Injury of the external branch of the superior laryngeal nerve is one of the complications in thyroid surgery, the frequency of which varies within very wide limits due to the difficulties in diagnosis. The complaints relate to a change in voice tone, which significantly impairs the quality of life of patients, especially those with voice profession. The most accurate specific method for diagnosis is electroneuromyography but this technique is very difficult to perform and not used in routine practice. To diagnose the lesion of the external branch of superior laryngeal nerve the authors used laryngoscopy, laryngostroboscopy and spectral analysis of the voice, which revealed the frequency of nerve injury and dynamic monitoring of voice recovery in the patient. Objective — to examine the frequency of lesions of the external branch of superior laryngeal nerve in thyroid surgery on the basis of changes in the laryngoscopic picture, spectral analysis of the voice and dynamic monitoring of their recovery during treatment Materials and methods. The study was conducted in the surgical department of the Ukrainian Scientific and Practical Center for Endocrine Surgery, Transplantation of Endocrine Organs and Tissues MOH of Ukraine with involvement of 241 operated patients. Examination of the larynx and voice examination were performed before surgery, on the 2 — 3 days and 6 and 12 months after surgery. Diagnosis was performed using methods: videolaryngoscopy, videolaryngostroboscopy, spectral analysis of the voice. Results. Clinical signs of trauma to the external branch of the superior laryngeal nerve were found in 8 (3.3 %) patients out of 241 operated. Patients received a course of phonopedia and stimulation therapy in the absence of contraindications. Voice recovery over time was recorded in 7 (87.5 %) patients, no voice recovery in 1 (0.4 %). Conclusions. Injury of the external branch of superior laryngeal nerve after surgery on the thyroid gland is a complication after thyroid surgery which does not happen often (3.3 %). This complication is very difficult to detect, considering inconspicuous symptoms, the lack of specificity of the laryngoscopic picture and the peculiarities of diagnostic methods. It is not always possible to fully restore the voice when the external branch of the superior laryngeal nerve is damaged (permanent injury accounts for 0.4 % of the total number of operations on the thyroid gland and 85.0 % of the total number of patients with damage to the external branch of the superior laryngeal nerve), which requires dynamic monitoring of patients and timely treatment administration.

The relevance of the study is due to the need for an extended search for information on the current state of the problem of acute otitis media in adults based on the experience of Ukrainian and foreign authors. The aim of our research: To analyze the world experience on the etiology, pathogenesis and diagnosis of acute otitis media in adults. Materials and methods: 125 modern literature sources of electronic databases PubMed, EMBASE, MED-LINE, U.S. National Library of Medicine Clinical Trials, Research Gate and Cochrane Library. Introduction: The problem of otitis media as a component of the problem of inflammatory diseases of the upper respiratory tract remains relevant in modern medicine, based on its incidence and prevalence in the structure of otolaryngological diseases. Despite the achievements of modern medical science, these indicators remain consistently substantial, which determines the relevance of further research to improve diagnosis and treatment. Results: By conducting a bibliographic method of research it was found that most scientific articles are devoted to the problem of acute otitis media in children, while the problem of acute otitis media in adults is not sufficiently studied. Clinical and experimental studies have established that the function of immune protection of the middle ear is present at almost all physiological levels from epithelial cells to intracellular nuclear factor. This function is realized through the messengers of the cytokine network. Among the pool of cytokines, IL-1, IL-6 and TNF-α are important for the pathogenesis of acute otitis media. One of the features of the immune defense is a clear succession of stages of inflammation with its own features at each stage. It is shown that each of the links of immune defense (including cytokines) is able to detect (in case of discrepancy in strength and time) a negative effect with the maintenance or intensification of inflammation. The data of experimental analysis of pathomorphological changes in the middle ear depending on the duration of the disease are presented. It is also shown that the issue of complicated course (in particular mastoiditis) is still relevant. The role of acute otitis media in the deveopment of intracranial complications (meningitis) has been established. The significance of comorbidity for the pathogenesis of acute otitis media and the role of diabetes mellitus in the structure of comorbidity was proved. The main factors of reducing the effectiveness of diagnosis and treatment of acute otitis media are convincingly outlined: the multifactorial nature of the etiology, the peculiarities of immune protection and the tendency of otopathogens to evade the host's immune response, the importance of comorbid pathology in adult pat ients with ENT diseases. A certain number of literature sources are devoted to the features of the course of acute otitis media in diabetes mellitus. The shortcoming identified by the results of the analysis of literature sources: the lack of research on the peculiarities of the clinic and diagnosis of acute otitis media in adults, especially in the setting of comorbid pathology, primarily type 2 diabetes mellitus, indicates the relevance of further research on this problem.

ABSTRACT. Worldwide, there are about 466 million people (6.1%) with hearing loss and approximately 34 million of them (7%) are children, two-thirds of whom live in developing countries. In the course of research, it has been proven that in 60% of cases, sensorineural deafness is combined with vestibular disorders, which can be both obvious (rarely in children) and hidden. Timely detection of vestibular disorders in young children, especially hidden ones, prevents delay in the child’s motor development and significantly reduces the risk of vestibular dizziness development in older age. The aim of the article was to study modern instrumental methods of balance function research in children based on scientific analysis of contemporary literary data. Materials and methods: A comprehensive search of relevant literature sources was conducted in December 2021 using electronic databases RubMed, EMBASE, MEDLINE, U.S. National Library of Medicine Clinical Trials, Research Gate and Cocharane Library. The results: Despite highly developed technological diagnostic capabilities of present-day medicine, the study of etiology, prevention and correction of various balance and hearing disorders in children of different ages is one of the most acute issues to be solved by modern medical community. Up-to-date improvements in the diagnostic methods of the auditory and vestibular analyzer expand the possibilities of interpreting their results and allow a deeper understanding of the degree of the stato-acoustic analyzer damage. To investigate the vestibular function, vestibulometry and otoneurological examinations are usually carried out, which are the same tests that are used in adults. However, such examinations require more patience from the child and they should be conducted in a playful manner. Detection of hidden vestibular dysfunctions ought to be comprehensive, in particular, using instrumental methods, one of which is static computer stabilometry, that creates an opportunity to determine translational and motor disorders. The conclusion. Long-term problems with balance in children can lead to a delay of motor functions development, which can further slow down the child's achievement of age-appropriate psychomotor stages and have a negative impact on school performance, and in general, on social, speech and intellectual development. Therefore, detection of vestibular dysfunction at an early age is of great medical and social importance. Acute otitis media is currently a curable disease in most cases, if undesirable consequences are prevented during the period of examination and treatment. Vestibular function can be adequately assessed using reliable instrumental tests. In this sense, static stabilometry is a very useful method for the objective determination of vestibular deficits in children, regardless of the presence or absence of any subjective complaints.

Objective — to analyse restoration of vocal function and features of the laryngoscopy picture in patients with paresis and paralysis of the larynx after thyroid surgery. Materials and methods. A prospective single-center investigation involved results of examinations of 132 patients with laryngeal motility disorders after thyroid surgery aged 18 to 70 years (the mean age 41.5 ± 1.4) years, from them 27 men (20.5 %) and 105 women (79.5 %). The diagnosis of laryngeal motility and voice quality disorders was performed by an otolaryngologist using indirect laryngoscopy, videolaryngoscopy and spectral analysis of the voice to determine the following indicators: maximum phonation time (MPT), fundamental frequency (FF), harmonic/noise ratio (HNR), Jitter, Shimmer and questionnaire of subjective self-assessment of voice quality (Voice Handicap Index, VHI — 30), a modified version by B.Jacobcon. Results. Restoration of vocal cords (VC) motility (laryngeal paresis) was observed in 123 (93.2 %) patients within 6 months after thyroid surgery, in 9 (6.8 %) patient’s laryngeal motility was not restored (laryngeal paralysis) with in a year after surgery. When assessing the voice in patients with laryngeal paresis after 6 months and laryngeal paralysis after 12 months, indices of voice acoustic analysis significantly improved in both groups compared to the early postoperative period, especially in patients with laryngeal paresis, but significantly differed in comparison to preoperative parameters. Conclusions. Method of voice spectral analysis has a significant diagnostic value; it allows to objectify the degree of voice disorders after thyroid surgery and their subsequent monitoring during treatment and rehabilitation. When restoring laryngeal motility, parameters of voice do not always restore completely, which indicates presence of relevant complaints and requires further examinations and administration of appropriate treatment.

State of the problem: One of the complications in thyroid surgery is a lesion of RLN which can be bilateral with a violation of respiratory function of the larynx and unilateral, in which the first priority is a violation of vocal function of the larynx. The most effective treatment for paralysis of the larynx is the method of laryngeal reinnervation, which can be non-selective, which is usually used in unilateral laryngeal paralysis and promotes reinnervation of both abductors and laryngeal adductors. Selective reinnervation is selectively focuses on the reinnervation of individual target muscles, so it is more often used in bilateral laryngeal paralysis. But despite this, it was used in unilateral laryngeal paralysis during surgery on the thyroid gland during intentional resection of the anterior branch of RLN with partial invasion of its tumour process. Aim: evaluation of the results of surgical treatment unilateral laryngeal paralysis by the method selective reinnervation in thyroidectomy. Materials and Methods: clinical case results of patient A. 15 years old with papillary thyroid cancer and metastases to regional lymph nodes of the neck (T4aN1M0) with absence disorders of laryngeal motility before surgery were analyzed. Examination of the larynx and voice examination were performed before surgery, 2-3 days and 6,12 months after surgery. Changes of laryngoscopic images and evaluation of the Indicators: maximum pho- nation time, fundamental frequency, noise to harmonic ratio, Jitter (loc), Shimmer (loc), Voice Handicap Index-30 (VHI-30), completed version of Jacobcon B. Results: Considering extralaryngeal bifurcation of the recurrent laryngeal nerve (RLN) and invasion of the tumor into the adductive branch of RLN on the left, its dissection was performed and end-to-end neuroanastomosis was formed, completed is selective laryngeal reinnervation. In the immediate postoperative period, patients complained of voice disorders. Study of voice parameters corresponded to severe voice disorders. Partial resumption of the mobility of the larynx and voice function was after 6 months. The signs of the laryngoscopic picture and the spectral analysis of the voice corresponded to the indicators before the operation after 12 months Сonclusions 1. Primary selective reinnervation of the larynx can be used to treat unilateral laryngeal paralysis under the following conditions: extralaryngeal branching of the recurrent laryngeal nerve (bifurcation), lesion of only one of its branches, which will provide sufficient coaxiality to perform anastomosis "end-to-end" and preservation electrical integrity of another branch. 2. This method allows you to restore the motility of the denervated vocal folds and the main indicators of the voice. 3. Given only one clinical case of treatment of unilateral laryngeal paralysis by selective reinnervation, this technique needs further study and refinement.