Vol 31, No 3 (2025)

In light of changes in weapon technologies and destructive capacity, as well as new delivery systems — including unmanned aerial vehicles, drones, precision-guided munitions with unified guidance modules, and missiles — mine-explosion trauma involving ENT organs has once again become highly relevant and requires analysis and comparison with previous military conflicts. The aim of this study was to review Russian and international literature on mine-explosion trauma and ENT organ injuries in the context of modern military conflicts and to compare the obtained findings with those reported by other investigators. The proportion of hearing organ injuries in modern warfare within the distribution of combined and complex mine-explosion injuries remains comparable to that reported in previous armed conflicts. Preservation of hearing function and prevention of complications of blast-related ear injury directly depend on the timeliness of evacuation of wounded patients with ENT injuries to rear specialized hospitals. Approximately 22% of wounded individuals with combined injuries of the ear and other anatomical regions will require tympanoplasty for traumatic tympanic membrane perforations and hearing-restoring procedures in specialized otologic centers after demobilization. Tinnitus resulting from blast overpressure and detonation exposure contributes to the aggravation of affective trauma and negatively influences the course of combat-related post-traumatic stress disorder. Analysis of the distribution of ENT injuries, particularly those affecting the auditory system, enables more accurate forecasting of the required scope of specialized otorhinolaryngological care during evacuation stages and after demobilization.

BACKGROUND: Vocal fold scarring remains a substantial and challenging problem in otorhinolaryngology. Current treatment modalities are unable to restore the native morphology and, consequently, the vibratory properties of damaged vocal folds. In this regard, regenerative medicine technologies represent a promising direction for further development.

AIM: To evaluate the efficacy of a collagen-containing extracellular matrix biomimetic in the restoration of scar lesions of the vocal folds in an experimental animal model.

METHODS: The experimental study was performed on 12 Soviet Chinchilla laboratory rabbit models of vocal fold scarring. Three months after injury, animals with damaged left vocal folds were divided into two groups (n = 6 each). In the experimental group, surgical scar excision was followed by injection of the bioimplant into the defect area; in the control group, only surgical excision of the scar was performed. The right vocal folds of all rabbits were used as an intact group (n = 12). Animals were monitored over time with endoscopic control. Three months after surgery, animals were euthanized, and vocal fold specimens were subjected to histological examination.

RESULTS: In the experimental group receiving the bioimplant injection, the resulting scar was subtle and almost indistinguishable from native vocal folds. The thickness of the formed scar was twofold lower than in the control group (p < 0.0001). Morphological assessment demonstrated that the structure of the vocal folds in the experimental group was comparable to intact specimens. Enhanced epithelialization of the mucosa and cartilage regeneration, less pronounced inflammatory changes and tissue fibrosis, and physiologic vascularization of the defect area were observed in the animals of the experimental group.

CONCLUSION: Implantation of a collagen-containing extracellular matrix biomimetic into the area of vocal fold injury promotes improved healing of the defect and formation of tissue morphologically closer to healthy vocal folds.

BACKGROUND: Opportunities for early detection of hearing loss in adults remain limited due to the absence of screening programs, low accessibility of audiological care, and insufficient public awareness regarding hearing health. Pure-tone audiometry, the basic method for assessing hearing acuity, requires expensive equipment and specially trained personnel. Smartphone-based audiometry, offered by several manufacturers as a simple and cost-effective screening tool, allows assessment of pure-tone hearing thresholds only and does not reflect the ability to understand speech in noise. However, contemporary clinical practice increasingly requires evaluation of functional capacity to maintain verbal communication in acoustically unfavorable environments, including competing speech, broadband noise, and reverberation.

AIM: To assess the technical performance of a pilot prototype of the tonal-speech screening audiometer SURDOSCOPE® for rapid diagnosis of hearing impairment in adults.

METHODS: An automated tonal-speech screening audiometer SURDOSCOPE® based on a tablet platform was proposed for use. The device enables self-assessment of pure-tone thresholds and speech intelligibility in noise (words and phrases presented against pink noise at a fixed signal-to-noise ratio), using speech synthesis and recognition technologies. Between 2023 and 2025, 124 examinations were performed using different algorithms in 31 participants aged 24–80 years (random sample). The audiometer was used in an automated tonal-speech screening mode in a self-assessment format without medical staff involvement. Conventional pure-tone audiometry performed using a clinical audiometer Maico MA42 served as the reference method.

RESULTS: A high level of agreement was established between hearing thresholds obtained with the screening audiometer and those measured with the clinical audiometer (mean difference not exceeding ± 5 dB HL). The SURDOSCOPE® audiometer also demonstrated high efficiency in rapid self-assessment of speech intelligibility in noise. The total duration of tonal-speech screening testing averaged 10.5 ± 5.7 minutes, whereas conventional pure-tone audiometry alone required 16.3 ± 2.1 minutes. Criteria were established to determine the need for further audiological evaluation.

CONCLUSION: Automated tablet-based tonal-speech screening audiometry provides accurate and reproducible self-assessment of pure-tone hearing thresholds and speech intelligibility in noise, remarkably reducing examination time and enabling appropriate referral of patients for further evaluation by an audiologist-otolaryngologist.

BACKGROUND: Surgical treatment of obstructive sleep apnea may be promising in selected patients; however, clear criteria for determining surgical indications have not been standardized, nor have objective methods for assessing treatment effectiveness. Polysomnography reflects sleep parameters influenced by multiple factors beyond upper airway anatomy during sleep. Attempts have been made to develop appropriate assessment methods, but the issue remains unresolved.

AIM: To evaluate the potential of computed tomography of the facial skeleton with the Müller maneuver in the diagnosis and assessment of surgical treatment outcomes in patients with obstructive sleep apnea.

METHODS: A total of 27 patients with obstructive sleep apnea were examined according to the following plan: ENT examination, anthropometric assessment, questionnaire survey, transnasal fibrolaryngoscopy with the Müller maneuver, and cone-beam computed tomography with the Müller maneuver, performed before and after laser-assisted uvulopalatoplasty. Inclusion criteria: patients older than 18 years diagnosed with obstructive sleep apnea of varying severity in the absence of indications for continuous positive airway pressure (CPAP) therapy, refusal of CPAP therapy, contraindications to CPAP, or poor CPAP tolerance; anteroposterior type of pharyngeal airway narrowing at the level of the soft palate on transnasal fibrolaryngoscopy with the Müller maneuver. Exclusion criteria: age under 18 years; pregnancy and breastfeeding; acute or chronic diseases in the exacerbation stage; lateral type of pharyngeal airway narrowing at the level of the soft palate on transnasal fibrolaryngoscopy with the Müller maneuver.

RESULTS: Cone-beam computed tomography analysis demonstrated that all patients exhibited a postoperative increase in pharyngeal airway volume, averaging 22%. Spearman correlation analysis between fibrolaryngoscopy with the Müller maneuver and cone-beam computed tomography data revealed a weak positive correlation (r = 0.147) between pharyngeal airway volume and the direction of airway narrowing, and a moderate positive correlation (r = 0.278) between pharyngeal airway volume and the degree of airway narrowing. These differences were not significant, possibly due to the limited sample size.

CONCLUSION: Cone-beam computed tomography of the facial skeleton with the Müller maneuver, including pharyngeal morphometry and mathematical data analysis, enables not only exclusion of condition of the paranasal sinuses and dentoalveolar system but also assessment of surgical treatment effectiveness in patients with obstructive sleep apnea. The findings indicate the need for further investigation.