OTORHINOLARYNGOLOGY

From Big Medical Encyclopedia

OTORHINOLARYNGOLOGY (grech, us, ot[os] an ear + rhis, rhin[os] a nose + larynx, laryng[os] a throat + logos the doctrine) — the section of clinical medicine studying physiology and pathology of an ear, nose and throat (a throat, a throat, a trachea) and areas, adjacent to them.

History

O.'s Allocation in independent discipline began with the middle of 19 century. The basis for association of diseases of an ear, a nose and a throat in one discipline was the anatomo-topographical unity of these bodies, their physiological and functional interrelation.

The main data on diseases of an ear, throat and nose were available already for doctors of an extreme antiquity. They quite successfully applied various methods of treatment separate from them still did not lose the value (e.g., acupuncture).

The first general ideas of a structure, function and diseases of an ear and upper respiratory tracts are available in Hippocrates, A. Tseljs, K. Galen's works. The big place is allocated to questions O. in the work «Canon of Medical Science» uche - the-legged Encyclopaedist of the Middle Ages Ibn-Sina. In 14 century rather detailed data relating to an otiatria are given by Guy de Chauliac. Doctors throughout many centuries used works of these scientists.

In 16 century A. Vezaly described a structure of acoustical stones; B. Evstakhy for the first time in details described a structure of the channel connecting a drum cavity to a nasopharynx to-ry bears his name, and also a structure of both muscles of a middle ear; G. Fallopy gave the detailed description of the channel of a facial nerve, ear labyrinth, a drum cavity. The fr. anatomist J. G. Duverney quite in detail reported about a macrostructure of an acoustic organ. At the beginning of 18 century A. Valsalva in «The treatise about an ear of the person» (1704) specified many anatomic features of an ear. The method of a samoprodu-vaniye of a middle ear was offered them. The ital. surgeon D. Cotugno established that the labyrinth contains liquid, but not air as it was considered earlier. In detail wedge, picture of diseases of a throat (katara, abscesses, etc.) described to G. Burkhava. The mechanism of swallowing,-voiced and speech production is studied by J. Morganyi in detail.

In the second half of 18 century the fr. surgeon P. Desault for the first time managed to carry out a laryngotomy. Opening of a galvanic current belongs to the same period that promoted development of conservative therapy of LOR-diseases.

The second half of 18 century is characterized by significant progress of scientific applied medicine in Russia. During this period for the first time in the Russian medical literature N. M. Am-bodikom-Maksimovich collected and published medical terminology, including terminology of LOR-diseases («The medicochirurgical dictionary», 1780; «The Anatomi-co-fiziologichesky dictionary», 1783).

It is necessary to carry appropriate section in «The management to teaching surgery» to the first domestic guides to diseases of an ear, a nose and a throat (1807 — 1808) F. Bush, in Krom O.'s bases at the level of knowledge of that time are quite in detail stated.

Development of the doctrine about a vestibular mechanism belongs to the first half of 19 century. So, Ya. Purkinye in 1820 proved communication of a nystagmus and dizziness, and M. Flurans in 1842 established dependence of disturbance of balance on a condition of semicircular channels of a labyrinth. It showed that the snail treats the hearing aid, and semicircular channels — to vestibular. Received by it and other scientists of the data J. R. Ewald developed, to-ry, using experimental data, generalized the patterns of function of semicircular channels of an inner ear known as «J. R. Ewald's laws».

In the middle of 19 century the capital guides to an otiatria of two large were published it is mute. scientists: W. Kramer «Recognition and treatment of ear diseases» and G. Lincke «Guide to the theory and practice of ear diseases». Introduction to practice of endoscopic methods of a research of ENT organs was essentially new achievement. It caused creation of new diagnostic, medical and surgical techniques, gave the chance to develop a wedge, the characteristic of acute and chronic diseases of an ear and upper respiratory tracts. Development of new endoscopic methods served one of the bases for formation of otorhinolaryngology as independent discipline.

In 1841 it is mute. the doctor F. Hofmann suggested to examine deep sites of an ear, nose and throat by means of a mirror, in the center to-rogo in the form of a small circle amalgam is cleaned off. Later the Würzburg doctor of A. F. Troltsch created a frontal mirror. In 1854 the London singing teacher Garcia (M. of Garcia) offered a method indirect laringoskopiya (see). This method was soon used for the diagnostic purposes by L. Tiirck in Vienna, and in Russia — K. A. Raukhfu-som. Using an indirect laringoskopiya, K. A. Raukhfus for the first time described a wedge, a picture acute under-skladkovogo laryngitis. Based on laringoskopichesky data, it first-ever made a section of a thyroid cartilage — a thyrotomy (1861) for the purpose of an oncotomy of a throat. It described clinic of stenoses of a throat. Further V. N. Nikitin created «The management to studying of a laringoskopiya and diseases of a throat» (1884). After introduction to practice of a method of an indirect laringoskopiya techniques of a back, and then front and average rinoskopiya were developed. Development of rhinology in Russia was promoted by P. P. Zabo-lotskogo-Desyatovsky's works on diseases of a nose and its adnexal bosoms. The great value for development of rhinology was played Frenkel's book which appeared in Germany (V. of Frankel) by «Diseases of a nose» (1876) and V. N. Nikitin's guide published in Russia of «A disease of a nasal cavity» (1882). In 1880 Tsim (To. Ziem), etc. developed a new diagnostic method — a trial puncture Highmore's (maxillary, T.) bosoms. Rino laryngology as endonasal (removal of polyps a loop, a turbinotomy, a galvanocautery of the lower nasal sinks, an etmoidektomiya and so forth), and ekst-ranazalny (began to develop widely surgical at paranasal sinusitis). The technique of radical operation for antritis was developed by Caldwell (G. Caldwell, 1893) and Luke (N. Luc, 1897), further is modified by A. Denker (1905) and A. F. Ivanov (1906).

Broad development was gained also by ekstraauralny surgery. Thanks to works it is mute. the doctor to H. Schwartze and his pupils the equipment of a simple mastoidotomy was developed. Later Kyuster (Kiister) and E. Zaufal developed the equipment radical, or obshchepolostny, ear operations. Also other operational methods of treatment at LOR-diseases began to develop. It was promoted considerably by introduction to medical practice of local anesthesia cocaine (V. K. of An of turnips, 1884), and then novocaine. The considerable role in it was played by progress of others medical and biol, sciences: anatomy, physiology, microbiology, etc. Anatomo-topographical researches of N. I. Pirogov and introduction of a radio and chloroformic anesthesia (1846 — 1847), and also J. Lister's doctrine about an antiseptic agent (1867) were of great importance for development of LOR-surgery. Wide perspectives of local anesthesia, especially with introduction to medical practice of adrenaline, promoted also development of a bronkhoskopiya and ezofagoskopiya.

In the second half of 19 century further researches in the field of morphology and physiology of an acoustic organ were conducted. It was promoted in many respects by development of the microscopic equipment. In 1851 the ital. scientist A. Korti for the first time described a microscopic structure of spiral (kortiyev) body. The detailed description of separate cells and formations of this body is made by Dey-ters (O. F. Page of Deiters), V. Hensen, Klaudius (R. M. Claudius). E. Reissner studied the membrane separating the cochlear course from a ladder of a threshold (a reyssner of the island a membrane). On the basis of these data and previous annate, and fiziol, researches in 1856 — 1859 G. Helmholtz created the theory hearing (see).

One of O. founders in Western Europe is avstr. scientist A. Polittser. He studied clinic of diseases of a middle ear (including and not purulent: adhesive otitis, otosclerosis, etc.) also developed their surgical treatment. The method of ear inflation offered by A. Polittser widely is applied around the world. Outstanding Western European scientists of the second half of 19 century were F.Betsold (Munich) dealing with issues of physiology of hearing; his pupil A. Denker (Gallet) modifying a number of the operations bearing his name, the author of the monograph about an otosclerosis, works on a surdomutism; other pupil F. Betsolda F. Siebenmann working in Basel — the author of many works on a patogistologiya of an ear and on a labirintologiya; L. Sta-cke — in Erfurt, the author of special modification of operation on a temporal bone and a method of plastics of outside acoustical pass, bearing his name; G. Killian working in Freyburge, the author of a method of a direct trakheobronkhoskopiya, etc. P. Menyer described in 1861 the disease of a vestibular mechanism bearing it a name (see. Menyera disease ). Numerous and original works of hl. obr. on physiology and pathology of a vestibular mechanism belong to R. Barani. The new methods of a research of an ear labyrinth bearing his name are offered them: colorizing of an ear across Barani, rotation on Barani's chair, the decree telny test across Barani, etc.

Otorhinolaryngology in Russia

In the second half of 19 century in high gear developed O. and in Russia. During this period in the country the first appeared otiatrichesky to lay down. institutions in St. Petersburg, Moscow, Kiev, Kharkiv and other cities. In a number of the Russian high fur boots privat-associate professor's courses on the Lake began to open. The big role in O.'s development was played by founders of the largest therapeutic schools S. P. Botkin and G. A. Zakharyin.

In the clinics they charged to assistants to master and implement endoscopic methods of a research of ENT organs in practice. One of S. P. Botkin's pupils D. I. Kosh-lakov became the Russia's first professor of laryngology (1861), other his pupil — A. F. The Prussian was the first professor of an otiatria (1890). Works of these scientists and works of their pupils brought many an ear, new in development of diseases, and a throat. For O.'s development activity of the Ukrainian physicians of H had essential value. M. Volkovich, N. P. Trofimov, etc. Value of activity of the pupil S. P. Botkin of N. P. Simanovsky — the founder and the head of the Russia's first clinic of diseases of an ear, a throat and a nose opened in 1892 in St. Petersburg in Army medical college is big. The school created by it, a cut B were representatives. I. Voyachek, M. F. Tsytovich, N. V. Belogolovov, H. M. Aspisov, etc., played a huge role in development domestic the Lake.

Creation (on private means) in Moscow of special clinic by diseases of an ear, nose and throat (1896) was an important event in the Russian O. The famous otorhinolaryngologist S. F was her first director. The matte investigating physiology and pathology of a vestibular mechanism. A number of methods of a research of vestibular function is offered them and new devices are designed (the centrifuge, the goniometer, etc.). N. P. Simanovsky's clinics and C. F. Shteyna there were the centers of development Russian Lakes. Domestic O.'s development was promoted in many respects by the organization in St. Petersburg (1885) Clinical in-that improvements of doctors and JIOP department at St. Petersburg women's medical in-those (1904). In Moscow the main center of development of O. would be Old and Ekaterina's where in 1880 the separate case for LOR-department was constructed. E. M. Stepanov directed this department', he actively developed and the ENT SPECIALIST - for - boyaevany implemented in a wedge, practice surgical methods of treatment. In the same time in Moscow un-those worked the large specialists giving an optional course O.,E. N. Malyutin famous for the works in the field of a phoniatrics and S. S. Preobrazhensky studying questions of deafness and relative deafness.

However only after Great October socialist revolution optimal conditions for scientific and practical development of medicine, including otorhinolaryngology were created. In 1922 O. was entered into the program of teaching medical in-t as an obligatory subject. It was a basis for the organization for all country of LOR-departments and at them large clinics, in to-rykh the most trained and qualified specialists were involved. The number of LOR-clinics sharply grew. Thanks to it the country was enriched not only with educational bases, but also the powerful health and scientific centers located in all federal republics and in the majority of the large regional cities. LOR-hospitals also in many industrial centers, regional and interdistrict-tsakh began to be created.

Since 1917 the department of otorhinolaryngology of VMA was headed by V. N. Voyachek who created school of the Soviet otorhinolaryngologists. Most of his pupils became heads of new departments. In Leningrad such outstanding scientists as B. V. Verkhovsky, L. E. Komendantov, L. T. Levin, V. F. Undrits, K. L. Hilov, R. A. Zasosov, etc. worked. In Moscow A. F. Ivanov, L. I. Sverzhevsky, A. G. Likhachev, Ya. S. Temkin, B. S. Preobrazhensky, I. I. Shcherbatov, V. K. Trutnev, I. I. Potapov, I. Ya. Senduljsky, etc. were heads of clinics and departments. Names of such scientific-otorino laryngologists as A. G. Fetisov, S. A are well-known. Proskuryakov, S. M. Kompaneets, S. G. Surukchi, A. I. Kolomiychenko, S. M. Burak, H. N. Lozanov, N. D. Hodyakov, A. O. Shulga, D. I. Tarasov, B. T. Palchun and others, directing large clinics in various cities of our country.

In the independent direction O. pathology of ENT organs was created by the prof. Throughout all history of the Soviet O. questions of the prof. of pathology of an ear, nose and throat borrowed and occupy one of important places both in scientific developments, and in practical activities of otorhinolaryngologists. Thanks to considerable improvement of working conditions severe forms of the prof. of pathology of an ear, nose and throat disappeared. The big contribution to development of this problem was made by A. V. Zakher, Ya. S. Temkin, B. S. Preobrazhensky, I. B. Soldatov, S. N. He-chinashvili, V. E. Ostapkovich, B. A. Shchaparenko, etc.

Founders of domestic phoniatrics (see) by right E are considered. N. Malyutin, F. F. Zase-datelev, L. D. Rabotnov, I. I. of le types, M. I. Fomichev, S. N. Rzhev-kin, etc. Thanks to works of these scientists the Soviet foniatrichesky school in 20 — gained the 30th the international recognition. During the post-war period the new stage in development of the Soviet phoniatrics begins, to-ry it is characterized by deep studying of questions of physiology and pathology of the voice device with use of the last achievements of the equipment. Scientific research in the field of a phoniatrics is conducted in Moscow and Leningrad, Novosibirsk, Donetsk, Kazan, Saratov, Tbilisi, etc. Foniatrami is carried out considerable work on rendering advisory, diagnostic and to lay down. the help to patients with disturbances of a voice.

Difficult technique of endolaryngologic interventions, especially at tuberculosis of a throat, and also need of the constant accounting of a condition of internals at tubercular damage of ENT organs was led to the fact that from O. the new branch — ftizio-laryngology was allocated. Soviet scientists L. E. Basenko, A. N. Voznesensky, F. I. Dobromylsky, A. P. Raspopov, etc., working in this area, made a number of valuable suggestions on diagnosis and treatment of tuberculosis of ENT organs.

A lot of work is carried out by N. P. The book, S. V. Mikhaylovsky, Ya. A. Shvartsberg, L. A. Zaritsky, etc. on studying scleromas (see), observed by hl. obr. in USSR and BSSR.

The Soviet otorhinolaryngologists achieved certain success in development of a problem «Quinsy and an adenoid disease». New data on an etiology, epidemiology, an immunopathology are obtained quinsies (see) and hron, tonsillitis (see). In development of this world problem the significant contribution was made by such domestic scientists as B. S. Preobrazhensky, B. K. Trutnev, I. B. Soldatov, G. N. Popova, N. D. Hodyakov, A. O. Shulga, etc.

Significant progress will be made the Soviet otorhinolaryngologists in a solution of the problem of an allergy in the Lake. Much attention to this question is paid by the Moscow, Leningrad and Kiev scientific research institute of an ear, nose and throat, and also a number of departments of higher education institutions.

In the USSR and the developed foreign countries the increasing value for diagnosis of LOR-diseases is gained by a X-ray analysis, a tomography.

In the USSR great success in development of slukhouluchshayushchy operations is also abroad achieved at otosclerosis (see) and hron, purulent average otitis and their effects. For improvement and widespread introduction in to lay down. practice of operation on recovery of hearing at patients with an otosclerosis to group of the Soviet scientists-otokhirurgov (N. A. Preobrazhensky, A. I. Kolomiychenko, V. F. Nikitina, K. L. Hilov, S. N. Hechinashvili) in 1964 the Lenin award is awarded. Due to the development of questions of indications to such operations and, the main thing, forecasting of improvement of hearing interest and in problems of physiology of hearing, funkts, to value of anatomic elements of an acoustic organ increased. The condition of a vestibular analyzer at an otosclerosis before operation is studied in detail.

Thanks to achievements of the Soviet and foreign science to the independent area it was allocated surdology (see), edges closely adjoins with audiology (see).

According to world statistics, to 4 — 6% of the population of the globe suffer relative deafness (see). In the USSR large researches on use of acoustic exercises for hard of hearing and deaf for the purpose of improvement of hearing are conducted. All conditions for education and training of hard of hearing and deaf children are created, compulsory education of deaf-mutes is entered, orphanages, day nursery, kindergartens are organized, special schools for children with defects of hearing are created.

V. P. Gamov, V. T. Palchun, Yu. E. Veltishchev conducted researches on studying of electrolytic composition of liquids of an inner ear normal and at pathology. The results of a research which showed importance of change of ionic composition of this liquid served as theoretical justification for development of treatment of a disease of Menyer hydrosodium carbonate.

Close functional and ana-tomo-topographical connection of an ear, nose and its adnexal bosoms with a head cavity caused deeper studying of related issues. There was a new discipline — otoneurology. Progress a wedge, otoneurology, and also bystry development of air and space medicine promotes the successful solution of many tasks in studying of physiology and pathology of a vestibular analyzer.

Rapid growth of aircraft till a space age channelized recent to a vestibulologiya — the doctrine about a vestibular mechanism, V. I. Voyachek, K. L. Hilov, G. G. Kulikovsky, L. A. Orbeli, L. E. Komendantov, A. P. Popov, I. I. Brya-nov played a role in development to-rogo. Norms of selection in modern aircraft are developed and value of a training of a vestibular mechanism is defined. With penetration of the person into space the special field of medical science — space medicine forms (see. Meditsina space ), edges it is designed to provide safe and effective participation of the person in development of space. The important place in space medicine is taken by a vestibulologiya, acoustics and LOR-ensuring the piloted space flights (prevention, diagnosis and treatment of LOR-diseases in flight and after its end). The analysis of results of space flights on a condition of a vestibular mechanism in the conditions of zero gravity is carried out, much attention at the same time is paid also to a condition of upper respiratory tracts. Space O. develops in close connection with clinical O. and physiology.

Care of children is one of the main objectives of the Soviet state. In the first years of the Soviet power a number of organizational actions for health protection of children and teenagers was carried out. Opening pediatric f-tov in medical higher education institutions, special pediatric in-t, wide network of children's BCs with LOR-departments was of great importance. A number of specialists, including I. I. Shcherbatov, M. G. Lichkus, D. M. Rutenburg, I. L. Kruchinina, etc., devoted the activity to O. of children's age.

Considerable success was achieved in our country by LOR-oncology. The big contribution to its development was made by V. I. Voyachek, A. F. Ivanov, L. I. Sverzhevsky, A. I. Feldman, M. Ya. Harshak, I. E. Davydov, S. A. Proskuryakov, V. F. Undrits, D. M. Rutenburg, K. L. Hilov, B. S. Preobrazhensky, F. S. Bokstein, N. A. Karpov, I. Ya. Sendulsky, A. I. Kolomiychenko, S. I. Mostova, N. N. Usoltcev, I. I. Potapov, M. I. Svetlanov, A. I. Pages, V. S. Pogosov, A. M. Talyshinsky, etc. In All-Union oncological scientific center for the first time in the USSR department of tumors of the head and neck is organized. Departments of the head and a neck, and also LAURE oncologists-cheskiye of department are created in many cities of our country. Continuous improvement of tactics of maintaining patients in before - and postoperative the periods (use of proteinaceous liquids, enzymes, a rational antibioticotherapia, an oxygenotherapy, hemotransfusion and blood substitutes, tubeless food, etc.), and also use of an intubation anesthesia at LAURE-oncological operations allowed to minimize risk of operational complications and as much as possible to expand surgical opportunities of LOR-oncology.

Great success is achieved in the field of recovery and reconstructive LOR-surgery in relation to oncological patients. The technique of development of a voice in patients after a resection and full removal of a throat is developed. The combined method of treatment of patients with malignant tumors of ENT organs continues to be developed. Methods of cryotherapy, treatment of LOR-diseases of ultrasound and by means of the laser are implemented.

At the heart of development of scientific research in the field of domestic O., as well as all medical science, strict planning and control lies. In 1976 the resolution of presidium of the USSR Academy of Medical Sciences created scientific councils and the independent problem commissions of allied value at presidium of the USSR Academy of Medical Sciences, including. Scientific council on otorhinolaryngology. It allows to direct activity of research in-t, laboratories and LOR-departments of medical in-t of our country and to exercise control of implementation of scientific achievements in practice of health care. The number of the main directions of scientific research on such questions as physiology and pathology of an acoustic organ increased; quinsy and adenoid disease; LOR-oncology; diseases of upper respiratory tracts; frustration of a voice and speech; improvement of the organization of the LOR-help. The main directions of scientific research are determined by O. first of all by problems of practical health care.

O.'s teaching in higher educational institutions is carried out according to the uniform program approved in 1980. Head department of M3 educational institutions of the USSR. Teaching is carried out taking into account a profile of training of specialists (pediatrics, stomatology, etc.).

Scientific about-va otorhinolaryngologists began to be organized in Europe and America in 60 — the 70th there are 19 century. In 1897 in Russia it was based Moscow scientific about-in otorhinolaryngologists, then St. Petersburg about-in by throat, nasal and ear diseases (1903). In 1910 the LOR-section Kiev about-va doctors opened, and a bit later (1911) the Odessa LOR-society began to function. In 1917 opening Ob-va of otorhinolaryngologists took place at Saratov un-those, and then and in many other cities. In 1933 it was created All-Russian, and in 1940 — All-Union otorhinolaryngological about-va. In federal republics, edges, areas and the nek-ry regional centers there are scientific LOR-societies making harmonious system. They function in close business contact with bodies of health care, and their activity promotes further development of science and practice on places.

Originally in Russia only certain otorhinolaryngologists did reports on Pirogovsky congresses (see). Further in connection with O.'s development at the initiative of the St. Petersburg LOR-society the question of need of convocation of special All-Russian congresses of otorhinolaryngologists was raised: The I Congress of otorhinolaryngologists took place in St. Petersburg in 1908, II — in Moscow in 1910, III — in Kiev in 1914. In days of the Soviet power congresses of otorhinolaryngologists took place with a large number of participants and an expanded perspective.

The I All-Union congress of otorhinolaryngologists was convened in Leningrad in 1924, II — in Moscow in 1927, III — in Odessa in 1929, IV — in Leningrad in 1935, V — in Leningrad in 1958, VI — in Yerevan in 1968, VII — in Tbilisi in 1975.

Republican congresses of otorhinolaryngologists, republican, regional, regional, interdistrict and regional LOR-conferences and meetings, numerous problem conferences and meetings are periodically convened. Scientific sessions of research L the SHOUTING institutes are systematically convened.

The world association of otorhinolaryngologists will organize periodically international congresses (congresses). The last world congress was called in Buenos - Ah-rese in 1977. In 1979 in Warsaw the I European congress of children's otorhinolaryngologists took place.

The organization of the otorhinolaryngological help to the population in pre-revolutionary Russia was on extremely low level. The number of otorhinolaryngologists made apprx. 400. Beds of an otorhinolaryngological profile there were several tens, and they were concentrated in to lay down. institutions of Petrograd and Moscow.

For years of the Soviet power the wide network of out-patient and polyclinic offices and hospital departments of an otorhinolaryngological profile is created. Each area (edge, the ASSR) the countries has otorhinolaryngological offices and departments in regional (regional, republican, the ASSR), city and central regional-tsakh. Otorhinolaryngological offices and departments are available also in MSCh of the industrial enterprises.

Methodical management of the organization of the otorhinolaryngological help is performed by the chief non-staff specialists respectively A M3 of the USSR, the Ministries of Health of federal republics, areas (edges, the ASSR). Evidence-based recommendations about the methodical management of the organization of the otorhinolaryngological help at its different stages are developed by the Moscow scientific research institute of an ear, throat and nose which is head together with head departments to lay down. - the prof. of the help to the population of M3 of the USSR and M3 of RSFSR.

Except medical and diagnostic activity, otorhinolaryngologists perform annual routine maintenances of the healthy contingents of the population (the children coming to day nursery gardens, schools; the youth going to the universities, and average educational institutions; workers and the serving separate industrial enterprises; machine operators of agriculture, etc.), carry out dispensary service of patients hron, diseases of upper respiratory tracts and an ear. The network of the suras-dologopedichesky offices joint with slukhoprotezny points, and also foniatrichesky offices is considerably expanded.

The rational structure of the organization of the otorhinolaryngological help in the USSR became possible thanks to growth of number of specialists and quantities of hospital beds of this profile. Security of the population with doctors-otorino-laryngologists in comparison with 1940 increased by 5 times. In 1966 on 1000 city dwellers there were more than 570 visits of the otorhinolaryngologist, and in 1979 — more than 650. The most part of these visits is connected with routine maintenances and dispensary service of the population.

Implementation in practice of health care of modern effective methods of prevention, diagnosis and treatment provided a steady tendency to reduction of prevalence of inflammatory diseases of an ear, throat and nose, in an etiology to-rykh nurseries inf matter. diseases, flu and acute respiratory diseases. The main share in structure of diseases of an ear, throat and nose diseases of a throat, first of all occupy an adenoid disease.

Dynamics of quantitative indices of a hospital lethality (on the example of RSFSR) demonstrates increase in efficiency of the stationary otorhinolaryngological help which level in 1950 made 1,0%; this indicator decreased by 8 — 9 times and does not exceed 0,12 — 0,13%.

Long-term plans of development of the medical and diagnostic help to the population of M3 of the USSR provide further improvement of the otorhinolaryngological help, first of all children's, slukhouluchshayushchy, foniatrichesky. The important place in system of the planned actions is allocated to prevention of diseases of an ear, throat and nose.

Military otorhinolaryngology

Military otorhinolaryngology is the general O.'s section and the industry of military medicine (see. Meditsina military ). Military O. in military medicine takes an important place. Hearing, sense of smell, feeling of balance and other functions of ENT organs are of great importance in military professions and connect military O. with other industries of military medicine — physiology of military work, military hygiene, field therapy, field surgery, the organization and tactics of military-medical service, etc.

Military O. studies influences on ENT organs of the exercise and psychological stresses caused by specifics of activity of various types of military forces (action of noise, vibrations, accelerations, pressure differences, etc.), and carries out research of protective agents and ways against the action injuring them; develops the most rational methods and means of increase in stability of ENT organs for the maximum reduction of terms of adaptation; provides medical control of the state of health of staff by carrying out regular medical inspection and dispensary observation; the ENT SPECIALIST-zabo-levayemosti carries out the systematic analysis and trudopoter of staff for the purpose of development and carrying out purposeful to lay down. - professional, actions. In activity of the military ENT specialist

questions of LOR-examination, i.e. definition funkts, features of ENT organs in connection with definition of suitability inspected to service in various types of military forces figure prominently: in aircraft, on the fleet, in amphibious and tank units etc. The order of medical survey is defined by the instruction for medical survey, the schedule of diseases and other documents for definition of the validity to military service.

At survey it is necessary for hl. obr. to be guided by data of special methods of a research (see. Audiometriya , Vestibulometriya , Manometriya ear , Stroboskopiya ).

Carefully made professional LOR-selection promotes the most reasonable distribution of the military personnel on types of military forces and various military specialties.

Fighting injuries of ENT organs one of the first were in detail described by N. I. Pirogov. Its recommendations about rendering medical aid at a fighting injury of ENT organs did not lose the value. During the Russian-Japanese war of 1904 — 1905 the specialized otorhinolaryngological help to wounded and patients in field army was not organized. At the I All-Russian congress of otorhinolaryngologists in St. Petersburg (1908) the decision on need of establishment for military districts the ENT SPECIALIST - a game-sultantov, and also was made on opening of LOR-departments at-tsakh and military hospitals. It was dictated by a large number of LOR-patients: in 1906 from total number of recruits it was exempted from an appeal on LOR-diseases of 14,5%. In 1914 at surgical military hospital in Moscow LOR-department on 50 beds was open, and since 1915 this surgical hospital with regular quantity of beds to 400 became specialized otoriiolaringologichesky hospital.

The department of otorhinolaryngology of VMA headed at that time by N. P. Simanovsky was the largest scientific center.

However military O. as the independent industry of military medicine developed and took the worthy place in system of military-medical service only during the Soviet power. The leading role in its development was played by the school of sciences created by V. I. Voyachek. Philosophy of treatment of injuries of ENT organs were established and measures of fight against asphyxia, the bleedings and a dysphagia arising at wounds are developed. The surgical profile of the LOR-specialist working in the commonwealth with the general surgeon, the ophthalmologist and the neurosurgeon is defined.

In the widest scale the qualified and specialized help to LOR-wounded and patients was organized during the Great Patriotic War. The number of the isolated and combined injuries of ENT organs, according to V. I. Voyachek, reached

6 — 7% of total number of wounded. At the same time wounds of a nose and adnexal bosoms met in 43,8% of cases, fish soup — in 42,4%, wounds simultaneous injury of a throat, throat or trachea — in 13,8% of cases. The isolated wounds occurred at 48,4% of wounded, and combined — at 51,6%. Successful development of topical issues of LOR-traumatology, high surgical activity and qualification of a large number of LOR-specialists provided a high recovery rate (82% of LOR-wounded).

Training of military otorhinolaryngologists began in the first years of development of the Soviet military O. at first in LOR-clinic of VMA, and then was expanded by attraction to this work the ENT SPECIALIST-otde-leniya of the Main hospital of the Soviet Army, district and naval hospitals. The center of research, educational, and also medical and advisory and expert work in the field of military O. is the department of otorhinolaryngology of VMA of S. M. Kirov.


Bibliography:

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Organization of the otorhinolaryngological help — Incidence of urban population and standards of the treatment-and-prophylactic help, under the editorship of I. D. Bogatyrev, M., 1967; Morozov A. B. Incidence of villagers of diseases of an ear, throat and nose and standards of their need for the otorhinolaryngological help, Owls. zdravookhr. No. 5, page 19, 1968; Safonov A. G. Ways of further development ENT SPECIALIST of the help to the population of the USSR, Vestn, otorinolar., L» 2, page 3, 1976.


N. A. Preobrazhensky; N. I. Kostrov, V. P. Fomina-Kosolapov (soldier.)., V. S. Kuznetsov (sots.).

Яндекс.Метрика