the back of the mirror and place
the plane of the mirror is at an angle of 45° to the median axis of the pharynx; if necessary, you can slightly
lift the soft palate upward, direct the light beam from the reflector directly to the mirror
(Fig. 1.7 b). The patient is asked to make the drawn-out sounds “e”, “and” (at the same time the epiglottis
will move anteriorly, opening the entrance to the larynx for inspection), then inhale. Thus,
You can see the larynx in two phases of physiological activity: phonation and inspiration.
The position of the mirror must be corrected until it reflects
picture of the larynx, but this is done with great care, very thin small
movements.
5. Remove the mirror from the larynx, separate it from the handle and immerse it in a disinfectant solution.

Indirect laryngoscopy (hypopharyngoscopy): a - position of the laryngeal mirror (front view); b position of the laryngeal mirror (side view); c - indirect laryngoscopy; d - picture of the larynx with indirect
laryngoscopy: 1 - epiglottis; 2 - false vocal folds; 3 - true vocal folds; 4 arytenoid cartilage; 5 - interarytenoid space; 6 - pyriform recess; 7 - fossae of the epiglottis; 8
- root of the tongue; 9 - aryepiglottic fold; 10 - subglottic cavity (tracheal rings); d - glottis
with indirect laryngoscopy

IMAGE AT INDIRECT LARYNGOSCOPY
1. In the laryngeal mirror an image is visible that differs from the true one in that
The anterior sections of the larynx in the mirror are at the top (they appear behind), the posterior sections are at the bottom
(seem ahead). The right and left sides of the larynx in the mirror correspond to reality
(do not change).
2. In the laryngeal mirror, the root of the tongue with the lingual tongue located on it is first of all visible
tonsil, then the epiglottis in the form of an unfolded petal. Mucous membrane
The epiglottis is usually pale pink or slightly yellowish in color. Between
two small depressions are visible on the epiglottis and the root of the tongue - the fossae of the epiglottis
(vallecules), limited by the median and lateral lingual-epiglottic folds.
3. During phonation, the vocal folds are visible; normally they are pearly white.
The anterior ends of the folds at the place of their origin from the thyroid cartilage form the anterior commissure angle.
4. Pink vestibular folds are visible above the vocal folds, between
vocal and vestibular folds have depressions on each side - laryngeal
ventricles, inside of which there may be small accumulations of lymphoid tissue - laryngeal
tonsils.
5. Below in the mirror the posterior parts of the larynx are visible; arytenoid cartilages are represented by two
tubercles on the sides of the upper edge of the larynx, have a pink color with a smooth surface,
the vocal processes of these cartilages are attached to the posterior ends of the vocal folds, between
The interarytenoid space is located by the cartilage bodies.

6. Simultaneously with indirect laryngoscopy, indirect laryngoscopy is performed
hypopharyngoscopy, while the following picture is visible in the mirror. From
arytenoid cartilages upward to the lower lateral edges of the petal
the epiglottis has aryepiglottic folds, they are pink
with a smooth surface. Lateral to the aryepiglottic folds
located pear-shaped pockets (sinuses) - the lower part of the pharynx,
the mucous membrane of which is pink and smooth. Tapering downwards
pear-shaped pockets approach the esophageal sphincter.
7. During inspiration and phonation, symmetrical mobility is determined
vocal folds and both halves of the larynx.
8. When you inhale, a triangular shape forms between the vocal folds.
a space called the glottis through it
examine the lower part of the larynx - the subglottic cavity; often
it is possible to see the upper rings of the trachea, covered with pink mucous
shell. The size of the glottis in adults is 15-18 mm.
9. When examining the larynx, you should make a general overview and evaluate
the condition of its individual parts.

Stage I. External examination and palpation. The examination begins with the healthy ear.
Inspect and palpate the auricle, the external opening of the auditory
passage, postauricular area, in front of the auditory canal.
1. To examine the external opening of the right ear canal in adults
it is necessary to pull the auricle backwards and upwards, grasping it with a large and
with the index finger of your left hand behind the helix of the auricle. For inspection on the left
The auricle should be pulled back in the same way with your right hand. In children, ear retraction
shells are produced not upward, but downward and posteriorly. When retracting the ear
In this way, the bone and membranous cartilage are displaced
sections of the auditory canal, which makes it possible to introduce the ear funnel to the bone
department. The funnel holds the ear canal in a straight position, and this
allows for otoscopy.
2. To examine the area behind the ear, turn away the right auricle with your right hand.
examined anteriorly. Pay attention to the postauricular fold (place
attachment of the auricle to the mastoid process), normally it is good
contoured.
3. With the thumb of the right hand, gently press on the tragus. Palpation is normal
the tragus is painless, in an adult it is painful with acute external
otitis, in a young child such pain appears even in middle age.

4. Then the right hand is palpated with the thumb of the left hand.
mastoid process at three points: projections of the antrum,
sigmoid sinus, apex of the mastoid process.
When palpating the left mastoid process, the auricle
pull with your left hand and palpate with your right finger
hands.
5. Use the index finger of your left hand to palpate the regional
lymph nodes of the right ear anteriorly, inferiorly, posteriorly
external auditory canal.
Use the index finger of your right hand to palpate in the same way
lymph nodes of the left ear. Normally, lymph nodes are not
are palpated.

Otoscopy.
1. Select a funnel with a diameter corresponding to the transverse diameter
external auditory canal.
2. Pull the patient’s right ear backwards and upwards with your left hand.
Using the thumb and index finger of the right hand, insert the ear funnel into the
membranous-cartilaginous part of the external auditory canal.
When examining the left ear, pull the pinna with your right hand, and the crow
enter with the fingers of your left hand.
3. The ear funnel is inserted into the membranous-cartilaginous part of the auditory canal
to keep it in a straight position (after retracting the ear
conchae upward and posteriorly in adults), the funnel cannot be inserted into the bony part
ear canal as it causes pain. When inserting the funnel, it is long
its axis must coincide with the axis of the ear canal, otherwise the funnel will rest against
his wall.
4. Lightly move the outer end of the funnel in order to
sequentially examine all parts of the eardrum.
5. When inserting the funnel, there may be a cough depending on irritation
endings of the branches of the vagus nerve in the skin of the auditory canal.

Otoscopic picture.
1. Otoscopy shows that the skin of the membranous-cartilaginous section has hair, and here
earwax is usually present. The length of the external auditory canal is 2.5 cm.
2. The eardrum is gray with a pearlescent tint.
3. Identification points are visible on the eardrum: short (lateral)
process and manubrium of the malleus, anterior and posterior malleus folds, cone of light
(reflex), navel of the eardrum (Fig. 1.8).
4. Below the anterior and posterior malleus folds, the tense part of the tympanum is visible
membranes, above these folds - the loose part.
5. On the eardrum there are 4 quadrants, which are obtained from the mental
drawing two lines mutually perpendicular. One line is drawn along the handle
hammer down, the other - perpendicular to it through the center (umbo) of the eardrum and
the lower end of the hammer handle. The resulting quadrants are called:
anterosuperior and posterosuperior, anterioinferior and posteroinferior.

Diagram of the eardrum:
I - anterosuperior quadrant;
II - anterioinferior quadrant;
III - posteroinferior quadrant;
IV - posterosuperior quadrant

Study of the function of the auditory tubes. Study of the ventilation function of the auditory
pipe is based on blowing through a pipe and listening to the sounds passing through it
air. For this purpose, a special elastic (rubber) tube with ear plugs is required.
inserts at both ends (otoscope), a rubber bulb with an olive at the end (balloon
Politzer), a set of ear catheters of various sizes - from 1st to 6th number.
5 methods of blowing the auditory tube are performed sequentially. Opportunity
performing one or another method allows you to determine I, II, III, IV or V degrees
patency of the pipe. When performing an examination, one end of the otoscope is placed in
the external auditory canal of the subject, the second - the doctor. The doctor listens through an otoscope
the sound of air passing through the auditory tube.
The empty swallow test allows you to determine the patency of the auditory tube during
making a swallowing movement. When opening the lumen of the auditory tube, the doctor
through the otoscope hears a characteristic light noise or crackling sound.
Toynbee's method. This is also a swallowing movement, but performed by the subject with
closed mouth and nose. During the examination, if the tube is passable, the patient
feels a push in the ears, and the doctor hears a characteristic sound of air passing.
Valsalva method. The subject is asked to take a deep breath and then
increased expiration (inflating) with the mouth and nose tightly closed. Under pressure
exhaled air, the auditory tubes open and air forcefully enters
tympanic cavity, which is accompanied by a slight cracking sound that is felt
the person being examined, and the doctor listens to a characteristic noise through an otoscope. In case of violation
patency of the auditory tube, the Valsalva experiment fails.

The ear balloon is inserted into the vestibule of the nasal cavity
on the right and hold it with the second finger of the left hand, and I
press the left wing of the nose against the septum with a finger
nose One olive of the otoscope is inserted into the external auditory
passage of the patient, and the second - into the doctor’s ear and ask the patient
say the words “steamer”, “one, two, three”. At the moment
pronouncing a vowel sound, squeeze the balloon with four
fingers of the right hand, with the first finger serving as a support. IN
moment of blowing when pronouncing a vowel sound
The soft palate deviates posteriorly and separates the nasopharynx.
Air enters the closed cavity of the nasopharynx and
presses evenly on all walls; part of the air with
passes forcefully into the pharyngeal openings of the auditory tubes, which
determined by the characteristic sound heard
through an otoscope. Then in the same way, but only after
left half of the nose, blowing is performed,
Politzer, left auditory tube.
Blowing of the auditory tubes, according to Politzer

Stage III. Radiation diagnostic methods.
X-rays are widely used to diagnose ear diseases.
temporal bones; the most common are three
special styling: according to Schuller, Mayer and Stenvers. At the same time
X-rays of both temporal bones are taken at once. Main
the prerequisite for traditional radiography of the temporal bones is
symmetry of the image, the absence of which leads to
diagnostic errors.
Lateral plain radiography of the temporal bones, according to Schuller
,allows us to identify the structure of the mastoid process. On
radiographs clearly show the cave and perianthral cells,
the roof of the tympanic cavity and the anterior wall are clearly defined
sigmoid sinus. From these images one can judge the degree
pneumatization of the mastoid process, characteristic of
mastoiditis destruction of bone bridges between cells.

Axial projection, according to Mayer, allows more clearly than in the projection along
Schuller, remove the bone walls of the external auditory canal,
supratympanic recess and mastoid cells. Extension
atticoantral cavity with clear boundaries indicates the presence
cholesteatomas.
Oblique projection, according to Stenvers. With its help, the top of the pyramid is displayed,
labyrinth and internal auditory canal. What matters most is
the ability to assess the condition of the internal auditory canal. At
diagnosis of neuroma of the vestibulocochlear (VIII) nerve is assessed
symmetry of the internal auditory canals provided they are identical
styling of the right and left ear. Laying is also informative in diagnostics
transverse fractures of the pyramid, which are most often one of
manifestations of a longitudinal fracture of the base of the skull.
The structures of the temporal bone and ear are visualized more clearly when
using CT and MRI.
Computed tomography (CT). It is performed in the axial and frontal
projections with a slice thickness of 1-2 mm. CT allows

Survey X-ray of the temporal bones
in Schüller installation:
1 - temporomandibular joint;
2 - external auditory canal;
3 - internal auditory canal;
4 - mastoid cave;
5 - perianthral cells;
6 - cells of the apex of the mastoid process;
7 - front surface of the pyramid

Survey X-ray of the temporal lobes
bones in laying, according to Mayer:
1 - cells of the mastoid process;
2 - antrum;
3 - anterior wall of the auditory canal;
4 - temporomandibular joint;
5 - internal auditory canal;
6 - core of the labyrinth;
7 - border of the sinus;
8 - tip of the mastoid process

X-ray of the temporal
bones in laying, by
To Stenvers:
1 - internal auditory
passage;
2 - auditory ossicles;
3 – mastoid cells

Computer tomogram
temporal bone is normal

Depending on the tasks facing the doctor, the volume
The research performed may vary. Information
about the state of hearing is necessary not only for diagnosis
ear diseases and resolving the issue of conservative and
surgical treatment, but also during professional selection,
selection of a hearing aid. It is very important
Hearing examination in children to identify early disorders
hearing

Hearing research using speech. After identifying complaints and
collecting anamnesis, performing a speech hearing test,
determine the perception of whispered and spoken speech.
The patient is placed at a distance of 6 m from the doctor; test ear
should be directed towards the doctor, and the opposite
the assistant closes, pressing the tragus tightly to the hole
external auditory canal with the second finger, while the third finger slightly
rubs II, which creates a rustling sound that drowns out that ear,
excluding rehearsal

The subject is explained that he must repeat loudly
heard words. To eliminate lip reading, the patient should not
look towards the doctor. Whisper, using the air remaining in
lungs after unforced exhalation, the doctor pronounces words with
low sounds (number, hole, sea, tree, grass, window, etc.), then
words with high sounds are treble (thicket, already, cabbage soup, hare, etc.).
Patients with damage to the sound-conducting apparatus (conductive
hearing loss) they hear low sounds worse. On the contrary, in case of violation
sound perception (sensorineural hearing loss) hearing deteriorates
high sounds.
If the subject cannot hear from a distance of 6 m, the doctor shortens
a distance of 1 m and again examines the hearing. This procedure is repeated until
until the subject hears all spoken words.
Normally, when studying the perception of whispered speech, a person hears
low sounds from a distance of at least 6 m, and high sounds - 20 m.
The study of spoken speech is carried out according to the same rules.
The results of the study are recorded in a hearing passport.

Tuning fork testing is the next step in hearing assessment.
Air conduction study. Tuning forks are used for this
S128 and S2048. The study begins with a low-frequency tuning fork
Holding the tuning fork by the stem with two fingers,
the impact of the jaws on the tenor of the palms causes it to oscillate. Tuning fork S2048
set into vibration by abruptly squeezing the jaws with two fingers
or with the flick of a fingernail.
A sounding tuning fork is brought to the external auditory canal of the subject
at a distance of 0.5 cm and hold it so that the jaws make
vibrations in the plane of the axis of the auditory canal. Starting the countdown from
moment of impact of the tuning fork, a stopwatch measures the time during
which the patient hears its sound. After the subject stops
hear a sound, the tuning fork is moved away from the ear and brought closer again, without exciting
it again. As a rule, after such a distance from the ear of the tuning fork, the patient
He hears the sound for a few more seconds. The final time is marked according to
to the last answer. The study is carried out similarly with a C2048 tuning fork,
determine the duration of perception of its sound through the air.

Bone conduction study. Bone conduction testing
tuning fork C128. This is due to the fact that the vibration of tuning forks is more
low frequency is felt by the skin, and tuning forks with a higher frequency
frequencies are heard through the air by the ear.
The sounding tuning fork C128 is placed perpendicularly with the leg on the platform
mastoid process. Duration of perception is also measured
stopwatch, counting time from the moment of excitation
tuning fork.
If sound conduction is impaired (conductive hearing loss), it worsens
perception through the air of a low-sounding tuning fork C128; at
In bone conduction studies, the sound is heard longer.
Impaired perception through the air of a high tuning fork C2048
accompanied mainly by damage to the sound-perceiving
device (sensorineural hearing loss). Decreases proportionally
and the duration of the sound of C2048 through air and bone, although the ratio
These indicators remain, as normal, 2:1.

Qualitative tuning fork tests are carried out with the aim of
differential express diagnosis of lesions
sound-conducting or sound-receiving sections of the auditory
analyzer. For this purpose, experiments are carried out by Rinne, Weber, Jelle,
Federice, when performing them they use a C128 tuning fork.
Rinne's experiment consists of comparing the duration of aerial and
bone conduction. The sounding tuning fork C128 is placed with its stem against
site of the mastoid process. After the cessation of sound perception
along the bone, a tuning fork, without exciting it, is brought to the external auditory
aisle. If the subject continues to hear sound through the air
tuning fork, Rinne’s experience is regarded as positive (R+). In that
if the patient stops sounding the tuning fork
mastoid process does not hear it and at the external auditory canal,
Rinne's experience is negative (R-).

With Rinne's positive experiment, air conduction of sound in
1.5-2 times higher than bone, when negative - vice versa.
Rinne's positive experience is observed normally, negative
- in case of damage to the sound-conducting apparatus, i.e. at
conductive hearing loss.
If the sound-receiving apparatus is damaged (i.e.
sensorineural hearing loss) conduction of sounds through the air, as in
normally, prevails over bone conduction. However, at the same time
duration of perception of the sounding tuning fork as if through air,
and bone conductivity is less than normal, therefore
Rinne's experience remains positive.

Weber's experiment (W). It can be used to evaluate the lateralization of sound.
A sounding tuning fork C128 is placed at the crown of the subject to
the leg was in the middle of the head (see Fig. 1.15 a). Branches
The tuning fork must oscillate in the frontal plane. IN
Normally, the subject hears the sound of a tuning fork in the middle of the head or
equally in both ears (normal<- W ->). With unilateral
damage to the sound-conducting apparatus, the sound is lateralized in
affected ear (for example, left W ->), with unilateral lesion
sound-receiving apparatus (for example, on the left) sound
lateralizes into the healthy ear (in this case, to the right<При двусторонней кондуктивной тугоухости звук будет латерализоваться
to the side of the worse hearing ear, with bilateral neurosensory - in
side of the better hearing ear.

Jelle's experiment (G). The method makes it possible to detect sound conduction disorders associated with
immobility of the stapes in the window of the vestibule. This type of pathology is observed in
particularly in otosclerosis.
A sounding tuning fork is placed on the crown of the head and at the same time a pneumatic
a funnel is used to condense the air in the external auditory canal (see Fig. 1.15 b). At the moment
compression, a subject with normal hearing will feel a decrease in perception,
which is associated with deterioration in the mobility of the sound-conducting system due to
pressing the stapes into the niche of the window of the vestibule - Jelle’s experience is positive (G+).
With the stapes immobilized, there is no change in perception at the moment of condensation
air in the external auditory canal will not occur - Jelle’s experience is negative
(G-).
Federici experiment (F). It consists of comparing the duration of perception of the sound
tuning fork C128 from the mastoid process and tragus during obturation of the external
ear canal. After the sound stops on the mastoid process, the tuning fork
placed the leg on the tragus.
In normal conditions and in cases of impaired sound perception, Federici’s experience is positive, i.e.
the sound of a tuning fork from the tragus is perceived longer, and if
sound conduction - negative (F-).
Thus, Federici's experience, along with other tests, allows
differentiate between conductive and sensorineural hearing loss.

The use of electroacoustic equipment allows dosing
the strength of the sound stimulus in generally accepted units - decibels
(dB), conduct a hearing test in patients with severe
hearing loss, use diagnostic tests.
An audiometer is an electrical sound generator that allows
produce relatively pure sounds (tones) both through air and through
bone. A clinical audiometer examines hearing thresholds in the range
from 125 to 8000 Hz. Nowadays audiometers have appeared,
allowing you to study hearing in an expanded frequency range - up to 18
000-20,000 Hz. With their help, audiometry is performed in advanced
frequency range up to 20,000 Hz over the air. Through transformation
attenuator, the supplied audio signal can be amplified up to 100-120
dB when studying air and up to 60 dB when studying bone
conductivity. The volume is usually adjusted in steps of 5 dB, in
on some audiometers - in more fractional steps, starting from 1 dB.

From a psychophysiological point of view, various
audiometric methods are divided into subjective and objective.
Subjective audiometric techniques are the most widely used
application in clinical practice. They are based on
subjective sensations of the patient and on the conscious, depending on his
will, response. Objective or reflex audiometry
based on reflex unconditional and conditioned responses
reactions of the subject that occur in the body during sound
influence and independent of his will.
Taking into account what stimulus is used in the study
sound analyzer, there are such subjective methods as
tone threshold and suprathreshold audiometry, research method
auditory sensitivity to ultrasound, speech audiometry.

Pure-tone audiometry can be threshold or suprathreshold.
Pure tone threshold audiometry is performed to determine thresholds
perception of sounds of different frequencies during air and bone conduction.
Using air and bone telephones, the threshold is determined
sensitivity of the hearing organ to the perception of sounds of different frequencies. Results
research is entered on a special form-grid, called
"audiogram".
An audiogram is a graphical representation of hearing threshold. Audiometer
designed to show hearing loss in decibels compared to
the norm. Normal hearing thresholds for sounds of all frequencies, both airborne and
bone conduction is marked with a zero line. Thus, tonal
A threshold audiogram primarily makes it possible to determine hearing acuity.
According to the nature of the threshold curves of air and bone conduction and their
relationships, one can also obtain a qualitative characteristic of the patient’s hearing, i.e.
determine whether there is a violation of sound conduction, sound perception or
mixed (combined) lesion.

If sound conduction is impaired, the audiogram shows an increase in
air conduction hearing thresholds mainly in the range
low and medium frequencies and, to a lesser extent, high frequencies. Auditory thresholds according to
bone conductivity remain close to normal, between threshold
curves of bone and air conduction there is a significant
called air-bone gap (cochlear reserve).
If sound perception is impaired, air and bone conduction
suffer to the same extent, the air-bone gap is almost
absent. In the initial stages, perception is predominantly affected
high tones, and in the future this is a violation
appears at all frequencies; there are breaks in the threshold curves, i.e.
lack of perception of certain frequencies
Mixed or combined hearing loss is characterized by the presence of
audiogram showing signs of impaired sound conduction and sound perception, but
There is a bone-air gap between them.

Audiogram for impairment
sound conduction:
a - conductive form of hearing loss;
b - sensorineural form of hearing loss;
c - mixed form of hearing loss

Pure tone suprathreshold audiometry. Designed to identify
phenomenon of accelerated increase in volume (FUNG - in domestic
literature, the phenomenon of recruitment, recruitment phenomenon - in
foreign literature).
The presence of this phenomenon usually indicates damage to receptors
cells of the spiral organ, i.e. about intracochlear (cochlear) lesion
auditory analyzer.
A patient with decreased hearing acuity develops increased
sensitivity to loud (suprathreshold) sounds. He notes unpleasant
sensations in the sore ear if someone speaks loudly or harshly to it
strengthen the voice. The presence of FUNG can be suspected by clinical
examination. This is evidenced by the patient’s complaints of intolerance
loud sounds, especially with a sore ear, the presence of dissociation between
perception of whispered and spoken speech. Whispering speech of the patient completely
does not perceive or perceives at the sink, while spoken
hears at a distance of more than 2 m. When carrying out Weber's experiment,
change or sudden disappearance of sound lateralization, with
tuning fork examination, audibility suddenly stops
tuning fork while slowly moving it away from the sore ear.

Methods of suprathreshold audiometry (there are more than 30 of them) allow direct or
indirectly detect FUNG. The most common among them
are classical methods: Luscher - definition
differential threshold for perception of sound intensity,
volume leveling according to Fowler (for unilateral hearing loss),
Small Increment Intensity Index (SMI, often referred to as
as SISI test). Normal differential sound intensity threshold
equal to 0.8-1 dB, the presence of FUNG is indicated by its decrease below
0.7 dB.
Study of auditory sensitivity to ultrasound. Normal
a person perceives ultrasound during bone conduction in the range
frequencies up to 20 kHz and more. If hearing loss is not associated with a lesion
cochlea (neurinoma of the VIII cranial nerve, brain tumors, etc.),
ultrasound perception remains the same as normal. At
In case of damage to the cochlea, the threshold for the perception of ultrasound increases.

Speech audiometry, unlike tonal audiometry, allows you to determine
social suitability of hearing in a given patient. The method is
especially valuable in the diagnosis of central hearing lesions.
Speech audiometry is based on determining intelligibility thresholds
speech. Legibility is understood as a value defined as
ratio of the number of correctly understood words to the total number
listened to, express it as a percentage. So, if out of 10
The patient correctly understood the words presented for listening
all 10, it will be 100% legible if you parse 8, 5 or
2 words, this will be 80, 50 or 20% intelligibility respectively.
The study is carried out in a soundproofed room. Results
studies are recorded on special forms in the form of curves
speech intelligibility, while the intensity is marked on the x-axis
speech, and on the y-axis is the percentage of correct answers. Curves
intelligibility is different for various forms of hearing loss, which has
differential diagnostic value.

Objective audiometry. Objective methods of hearing research
based on unconditioned and conditioned reflexes. Such research has
significance for assessing the state of hearing in cases of damage to the central parts
sound analyzer, during labor and forensic testing
examination. With a strong sudden sound, unconditioned reflexes
are reactions in the form of pupil dilation (cochlear-pupillary reflex,
or auropupillar), closing the eyelids (auropalpebral, blinking
reflex).
Most often, galvanic skin testing is used for objective audiometry.
and vascular reactions. The galvanic skin reflex is expressed in
change in potential difference between two areas of skin under
influenced, in particular, by sound stimulation. Vascular reaction
consists in changing vascular tone in response to sound stimulation, which
recorded, for example, using plethysmography.
In young children, the reaction most often recorded is during play.
audiometry, combining sound stimulation with the appearance of a picture in
the moment the child presses the button. Loud sounds at first
are replaced by quieter ones and auditory thresholds are determined.

The most modern method of objective hearing testing is
audiometry with recording of auditory evoked potentials (AEP). The method is based
on registration of sounds evoked in the cerebral cortex
potentials on the electroencephalogram (EEG). It can be used in children
infancy and young age, in mentally handicapped persons and persons with normal
psyche. Since EEG responses to sound signals (usually short - up to 1 ms,
called audible clicks) are very small - less than 1 µV, to register them
use averaging using a computer.
Recording of short-latency auditory evoked responses is more widely used.
potentials (KSVP), giving an idea of ​​the state of individual formations
subcortical pathway of the auditory analyzer (vestibular-cochlear nerve, cochlear
nuclei, olives, lateral lemniscus, quadrigeminal tuberosities). But CVEPs do not provide any complete picture of the response to a stimulus of a certain frequency, since
the stimulus itself should be short. In this regard, more informative
long-latency auditory evoked potentials (LAEPs). They register
responses of the cerebral cortex to relatively long-term, i.e. having a certain
frequency of sound signals and they can be used to remove auditory
sensitivity at different frequencies. This is especially important in pediatric practice, when
Conventional audiometry, based on the patient's conscious responses, is not applicable.

Impedance audiometry is one of the methods of objective assessment
hearing based on acoustic impedance measurement
sound-conducting apparatus. In clinical practice they use
two types of acoustic impedance measurements - tympanometry and
acoustic reflexometry.
Tympanometry consists of recording acoustic
resistance that a sound wave encounters when
propagation through the acoustic system of outdoor, middle and
inner ear, when air pressure changes in the outer ear
ear canal (usually from +200 to -400 mm water column). Curve,
reflecting the dependence of the resistance of the eardrum
from pressure, called a tympanogram. Various types
tympanometric curves reflect normal or
pathological condition of the middle ear.

Acoustic reflexometry is based on recording changes
compliance of the sound-conducting system, occurring when
contraction of the stapedius muscle. Triggered by sound stimulus
nerve impulses travel along the auditory tract to the superior olive
nuclei, where they switch to the motor nucleus of the facial nerve and go to
stapedius muscle. Muscle contraction occurs on both sides. IN
a sensor is inserted into the external auditory canal, which responds to
change in pressure (volume). In response to sound stimulation
an impulse is generated, passing through the above-described reflex
arc, as a result of which the stapedius muscle contracts and comes into
the eardrum moves, the pressure (volume) changes
external auditory canal, which is what the sensor records. Normal threshold
the acoustic reflex of the stapes is about 80 dB above
individual sensitivity threshold. For neurosensory
hearing loss accompanied by FUNG, reflex thresholds are significantly
are decreasing. For conductive hearing loss, pathology of the nuclei or brainstem
facial nerve acoustic reflex of the stapes is absent on the side
defeats. For differential diagnosis of retrolabyrinthine
damage to the auditory tract, the decay test is of great importance
acoustic reflex.

Types of tympanometric curves (according to Serger):
a - normal;
b - with exudative otitis media;
c - when the chain of auditory ossicles breaks

The examination of the patient always begins with clarification of complaints and
history of life and illness. The most common complaints
for dizziness, balance disorder, manifested
disturbance of gait and coordination, nausea, vomiting,
fainting, sweating, change in skin color
covers, etc. These complaints may be persistent or
appear periodically, be fleeting, or
last for several hours or days. They may occur
spontaneously, for no apparent reason, or under the influence
specific environmental factors and the body: in transport,
surrounded by moving objects, when overtired,
motor load, certain head position, etc.

Vestibulometry includes identifying spontaneous symptoms,
conducting and evaluating vestibular tests, analysis and generalization
received data. To spontaneous vestibular symptoms
include spontaneous nystagmus, changes in muscle tone of the limbs,
gait disturbance.
Spontaneous nystagmus. The patient is examined in a sitting position or in
supine position, with the subject watching the finger
doctor, at a distance of 60 cm from the eyes; finger moves
consistently in horizontal, vertical and diagonal
planes. Eye abduction should not exceed 40-45°, since
overstrain of the eye muscles may be accompanied by twitching
eyeballs. When observing nystagmus, it is advisable to use
High magnification glasses (+20 dioptres) to eliminate interference
fixation of gaze. Otorhinolaryngologists use for this purpose
special Frenzel or Bartels glasses; even more clearly
spontaneous nystagmus is detected by electronystagmography.

When examining the patient in a supine position with the head and
the body is given different positions, while in some
patients observe the appearance of nystagmus, designated as
positional nystagmus (nystagmus of position). Positional nystagmus
may have a central genesis, in some cases it is associated with
dysfunction of the otolith receptors, from which the
tiny particles and enter the ampoules of the semicircular canals with
pathological impulses from cervical receptors.
In the clinic, nystagmus is characterized by plane (horizontal,
sagittal, rotatory), in direction (right, left, up,
down), by strength (I, II or III degree), by the speed of oscillatory cycles
(live, sluggish), amplitude (small-, medium-, or large-scale),
by rhythm (rhythmic or disrhythmic), by duration (in seconds).

In terms of strength, nystagmus is considered degree I if it occurs only when
looking towards the fast component; II degree - not visible
only towards the fast component, but also directly; finally,
III degree nystagmus is observed not only in the first two
eye positions, but also when looking towards the slow
component. Vestibular nystagmus usually does not change its
directions, i.e. in any eye position its fast component
directed in the same direction. About extralabyrinthine
the (central) origin of nystagmus is evidenced by its
undulating character, when it is impossible to distinguish fast and
slow phase. Vertical, diagonal,
multidirectional (changing direction when looking at
different sides), converging, monocular,
asymmetrical (not the same for both eyes) nystagmus
characteristic of disorders of central origin.

Tonic reactions of hand deviation. They are examined at
performing index tests (finger-nose, finger-finger), Fischer-Wodak test.
Index samples. When performing a finger-nose test
the subject spreads his arms to the sides and first with open, and
then, with his eyes closed, tries to touch with his index fingers
fingers of one and then the other hand to the tip of your nose. At
in the normal state of the vestibular analyzer it is without
difficulty completing the task. Irritation of one of
labyrinths leads to missing with both hands in
the opposite side (towards the slow component
nystagmus). When the lesion is localized in the posterior cranial fossa
(for example, with pathology of the cerebellum) the patient misses
with one hand (on the side of the disease) to the “sick” side.

During the finger-finger test, the patient alternately uses his right and left hand
should hit the doctor's index finger with your index finger,
located in front of him at arm's length. Try
performed first with open, then with closed eyes. Normal
the subject confidently hits the doctor's finger with both hands, as if with
with eyes open and with eyes closed.
Fischer-Wodak test. It is performed by the subject sitting with the
eyes and with arms extended forward. Index fingers extended
the rest are clenched into a fist. The doctor positions his index fingers
opposite the patient's index fingers and in the immediate
proximity to them and observes the deviation of the subject’s hands. U
in a healthy person there is no deviation of the hands; in case of damage
maze, both hands are deviated towards the slow component
nystagmus (i.e. towards the labyrinth, the impulse from which
reduced).

Study of stability in the Romberg pose. The subject is standing
bringing your feet together so that their toes and heels touch, hands
extended forward at chest level, fingers spread, eyes
closed. In this position, the patient should be secured,
so that he doesn't fall. If the function of the labyrinth is impaired, the patient
will deviate in the direction opposite to nystagmus. Should
take into account that even with cerebellar pathology there may be a deviation
body in the direction of the lesion, so the study is in the pose
Romberg is supplemented by turning the subject’s head to the right and
to the left. When the labyrinth is damaged, these turns are accompanied by
change in the direction of fall, with cerebellar damage
the direction of deviation remains unchanged and does not depend on
turning the head.

Gait in a straight line and flank:
1)
2)
when examining the patient's gait in a straight line with his eyes closed
takes five steps forward in a straight line and then, without turning, 5 steps
back. If the function of the vestibular analyzer is impaired, the patient
deviates from a straight line in the direction opposite to nystagmus, with
cerebellar disorders - in the direction of the lesion;
flank gait is examined as follows. The subject leaves
right foot to the right, then puts the left one and takes 5 steps in this way, and
then similarly takes 5 steps to the left. In case of violation
vestibular function, the subject performs the flank gait well in
both sides, if the function of the cerebellum is impaired, it cannot perform it in
side of the affected cerebellar lobe.
Also for the differential diagnosis of cerebellar and vestibular
lesions, a test for adiadochokinesis is performed. The subject performs it with
with eyes closed, both arms extended forward, makes a quick change
pronation and supination. Adiadochokinesis - a sharp lag of the hand on the “sick”
side with impaired cerebellar function.

Vestibular tests allow us to determine not only the presence
dysfunction of the analyzer, but also to provide high-quality and
quantitative characteristics of their features. The essence of these samples
consists of stimulating vestibular receptors with the help of
adequate or inadequate dosage effects.
Thus, for ampullary receptors an adequate stimulus is
angular accelerations, dosed rotational acceleration is based on this
test on a rotating chair. An inadequate irritant for those
same receptors is the effect of dosed caloric
stimulus when infusion of different water into the external auditory canal
temperature leads to cooling or heating of liquid media
inner ear and this causes movement according to the law of convection
endolymph in the horizontal semicircular canal located
closest to the middle ear. Also an inadequate irritant for
vestibular receptors are exposed to galvanic current.
For otolith receptors, an adequate stimulus is
linear acceleration in horizontal and vertical planes
when performing a test on a four-bar swing.

Rotational test. The subject is seated in a Barani chair like this
so that his back fits snugly against the back of the chair, his legs
were placed on a stand, and their hands were on the armrests. Patient's head
leans forward and down 30°, eyes should be closed. Rotation
produced evenly at a speed of 1/2 revolution (or 180°) per second, in total
10 revolutions in 20 s. At the beginning of rotation, the human body experiences
positive acceleration, at the end - negative. When rotating
clockwise after stopping the endolymph flow in horizontal
the semicircular canals will continue to the right; hence slow
the component of nystagmus will also be to the right, and the direction of nystagmus (fast
component) - left. When moving to the right when the chair stops at
in the right ear, the movement of the endolymph will be ampulofugal, i.e. from the ampoule, and in
left - ampulopetal. Therefore, post-rotational nystagmus and
other vestibular reactions (sensory and autonomic) will
are caused by irritation of the left labyrinth, and the post-rotation reaction
from the right ear - observed when rotating counterclockwise, i.e.
to the left. After the chair stops, the countdown begins. Subject
fixes his gaze on the doctor’s finger, while determining the degree of nystagmus,
then determine the nature of the amplitude and liveliness of the nystagmus, its
duration when the eyes are positioned towards the fast component.

If the functional state of the anterior receptors is studied
(frontal) semicircular canals, then the subject sits in
Barani chair with the head tilted back 60°, if
the function of the posterior (sagittal) canals, head is studied
tilts 90° to the opposite shoulder.
Normal duration of nystagmus when examining lateral
(horizontal) semicircular canals is 25-35 s, with
examination of the posterior and anterior canals - 10-15 s. Character
nystagmus when irritating the lateral canals is horizontal, the anterior ones are rotatory, the posterior ones are vertical;
in amplitude it is small or medium in scope, grades I-II,
lively, quickly fading.

Caloric test. During this test, a weaker level is achieved than with
rotation, artificial stimulation of the labyrinth, mainly receptors
lateral semicircular canal. An important advantage of the caloric test
is the ability to irritate isolated ampullary receptors of one
sides.
Before performing an aqueous caloric test, make sure that there is no
dry perforation in the eardrum of the ear being examined, since
water into the tympanic cavity can cause exacerbation of chronic
inflammatory process. In this case, an aerial
calorization.
The caloric test is performed as follows. The doctor draws Zhane into the syringe
100 ml of water at a temperature of 20 ° C (with a thermal caloric test, the temperature
water is +42 °C). The subject sits with his head tilted back 60°; at the same time
The lateral semicircular canal is located vertically. Pour into external
ear canal 100 ml of water in 10 s, directing the stream of water along its posterior superior
wall Determine the time from the end of the infusion of water into the ear until the appearance of
nystagmus is a latent period, normally equal to 25-30 s, then it is recorded
The duration of the nystagmus reaction is normally 50-70 s. Characteristics
nystagmus after calorization is given according to the same parameters as after rotation
samples. When exposed to cold, nystagmus (its fast component) is directed towards
the side opposite to the ear being tested, during thermal calorization - to the side
irritated ear.

Methodology
caloric test

Pressor (pneumatic, fistula) test. It is carried out for
identifying a fistula in the area of ​​the labyrinthine wall (most often in
area of ​​the ampulla of the lateral semicircular canal) in patients
chronic purulent otitis media. The sample is produced
thickening and rarefaction of air in the external auditory canal,
either by applying pressure to the tragus or using a rubber bulb.
If, in response to air thickening, nystagmus and other
vestibular reactions, then the pressor test is assessed as
positive. This indicates the presence of a fistula. Should
take into account, however, that a negative test does not allow complete
confidently deny the presence of a fistula. With extensive
perforations in the eardrum can be made
direct pressure with a probe with cotton wool wrapped around it
to areas of the labyrinthine wall that are suspicious for a fistula.

Study of the function of the otolithic apparatus. It is carried out mainly
in professional selection, in clinical practice, direct methods
and indirect otolitometry are not widely used. WITH
taking into account the interdependence and mutual influence of the otolith and cupular
departments of the analyzer V.I. Vojacek proposed a technique he called
"double experiment with rotation" and known in the literature as "Otolith
Vojacek reaction.
Otolithic reaction (OR). The subject sits in a Barany chair and
tilts the head along with the body 90° forward and down. In this
position it is rotated 5 times for 10 s, then the chair
stop and wait 5 s, after which they are asked to open their eyes and
straighten up. At this moment a reaction occurs in the form of a tilt
torso and head to the side. Functional state of the otolith
the apparatus is assessed by degrees of deviation of the head and torso from
midline towards the last rotation. Also taken into account
severity of vegetative reactions.

Thus, a deviation of an angle from 0 to 5° is assessed as degree I
reactions (weak); deviation of 5-30° - II degree (medium strength).
Finally, deviation by an angle of more than 30° is grade III (strong), when
the subject loses his balance and falls. Reflex angle
the slope in this reaction depends on the degree of influence of the otolith
irritation when straightening the body on the function of the anterior
semicircular canals. In addition to the somatic reaction, this
experience takes into account vegetative reactions, which can also be
three degrees: I degree - paleness of the face, change in pulse; II
degree (moderate) - cold sweat, nausea; III degree - change
cardiac and respiratory activity, vomiting, fainting. Experience
double rotation is widely used during examination
healthy people for the purpose of professional selection.

When selecting aviation and astronautics for research
sensitivity of the subject to the cumulation of the vestibular
irritation, the proposed
K.L. Khilov back in 1933, a technique for motion sickness
four-bar (double-bar) swing. Swing area
oscillates not like an ordinary swing - in an arc, but remains
constantly parallel to the floor. The subject is on
swing platform lying on your back or side, using
electrooculography techniques record tonic movements
eye. Modification of the method using small
dosed according to the amplitude of swings and registration
compensatory eye movements is called “direct
otolitometry".

Stabilometry. Among the objective methods for assessing static
equilibrium method is becoming increasingly widespread
stabilometry, or posturography (posture - pose). The method is based
on recording oscillations of the center of pressure (gravity) of the body
patient installed on a special stabilometric
platform. Body vibrations are recorded separately in
sagittal and frontal planes, calculate a whole series
indicators that objectively reflect the functional state
equilibrium systems. The results are processed and summarized with
using a computer. Combined with a set of functional
sample computer stabilometry is
highly sensitive method and is used to detect
vestibular disorders at the earliest stage, when
subjectively they do not yet manifest themselves (Luchikhin L.A., 1997).

Stabilometry finds application in differential
diagnosis of diseases accompanied by the disorder
balance. For example, a functional test with rotation
head (Palchun V.T., Luchikhin L.A., 1990) allows for early
stages to differentiate disorders caused by
damage to the inner ear or vertebrobasilar
insufficiency. The method makes it possible to control
dynamics of the development of the pathological process in the disorder
balance functions, objectively assess the results of treatment.

Etiology Watery eyes in older people are most often associated with age-related changes in the skin of the lower eyelids. She loses her tone and sinks. As a result of senile blepharoptosis (drooping eyelids), the lacrimal openings are displaced and the outflow of tear fluid is disrupted. It begins to accumulate and just flow down your cheeks.

Another cause of lacrimation in old age is keratoconjunctivitis sicca. This disease occurs due to insufficient hydration of the cornea and conjunctiva as a result of age-related thinning of the protective film. In this case, the patient may complain of severe pain in the eyes, which most often appears in the morning and evening, the inability to tolerate bright light and a feeling of sand in the eyes.

In older people, lacrimation can also be caused by blepharitis (inflammation of the eyelids), which develops as a result of infection with staphylococcus. Seborrheic blepharitis often accompanies keratoconjunctivitis sicca.

The development of Sjögren's syndrome, which is accompanied not only by dryness of the cornea, but also of the oral cavity, may be another cause of lacrimation.

Treatment of lacrimation in elderly and senile people should be carried out taking into account the causes of the occurrence and development of the process. First of all, it is necessary to establish what is the cause of lacrimation - age-related changes in the protective and auxiliary apparatus of the eye or diseases of the lacrimal organs.

When the first symptoms of lacrimation occur in elderly and senile people, it is necessary to radically try to eliminate the cause of its occurrence.

The patient should be taught proper tear wiping techniques. To do this, the patient must cover the eye and remove the tear with a light blotting movement from the outer corner of the eye to the inner corner with a clean handkerchief or cotton-gauze swab. The lower eyelid presses against the eyeball rather than pulling away from it.

Dryness of the mucous membranes of the upper respiratory tract is caused by atrophic processes of the mucous membranes. Some of the mucous glands become empty; in the lobules of others, the secretion lingers and becomes thick. The sense of smell can remain good until old age, but still, at 75-90 years old, smell impairment is much more common than in younger people. The acuity of smell decreases gradually and is therefore invisible to patients.

Causes Dry nose is an indispensable companion to diabetes and decreased production of sex hormones in older men and women.

Dry mucous membranes, including the nose and mouth, are also a characteristic sign of an autoimmune disease such as Sjogren's syndrome, which affects almost all the exocrine glands of the body.

Symptoms of the disease manifest themselves as a feeling of dryness and burning in the nose, itching in the nasal cavity, nasal congestion (especially at night), and the formation of crusts on the mucous surface. Headaches and nosebleeds may occur. Dryness appears around the nose - along the edge between the mucous membrane and the skin of the nostrils, while painful cracks may appear on the skin, which sometimes bleed.

Treatment The treatment of dry nose is based on local symptomatic therapy aimed at regenerating the nasal mucosa by moisturizing it and softening the crusts formed from the drying secretion of the nasal glands.

Treatment Air humidification Irrigation of the mucous membrane with salted water (you can use preparations based on sea water - Otrivin More, Aqua Maris) Vitaon is a regenerating preparation for external use for the skin and mucous membranes, which is an oily plant extract

It is recommended to lubricate the nasal cavity with an oil solution of vitamins A and E (Aevit) or Aekol solution, which contains these vitamins and is used externally as a wound healing agent.

The main folk remedies for dry nose include various oils - olive, peach, almond, flaxseed, sesame oil, tea tree oil. Oils prevent the mucous membrane from drying out if you regularly, at least three times a day, lubricate them in the nose.

Nosebleeds Nosebleeds (epistaxis) are bleeding from the nasal cavity, usually seen as blood leaking through the nostrils, a common condition that complicates the course of some diseases. A typical disease of old age, especially in men

When examining such patients, common diseases are sometimes revealed - hypertension, atherosclerosis, venous congestion, cardiac decompensation, diseases of the kidneys, liver and hematopoietic organs. Each such patient is subject to a general therapeutic examination.

Treatment First aid for nosebleeds involves quickly stopping blood loss in order to prevent the bleeding from increasing, as well as hemostatic and etiotropic therapy. Treatment of massive bleeding is usually carried out in a comprehensive manner.

To stop nosebleeds, there are proven and simple folk methods of help. Usually, in order to stop the “front” bleeding, it is enough for the victim to take a horizontal (sitting) position, without throwing back his head, so as not to impede the venous outflow

Nasal hydrorhea is the discharge of clear fluid from the nose, caused by increased permeability of the vascular wall. Nasal discharge increases with fluctuations in ambient temperature or ingestion of hot food. A characteristic sign is the appearance of droplets of clear liquid on the tip of the nose, usually unnoticed by the patient.

Causes When examining the nose in such people, no pathology is detected, except for age-related changes in the mucous membrane.

Chronic rhinosinusitis is a chronic inflammation of the nasal mucosa spreading to the paranasal sinuses.

breathing is impaired, thereby promoting the development of inflammatory changes in the underlying parts of the respiratory tract, maintaining their chronic course; patients often complain of pressing, dull headaches

Causes Untreated or undertreated acute rhinosinusitis (inflammation of the paranasal sinuses). Anatomical features of the nasal cavity that prevent normal ventilation of the paranasal sinuses (for example, a deviated nasal septum). They can be congenital or acquired (as a result of trauma to the nose or face). Allergy. Adverse environmental factors (inhalation of dusty, polluted air, toxic substances). Smoking, alcohol abuse.

Treatment Medications include vasoconstrictor drops and nasal sprays for a short course (5-7 days), nasal sprays with antibiotics and steroid hormones, and for purulent exacerbations - systemic antibiotics. Physiotherapy (treatment using natural and artificially created physical factors) is prescribed at the subsiding stage. exacerbation, with good outflow of contents from the sinuses

Rinsing the nose with saline solution or antiseptics: independently at home using special devices for a nasal shower, sprays or syringes; in the conditions of an ENT office, the nose and paranasal sinuses are washed using the method of moving drugs (the popular name for the method is “cuckoo”). The solution is poured into one nostril of the patient, the contents are sucked out of the other nostril using suction, while the patient repeats “peek-a-boo” so that the solution does not enter the oropharynx

Causes: local irritating factors (smoking, alcoholism, occupational hazards in the present and past), diseases of the digestive tract, metabolic disorders, pharyngeal paresthesia, associated in most cases with cervical osteochondrosis

In some patients, changes in the pharynx are supported by hidden infections, allergic reactions, foci of infection in the teeth, gums, tonsils

Chronic pharyngitis is often considered not as an independent pathology, but as a symptom of diseases of the gastrointestinal tract, osteochondrosis of the vertebrae in the neck and pathologies of the endocrine system, in particular the thyroid gland. This condition is called pharyngopathy

Treatment of any form of pharyngitis involves the complete elimination of the factors that caused the disease. If chronic pharyngitis is a consequence of other diseases, then their proper treatment is necessary. Quitting smoking and drinking alcoholic beverages is necessary in order to quickly get rid of the symptoms accompanying chronic pharyngitis

Treatment with antibiotics is almost always necessary for exacerbations of the chronic form of the disease. Systemic antibacterial therapy is required in cases where the symptoms of the disease are severe. In other cases, therapy with local drugs is prescribed (Bioparox, IRS-19, Imudon)

In addition to antibacterial therapy, patients are recommended to gargle with antiseptic and anti-inflammatory solutions, herbal decoctions (chamomile, sage). Tablets, lozenges and lozenges, sprays, which contain anti-inflammatory, antiseptic, analgesic substances and essential oils, are also used to treat exacerbations of chronic pharyngitis

The effectiveness of treatment increases with the use of physiotherapeutic methods of treatment (UHF, inhalation with essential oils or soda, ultrasound). To improve the body's resistance to infections, it is necessary to prescribe vitamin therapy and drugs that strengthen the immune system

In addition to drug treatment, patients should follow a diet necessary in order to spare a sore throat. Do not eat hot or cold food, spicy, salty or sour foods. Plenty of warm drinks are recommended (not hot!), it is useful to drink warm milk with the addition of honey and butter

In old age, the number of precancerous diseases and cancerous tumors, primarily of the larynx, increases. Therefore, when monitoring individuals of this age group, constant oncological vigilance is required. In addition, old people do not attach importance to the emerging signs of the disease and do not seek help.

Otitis medium purulent chronic. It is characterized by persistent perforation of the eardrum, constant or periodically stopping and renewing suppuration and hearing impairment. Most often it develops due to prolonged acute otitis media. Reasons: decreased body resistance, chronic specific and nonspecific infections, diabetes mellitus, rickets, vitamin deficiency, blood diseases, pathology of the upper respiratory tract (adenoids, hypertrophic rhinitis, severe curvature of the nasal septum, chronic sinusitis, etc.).

Post-influenza otitis Otitis is inflammation of the ear. There are external, middle and internal otitis. Otitis media is the most common. And one of the common causes is the flu. In most cases, otitis media affects children. Their disease is particularly severe, painful, with high fever, accompanied by significant hearing loss. A neglected or improperly treated process can cause complications in the meninges and brain.

MESOTYMPANITIS Characterized by the presence of a permanent central perforation of the eardrum when it does not reach the bone ring. The course of mesotympanitis is usually calm; discharge from the ear sometimes continues for years without causing any serious complications. Suppuration often stops on its own, resuming again during an exacerbation, the causes of which may be a cold, water getting into the ear, respiratory diseases, diseases of the nose, nasopharynx, paranasal sinuses.

Mastoiditis Mastoiditis is an acute purulent inflammation of the tissues of the mastoid process of the temporal bone. In the thickness of the mastoid process there are air cells that communicate with the cavity of the middle ear. Inflammation of the mastoid cells is often a complication of acute purulent inflammation of the middle ear (acute otitis media). As an independent disease, mastoiditis can occur as a result of injury or sepsis. With mastoiditis, purulent melting of the mucous membrane of the cells and bone tissue of the mastoid process occurs, their destruction and the formation of large cavities filled with pus. Mastoiditis is caused by the same microorganisms as the previous otitis media - staphylococci, streptococci, viruses and fungi. The development of the disease is influenced by various unfavorable factors affecting the body and weakening the overall reactivity of the body.

Mastoiditis Symptoms and course: the disease usually develops at the end of acute otitis - in the 3rd week of the disease. The temperature rises to degrees again, headache, insomnia, and loss of appetite appear. There is pain in the ear of a pulsating nature, its intensity increases every day. When pressing on the mastoid process (behind the ear), sharp pain is noted, the skin over it is hyperemic and swollen. The main symptom is profuse suppuration from the ear. During otoscopy (examination of the ear) - the eardrum is hyperemic, looks thickened - fleshy, the external auditory canal is narrowed due to the lowering of its postero-superior wall, there is a large amount of pus in the auditory canal. Sometimes pus can break through under the periosteum of the mastoid process, peeling it off along with the skin. In this case, a subperiosteal abscess is formed, the auricle moves anteriorly and downward, and the skin behind the ear becomes shiny and bright red.

Tonsillitis Sore throat (acute tonsillitis) is an acute infectious disease, which is characterized by inflammation of the lymphoid formations of the peripharyngeal ring (Pirogov-Valdeira), most often the palatine tonsils (in common parlance, “tonsils” are located on the sides of the entrance to the pharynx and are clearly visible if you look into the open mouth) . tonsil and pharynx

CHRONIC TONSILLITIS Chronic tonsillitis is characterized by periodic exacerbations (after hypothermia, emotional stress and other factors). Chronic tonsillitis is a source of infection in the body. This focus undermines the body's strength and can contribute to the spread of infection to other organs (the heart and kidneys are most often affected, since streptococcus has an affinity for the tissues of the kidneys and heart).

Sore throat with agranulocytosis. Agranulocytosis is a blood disease in which the content of granulocytes (white blood cells that perform a protective function by capturing and destroying foreign cells) is sharply reduced or completely absent. Agranulocytosis can occur under the influence of radiation, drugs that suppress cell division, as well as the rapid death of granulocytes during treatment with certain drugs (butadione, amidopyrine, phenacetin, analgin). The first manifestations of agranulocytosis are fever, sore throat, stomatitis (inflammation of the oral mucosa). The body temperature rises to several degrees, severe chills are noted, and the general condition is serious. Patients are bothered by severe pain in the throat and drooling, and there is an unpleasant putrid odor from the mouth. Sore throat in this disease is ulcerative-necrotic, the process can spread to the mucous membrane of the gums, soft palate, posterior wall of the pharynx, and the entrance to the larynx. Due to swelling of the mucous membrane, the voice takes on a nasal tone.

Retropharyngeal abscess Characterized by complaints of choking and sharp pain when swallowing, with food often getting into the nose. The patient refuses food. When the abscess is located in the nasopharynx, nasal breathing is disrupted and a closed nasal sound appears. When the abscess spreads to the lower parts of the pharynx, inspiratory shortness of breath occurs, accompanied by wheezing, especially when the patient is in an upright position. Body temperature reaches °C. The forced position of the head is characteristic: it is thrown back and tilted to the painful side. Swelling is often observed behind the angle of the lower jaw and along the anterior edge of the sternocleidomastoid muscle.

Laryngeal stenosis is a partial or complete narrowing of the lumen of the larynx, leading to difficulty passing air during breathing. If stenosis occurs within a short time and quickly leads to the development of general hypoxia in the body, then we are talking about acute stenosis. Chronic laryngeal stenosis is characterized by a slow development of symptoms and is persistent. larynx

Syphilitic tonsillitis Syphilitic tonsillitis has recently occurred quite often. The disease is caused by the spirochete pallidum. The primary stage of syphilis in the pharynx can occur during oral sex, with the following clinical manifestations: slight pain when swallowing on the affected side; on the surface of the tonsil there is a red erosion, an ulcer or the tonsil takes on the appearance of acute tonsillitis; The tonsil tissue is dense when palpated; There is a unilateral enlargement of the lymph nodes. Secondary syphilis of the pharynx has the following characteristic signs: diffuse copper-red color of the mucous membrane, involving the arches, soft and hard palate; papular rash of a round or oval shape, grayish-white; enlargement of regional lymph nodes. Tertiary syphilis manifests itself in the form of a limited gummous tumor, which, after decay, forms a deep ulcer with smooth edges and a greasy bottom with further destruction of surrounding tissues if left untreated. The treatment is specific; rinsing with disinfectant solutions is prescribed locally.

LARRYNAL TUMORS Hoarseness or other voice changes. Swelling in the neck area. Sore throat and discomfort when swallowing, soreness. Sensation of a foreign body in the larynx when swallowing. Constant cough. Breathing disorders. Ear pain. Weight loss.

A retropharyngeal abscess (retropharyngeal abscess) is formed as a result of suppuration of the lymph nodes and tissue of the retropharyngeal space. Infectious agents penetrate through the lymphatic tract from the nasal cavity, nasopharynx, auditory tube and middle ear. Sometimes an abscess is a complication of influenza, measles, scarlet fever, and can also develop when the mucous membrane of the posterior pharyngeal wall is injured by a foreign body or solid food. It is observed, as a rule, in early childhood in exhausted and weakened children.

Sore throat with alimentary-toxic aleukia. Alimentary-toxic aleukia occurs when eating products from cereals that have overwintered in the field (wheat, rye, millet, buckwheat) infected with Fusarium fungi. The hematopoietic apparatus is mainly affected (inhibition of hematopoiesis). A secondary infection often occurs. Sore throat is usually observed during the height of the disease. The patient's condition is serious, body temperature reaches degrees, weakness is noted. Bright red rashes appear on the skin of the torso and limbs, and hemorrhages appear on the skin of the face, upper limbs and chest. Along with the rash, a sore throat appears. Sore throat can be catarrhal, but more often a necrotic or gangrenous form occurs. Dirty-brown deposits from the tonsils spread to the palatine arches, uvula, back wall of the pharynx, and can descend into the larynx. A sharp foul odor from the mouth is detected. At the same time, bleeding occurs from the nose, throat, ears, and intestines. Lymph nodes are not enlarged.

Laryngeal tonsillitis Laryngeal tonsillitis (angina laryngis) is an acute inflammation of the lymphadenoid tissue of the larynx (in the area of ​​the aryepiglottic folds, interarytenoid space, in the Morganian ventricles, in the pyriform sinuses and individual follicles). As an independent disease, it is rare; it can occur as a result of hypothermia, after the flu, when the larynx is injured by a foreign body, etc. Clinical picture. I am concerned about pain when swallowing, pain when turning the neck, dry throat. In some cases, a change in voice, hoarseness, and difficulty breathing can be noted. Laryngeal stenosis occurs relatively rarely. Body temperature with laryngeal sore throat is often higher by up to 37.538.0 °C, the pulse is increased, there are chills and sweating. When palpating the neck in such patients, one can detect enlarged, sharply painful lymph nodes, usually on one side. Laryngoscopy reveals hyperemia and infiltration of the mucous membrane of the larynx on one side or in a limited area. Sometimes individual follicles with pinpoint plaques are visible. With a prolonged course of the disease, abscesses may form on the lingual surface of the epiglottis, aryepiglottic fold or other area.

VASOOMOTOR RHINITIS Vasomotor rhinitis is a functional condition associated with dysregulation of the tone of the vessels located under the mucous membrane of the inferior turbinates. Normally, the inferior turbinates regulate the volume of inhaled air, decreasing or increasing in size (due to blood supply) in response to its temperature and humidity, as well as the tone of the vessels in one of the inferior turbinates more than in the other (the tone changes approximately once an hour) - so-called "nasal cycle" With vasomotor rhinitis, the nasal cycle is either shortened or lengthened, or generally the vascular tone is low on both sides. Characteristic signs of vasomotor rhinitis are alternating congestion of one half of the nose or the appearance of congestion when taking a supine position on the side on which the person lies.

NOSE BOIL A boil is an inflammation of the hair follicle along with the surrounding area of ​​skin. Inflammation occurs due to the penetration of infection - bacteria - into the hair follicle. Microbes begin to develop in it, which leads to the formation of a purulent focus in the skin. The disease usually begins acutely. Initially, the patient feels some discomfort in the nose, which gradually turns into pain. The pain can be moderate or severe - it depends on the location of the boil. In the area of ​​the vestibule of the nose, swelling appears as a result of swelling of the soft tissues, as well as its redness. These are signs of inflammation in the skin. This can last for days. Then, in the center of the boil, softening appears in the form of a paler area with a visible emerging area of ​​pus breakthrough. The boil may burst on its own. This can happen either spontaneously, or when carelessly touching the boil. A boil can form not only in the vestibule of the nose, but also in other areas - on the back or wing of the nose.

Sore throat with infectious mononucleosis. Infectious mononucleosis is an acute viral disease caused by the Epstein-Barr virus (human herpes virus type 4). With this disease, all lymph nodes (most often cervical) become enlarged, and the liver and spleen are also enlarged. The disease begins with malaise, sleep disturbances, loss of appetite, then the body temperature rises sharply to degrees. The submandibular, cervical and occipital lymph nodes are swollen and painful to the touch, then the remaining lymph nodes (axillary, inguinal) are involved in the process. At the same time, an enlargement of the liver and spleen appears. Sore throat in infectious mononucleosis begins with a sharp swelling of the mucous membrane of the pharynx of the palatine and pharyngeal tonsils, this leads to difficulty in nasal breathing, nasal sound, and stuffy ears. Otherwise, the sore throat resembles a banal (catarrhal, lacunar, follicular), diphtheria or ulcerative membranous sore throat. Plaques in the throat last a long time - for several weeks or even months.

Leukemia is a rapidly progressing disease of the hematopoietic system, in which the growth of young (immature) blood cells that have lost the ability to mature occurs. There are acute and chronic leukemias; tonsillitis is more often observed in acute leukemias. The onset of the disease is sudden, body temperature rises sharply, severe weakness and dizziness are noted. Acute leukemia is characterized by multiple hemorrhages and bleeding. Even minor trauma to the mucous membrane of the respiratory tract or gums can lead to prolonged bleeding, which can cause death. Acute leukemia is also characterized by enlargement of the lymph nodes, liver and spleen. Sore throat occurs on the 3-4th day of the disease, at first the sore throat is catarrhal, later it turns into ulcerative-necrotic and gangrenous. The ulcerative-necrotic process spreads to the mucous membrane of the gums, oral cavity, and pharyngeal walls. The plaque formed on the surface of necrotic areas has a dirty gray or brown color; after the plaque is rejected, bleeding ulcers open.

NOSEBLEEDINGS The patient's head should be higher than his torso. Tilt the patient's head slightly forward so that blood does not enter the nasopharynx and mouth. You can't blow your nose! Place cold on the bridge of your nose. If you are bleeding from the front of your nose, close your nostrils for a few minutes. If this does not stop the nosebleed, insert cotton swabs into the nasal passages and press them with your fingers against the nasal septum for a minute. The tampon is prepared from cotton wool in the form of a cocoon 2.5-3 cm long and 1-1.5 cm thick (0.5 cm for children). It is better to moisten tampons with hydrogen peroxide. General information: Nosebleeds occur both with injuries to the nose and with various diseases (hypertension, atherosclerosis, hemophilia, anemia, kidney and liver diseases, heart defects, infectious diseases). Most often, the anterior third of the cartilaginous septum of the nose bleeds. This bleeding usually stops easily. More dangerous is bleeding from the middle and posterior sections of the nasal cavity, which contain fairly large vessels.