22
Проблемы смежных специальностей
Общие вопросы оториноларингологии
UDC: 616.21- 053.9-07 (575.1)
STATE OF ENT ORGANS OF ELDERLY AND SENILE PEOPLE AS AN EXAMPLE
OF JIZZAKH REGION OF UZBEKISTAN
A.B. Rasulov, E.M. Hasanov, Z.R. Khayruddinova
Tashkent Institute of Postgraduate Medical Education
From the first days of independence
under the leadership of Presidentgreat
attention pays to the preservation and
improvement of health, upbringing of
physically and spiritually developedrising
generation. In the book of President Islam
Karimov "Uzbekistan on the threshold of
independence" gives a detailed analysis of
policies carried out in the country to ensure
a bright future for people, the further
development of our society [10].
As
a
result
of
the
consistent
implementation of measures aimed at
reforming of the domestic medicine today in
the country formed an effective network of
rural medical posts to provide primary
health care to the population, created district
and city health associations, regional and
national multidisciplinary and specialized
medical centers and emergency medical
assistance at all levels. In recent years the
large-scale work carries out in Republic
aimed at the comprehensive strengthening
and development of the health care system,
an increase in life expectancy, improving the
standard of well-being of citizens [10].
At the solemn meeting devoted to the
22
nd
anniversary of the Constitution, the
President of Uzbekistan Islam Karimov
announced that2015
th
year inUzbekistan will
be the "Year of attention and care for the
older
generation"
("Keksalarniezozlashyili"). The President
emphasized that in Uzbekistan there are
more than 2 million 873 thousands of people
over 60 years, 225,000 of people over the
age of 80 years, 44 thousands – of 90 years,
and 8700 - have stepped 100-year milestone.
It should be noted that among these there are
3109 participants of the Second World War
and 69,994 veterans of the labour front [11].
Old age is the most necessary and
most important stage of the implementation
of the individual, wrote I.I. Mechnikov in
"Studies of human nature" (1908.). Rich, old
age
held
without
serious
illnesses,
psychological and social problems helps to
understand the most important thing for
which there was no enough time in the
bustle and noise of everyday life. Full
retirement deprives a person of the fear of
death [1]. With the increasing number of
older and senile peoplethe whole sphere of
social and economic relations complicates,
the overall health of the population
deteriorates, that’s why a care about the least
socially protected part of the society is an
important task of any state [4].
One or more chronic diseases, against
whichthe level of physical and social
activity reduces in elderly and senile age
occurs in 80-86% of those 60 and older, and
in 97-98% of those 70 and older. Diseases
are sluggish with long-term recovery [5].
The need for medical care of older people is
by 50%more than the level for the middle-
aged
population,
and
the
need
for
hospitalization of the population aged 60
years and over is 3 times higher than for the
rest of the population [7]. Deterioration of
health of the elderly leads to restriction or
loss of physical capacity, reduced mobility
and the ability to self-service, increases the
need for assistance and medical care [6]. At
the time of independence in Uzbekistan
median age increased from 67 years in 1990
to 73.5 years, and women – to 75,8 years
[11]. In the context of a progressive aging of
population the maintenance of health and
23
prolongation of active period of human life
should be provided a complex of measures
among which the most important place is
occupied by the organization of health and
social care for the elderly [2]. The
identification of problems and needs of
population
is
necessaryfor
the
implementation of targeted health care to
certain groups of the latter.
Objective
In response to the President's decree
"On measures to further strengthen the
social support of veterans of war and labour
front of 1941-1945", dated October 13, 2014
inJizzakh region, along with other areas of
the Republic, a survey of middle and old age
was conducted.
Material and methods
A total of 364 persons were examined.
The age of the patients was from 71 to 106
years (mean age 87,6±1,7 years), of whom
178 were men, women – 186. Age of men
ranged from 71-104 years, the average age
was 81,2±19 years, women – from 72 to 106
years, the average age – 89,0±1,5 years. The
grouping patients were examined by age.
Age groups of the examined patients were
established on the basis of the classification
of age groups of WHO: 60-75 years old –
older age, 75-90 years – senile, and more
than 90-long-livers [3]. So elderly patients
were 109 people, while their average age
was 73,8±0,6 years, senile patients were
188, mean age 83,8±1,9 years, a group of
long-living persons was combined in 53
people aged from 90 to 100 years and 14
aged more than 100 years, mean age of this
group was 94,2±2,1 years.
The most frequent complaints of ENT
organs were hearing loss and speech
intelligibility, tinnitus, dry and sore throat.
The study was conducted using an active
questioning of patients' complaints, focused
on data from medical history and visual
instrumental inspection of ENT-organs. The
most
common
ENT
pathology
was
presbiacusis – senile deafness with various
degrees of hearing loss. Subatrophic and
atrophic pharyngitis, atrophic rhinitis, septal
deviation in different variants often met. In
11 patients defects of the nasal septum were
revealed, which appeared as a result of a
long course of atrophic rhinitis. Also was
found 19 (5,2%) conditionally healthy
people, those patients considered non-ENT
pathology and a good social ear, which does
not require the application of any effort to
communicate. Thus, there were 345 (94,8%)
of patients with any pathology of upper
respiratory tract, that was slightly below the
data of E.M. Likhachova [5].
Presentation of the occurrence of
diseases in groups of patients is shown in
table.
Table
The incidence of diseases of ENT-organs in groups, abs. (%)
Nosology
Elderly
patients,
n=109
Senile
Patients,
n=188
Long-livers
Patients,
n=67
Total, n=364
Presbiacusis
43 (39,4)
159 (84,6)
66 (98,5)
268 (73,6)
Subatrophic
pharyngitis
46 (42,2)
51 (27,1)
26 (38,8)
123 (33,8)
Atrophic pharyngitis
38 (34,9)
67 (35,6)
37 (55,2)
142 (39,0)
Atrophic rhinitis
23 (21,1)
35 (18,6)
21 (31,3)
79 (21,7)
Deviated nasal
septum
86 (78,9)
92 (48,9)
33 (49,3)
211 (58,0)
Cerumen impaction
29 (26,6)
56 (29,8)
43 (64,2)
128 (35,2)
Chronic otitis
5 (4,6)
3 (1,6)
1 (1,5)
9 (2,5)
Conditionally healthy
11 (10,1)
7 (3,7)
1 (1,5)
19 (5,2)
The study ofnasologies in selected
areas of Jizzakh region had no statistically
significant difference in the incidence of
pathologies in any nasologies, except for the
24
greater incidence of atrophic rhinitis
withdefect of nasal septum in Bakhmal area.
However, due to the narrow focus of the
survey of the defined population and
insufficient research it is not possible to talk
about predisposing factors of this disease in
this area. The incidence of diseases in both
sexes in all groups is comparable and has no
statistically significant difference. The
proportion of senile deafness as well as
atrophic diseases of the upper respiratory
tract, increased with age reaching a peak in
the group of centenarians – 98,5%.
The obtained data on the whole are
consistent with the literature, so A.B.
Bizunkov says that one in three people over
the age of 65 years suffer from hearing
impairment, which complicates life and
social communication.
With age the
percentage of hearing impairment increases
but does not reach 100%. The most often
socially inadequate hearing at the age-
related deafness observes in men [1].
The age degenerative and atrophic
changes of the mucous membranes of the
upper respiratory tract (thinning of the
mucous membranes and decrease the
amount of glandulas in them) described by
I.B. Soldatov are the second most common
pathology of ENT-organs and arise all
elderly and senile people [9]. This is
confirmed by our findings. Independence
and further development of our country,
undoubtedly, creates prerequisites for the
prosperity of domestic medicine, the reform
of the healthcare industry in Uzbekistan
yields positive results [8].
In summary it should be noted that
demographic changes lead to increased
attention to the health and social care of the
elderly, the introduction of its new, effective
forms
taking
into
account
regional
perspective, the needs of the elderly
population in various kinds of medical
assistance and social care.
References
1. Bizunkov A.B. Age hearing loss: to
fight against old age or live with it? // J.
Clin. Immunol. Allergol. Infectol. – 2011. –
№9-10. – Р. 49.
2. Egorov V. District territorial
Geriatric Center as a modern form of
medical and social assistance to the
population of elderly and senile // Author's
abstract, dis... Master of Sciences. – M.,
1996. – 24 p.
3. Health of elderly: report of a WHO
Expert Committee. – Geneva: WHO, 2002.
– P. 57-67.
4.
Lazebnyk
L.B.,
Konev
Y.
Demographic aspects of aging in Moscow,
Russia and the CIS (plenary report) // Clin.
Gerontol. – 2008. – Vol. 12, №5. – P. 4-6.
5. Likhachev E.M., Efremushkin G.G.,
Bosova E.A. The structure of morbidity
level and the need for treatment in elderly //
Clin. Gerontol. – 2002. – Vol. 8, №5. – P.
110.
6. Maksimova T.M. The modern state,
trends and projections of public health. –
M.: PERSE, 2002. – 198 p.
7. Maksimova T.M., Gaenko O.N.
Medical support of the population in terms
of social differentiation in society // Probl.
Soc. Hyg., Health and Med. History. – 2001.
– №3. – P. 10-14.
8. Sanaev F. Public health – themain
priority // Health of Uzbekistan. – 2013. –
№33.
9.
Soldatov
I.B.
Guidance
of
Otorhinolaryngology. – M.: Medicine, 1997.
– 608 p.
10. http://ite-uzbekistan.uz /vis/beauty
/rus/press/news.php=9269
11. http://fikr.uz/posts/22697.html.
Summary
In the year of "Attention and care of
the older generation" the study of ENT-
organs was carried out in elderly and senile
patients in Jizzakh region of Uzbekistan.
ENT diseases were revealed in 94.8% of
people in this age group. Senile deafness and
atrophic processes of the upper respiratory
tract prevailed.
Резюме
В год «Внимания и заботы о
старшем поколении» было проведено
исследование
ЛОР-органов
у
лиц
пожилого и старческого возраста в
Джизакской
области
Узбекистана.
Заболевания ЛОР-органов выявлены у
25
94,8%
обследованных.
Среди
заболеваний преобладали старческая
тугоухость и атрофические процессы
верхних дыхательных путей.
УДК: 616.211:616.831-06-07-08
ОСОБЕННОСТИ КЛИНИЧЕСКОГО ТЕЧЕНИЯ, ДИФФЕРЕНЦИАЛЬНАЯ
ДИАГНОСТИКА И ЛЕЧЕНИЕ ОДОНТОГЕННЫХ И РИНОГЕННЫХ
ВНУТРИЧЕРЕПНЫХ ОСЛОЖНЕНИЙ
Т.Н. Буркутбаева, Б.Н. Садыков, М.С. Жумахметов,
С.Н. Умбеткулова, Т.М. Шамшудинов
Казахский медицинский университет непрерывного образования,
ГКП на ПХВ Городская клиническая больница №5
По
данным
отечественных
и
зарубежных
источников,
частота
развития внутричерепных осложнений
колеблется от 0,01 до 8%, не превышая в
среднем 1,6% от общего числа синуситов
[2].
У 24,4% взрослых пациентов
риносинусогенные
осложнения
возникают
в
результате
острого
поражения околоносовых пазух, у 75% –
при обострении хронического процесса.
При
внутричерепных
осложнениях
лобная пазуха поражается в 30%,
верхнечелюстная – в 22%, решетчатая – в
20%, клиновидная – в 6%, но чаще
осложнения
возникают
на
фоне
пансинусита.
Среди
больных,
находящихся
на
лечении
в
оториноларингологических стационарах,
от 15 до 36% составляют лица,
страдающие
синуситами
[3].
Исследования показывают, что удельный
вес госпитализированных по поводу
заболеваний
околоносовых
пазух
увеличиваются ежегодно на 1,5-2% [4].
Несмотря
на
большой
спектр
консервативных и хирургических форм и
методов лечения синуситов, они нередко
могут
вызывать
внутричерепные
осложнения, количество которых не
имеет тенденции к снижению.
Цель исследования
Анализ результатов лечения у
больных
с
одонтогенными
и
риногенными
внутричерепными
осложнениями и разработка современной
тактики ведения больных в условиях
специализированного
лечебного
учреждения.
Материал и методы
За период с 2012 по 2015 гг. в ГКБ
№5
на
обследовании
и
лечении
находились 4804 пациента с гнойными
синуситами. Одонтогенные и риногенные
внутричерепные
осложнения
наблюдались у 9 больных. Лиц мужского
пола было 3, женского 6. Летальных
исходов не наблюдалось. 7 больных были
в возрасте от 35 до 50 лет, 2 – в возрасте
от 18 до 35.
Всем пациентам было произведено
клиническое
обследование,
их
консультировали окулист, невропатолог,
нейрохирург, терапевт, инфекционист, по
показаниям
другие
специалисты.
Применяли эндоскопические методы
исследования,
рентгенографию
околоносовых
пазух,
производили
панорамные
снимки,
компьютерную
томографию околоносовых пазух (КТ),
магнитно-резонансную
томографию
головного мозга (МРТ), трехмерную
компьютерную
томографию
зубочелюстной
системы,
иммуноферментный
анализ
(ИФА),
люмбальную пункцию с лабораторным
исследованием ликвора.
Результаты и обсуждение
Пример №1: Больная М., 48 лет,
поступила с жалобами на сильные
головные боли в затылочной области.
Обратилась к терапевту поликлиники и
получала
лечение
по
поводу
артериальной гипертензии в течение
недели. Через неделю, когда появилась
боль в области шеи, обратилась в ГКБ
№5.
На
КТ
ППН
обнаружено
изолированное
поражение
основной
