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DISPENSARY DYNAMIC OBSERVATION OF PATIENTS WITH OTORINOLARYNOLOGICAL PROFILE AND SANATORIORAL TREATMENT

When organizing a dynamic follow-up clinic, the physician should be strictly guided by the relevant orders and instructions on the aircraft.

The most common diseases of the ear, throat, nose among the military are chronic tonsillitis, acute and chronic rhinitis, sinusitis and otitis media.

Primary prevention of these diseases includes:

- the implementation of measures to prevent hypothermia; providing personnel with warm clothes and shoes, appropriate weather conditions, the nature and duration of classes; maintenance of the established air temperature in the sleeping and service premises, timely ventilation of the premises; drying outfits, footcloths and shoes; prohibition of singing in the ranks at temperatures below minus 5? and in wet weather, especially when people are in a hot state (returning from school, from work, from the bath);

- properly organized physical training and hardening of military personnel;

- compliance with established standards for sound pressure and vibration levels during the organization of various works, as well as the use of personal noise protection equipment (ear plugs, ear plugs, helmets, etc.);

- adherence to preventive measures for cases of barotrauma of the ear and paranasal sinuses in flight personnel, submariners and divers (identification of inflammatory processes of airborne diseases, determination of patency of auditory tubes with access to flights and work) implementation of compression, decompression, and pressure chamber training rules for diving and caisson operations;

- the promotion of hygienic knowledge on the prevention of diseases of ENT organs.

Secondary prophylaxis includes dynamic clinical follow-up for persons with adenoids, chronic diseases of the paranasal sinuses, chronic tonsillitis, chronic laryngitis, chronic otitis media, in order to carry out planned therapeutic and preventive measures.



The technique of dynamic follow-up for major diseases of officers, generals, admirals, warrant officers, warrant officers, extra-military service personnel, students and cadets of military schools, military women.

1. Condition after suffering a sore throat:

a) the frequency of mandatory follow-up examinations by a doctor of a part (clinic): weekly;

b) duration of observation: within a month;

c) the frequency of specialist consultations: therapist, otolaryngologist - 1 time per year;

d) the list and frequency of laboratory, radiological and other special studies (all studies are carried out to the maximum extent possible): upon examination to identify metatonsillar diseases - a clinical blood test, general urinalysis, temperature measurement, ECG; in the detection of subfebrile condition, tachycardia, cardiac arrhythmias and conduction disorders, in the presence of pathological sediment in the urine, changes in the peripheral blood - consultation of a therapist and inpatient treatment;

e) the main therapeutic and preventive measures: the active detection and timely isolation of all patients with angina, as well as the conduct of other anti-epidemic measures that have had tonsillitis in the absence of complications, are released from heavy physical work and outdoor outfits for 7 days, from sports competitions - for 1 month; in the detection of chronic tonsillitis - rehabilitation;

f) clinical criteria for the effectiveness of the clinical examination during the calendar year:

recovery - the absence of complications during the year;

worsening - the development of complications.

2. Chronic tonsillitis, pharyngitis, sinusitis and other focal infections (threatened by rheumatism, diffuse glomerulonephritis and other diseases):

a) the frequency of mandatory follow-up examinations by a doctor of a part (clinic) - 1 time in 6 months;

b) the duration of the observation - within 2 years after the rehabilitation of the foci of infection, at a persistently normal body temperature, normal objective and other indicators;

c) the frequency of specialist consultations: therapist, otolaryngologist, dentist - annually;

d) the list and frequency of laboratory, radiological and other special studies (all studies are performed to the maximum extent possible) - a clinical blood test, general urine test 2 times a year; C-reactive protein, DPA test, ECG - 1 time per year; according to indications - bacteriological examination of a smear from the throat and tonsils, determination of the sensitivity of microflora to antibiotics, ASL and other immunological studies; with exacerbations of the disease - a general analysis of blood and urine, ECG, radiography of the sinuses;

d) the main preventive measures:

1) rehabilitation of foci of chronic infection;

2) general strengthening therapy, planned hardening of the body;

3) during the period of exacerbation of chronic tonsillitis, tonsillitis, sinusitis, repeated acute respiratory infections, influenza, treatment with antibiotics and antirheumatic drugs is prescribed for 7-10 days in order to prevent meta-infectious diseases (rheumatism, nephritis, etc.);

4) seasonal bicillin-drug prophylaxis, if radical rehabilitation is not possible;

5) physiotherapy (UV radiation, ultrasound, etc.);

6) organized recreation, spa treatment;

f) clinical criteria for the effectiveness of the clinical examination during the calendar year:

recovery - absence of complaints within 2 years after the rehabilitation of the foci of infection with persistently normal body temperature, normal objective indicators;

unchanged - if there is a focus of infection, subjective and objective indicators are the same;

worsening - the development of rheumatism, the occurrence of complications from the heart and kidneys.

3. Chronic suppurative otitis media. Condition after radical ear surgery:

a) the frequency of mandatory follow-up examinations by a doctor of a part (clinic) - 1 time in 6 months;

b) the duration of the observation - during the year in the absence of relapse and complications after a radical operation;

c) frequency of specialist consultations - otolaryngologist 1 time per month; optometrist and neurologist - according to indications;

d) the list and frequency of laboratory, radiological and other special studies (all studies are performed to the maximum extent possible): clinical blood test, general urinalysis - 2 times a year; radiography of the temporal bone, examination of the microflora that is separated from the ear and determination of its sensitivity to antibiotics, tonal audiometry - according to indications;

d) the main preventive measures:

1) rinsing the ear with disinfectants, pouring therapeutic solutions into the ear;

2) sanitation of the upper respiratory tract;

3) removal of granulations, polyps;

4) physiotherapy;

5) surgical treatment - according to indications;

f) clinical criteria for the effectiveness of the clinical examination during the calendar year: recovery - complete and persistent absence of the inflammatory process (closure of perforation, scarring, epidermis, cessation of discharge from the middle ear) during the year; improvement - the absence of secretions in the external auditory canal, pain in the ear and parotid region; no change - complaints and objective data are the same; worsening - the presence of persistent purulent discharge in the external auditory canal, earache, headache, dizziness.

4. Progressive, prolonged hearing loss (cochlear neuritis, otosclerosis, adhesive otitis media, condition after stapedoplasty):

a) the frequency of mandatory follow-up examinations by a doctor of a part (clinic) - 1 time in 6 months;

b) the duration of the observation is constant;

c) the frequency of specialist consultations:

otolaryngologist - 1 time in 6 months; optometrist, neurologist - according to indications;

d) the list and frequency of laboratory, radiological and other special studies (all studies are performed to the maximum extent possible): clinical blood test, general urine test - 1 time per year; X-ray of the temporal bone, the study of vestibular function - according to indications;

d) the main preventive measures:

1) the prohibition of smoking, drinking alcohol and taking ototoxic medicines;

2) avoid being in a noisy environment; if it is necessary to work in a noisy environment, use protective equipment (anti-noise antiphons);

3) treatment, including surgical treatment - on the recommendation of specialists;

f) clinical criteria for the effectiveness of the clinical examination during the calendar year: improvement - reduction of ear noise, reduction of dizziness, reduction in the number of days of disability; impairment - hearing loss, increased intensity of noise, dizziness and the number of days of disability.

5.
Condition after tonsillectomy:

a) the frequency of mandatory follow-up examinations by a doctor of a part (clinic) - 1 time in 2 months;

b) the duration of the observation is 6 months after tonsillectomy in the absence of relapse and complications;

c) the frequency of specialist consultations: otolaryngologist - 1 time in 3 months; therapist - once every 6 months;

d) the list and frequency of laboratory, radiological and other special studies (all studies are performed to the maximum extent possible): clinical blood test, general urinalysis, ECG - once every 2 months, biochemical blood tests - according to indications;

d) the main preventive measures:

1) avoid hypothermia;

2) drug therapy - according to indications;

f) clinical criteria for the effectiveness of the clinical examination during the calendar year: recovery - the absence of relapse within 6 months; worsening - the development of relapses and complications.

6. Chronic allergic rhinosinitis:

a) the frequency of mandatory follow-up examinations by a doctor of a part (clinic) - 1 time in 6 months;

b) the duration of the observation is constant;

c) frequency of specialist consultations: otolaryngologist -1 time in 6 months, allergist - according to indications;

d) the list and frequency of laboratory, radiological and other special studies (all studies are performed to the maximum extent possible): clinical blood test, general urine test - 1 time per year; radiography of the sinuses, diagnostic puncture, specific allergic tests - according to indications;

d) the main preventive measures:

1) prevention of hypothermia;

2) exclusion of exposure to a specific allergen;

3) drug therapy - according to indications;

f) clinical criteria for the effectiveness of the clinical examination during the calendar year - improvement of nasal breathing, reduction in the number of exacerbations; without changes - subjective and objective data are the same; worsening - frequent exacerbations, worsening nasal breathing, the appearance of polyps.

7. Hyperkeratosis, pachydermia of ENT organs, nasal polyps, infiltrates in the pharynx and larynx, chronic hyperplastic laryngitis:



a) the frequency of mandatory follow-up examinations by a doctor of a part (clinic) - 1 time in 6 months;

b) the duration of follow-up - within 5 years in the absence of relapse after surgical treatment;

c) frequency of specialist consultations: otolaryngologist - once every 6 months; dentist, surgeon, oncologist - according to indications;

d) the list and frequency of laboratory, radiological and other special studies (all studies are performed to the maximum extent possible): clinical blood test, general urine test - once every 6 months; radiography, tomography, electronic stroboscopy, microlaryngoscopy - according to indications;

d) the main preventive measures:

1) the prohibition of smoking and alcohol;

2) reduction of voice load;

3) drug and surgical treatment - according to indications;

f) clinical criteria for the effectiveness of the clinical examination during the calendar year: improvement - reduction of exacerbations, restoration of sonority; deterioration - frequent exacerbations, difficulty in nasal breathing, hearing loss, signs of malignancy.



Sanatorium treatment of diseases of the ear, throat, nose is one of the links in comprehensive treatment and prophylactic measures, as is the treatment of other somatic diseases - a continuation of the previous treatment in the unit, clinic, hospital.

To ensure the continuity and maximum effectiveness of sanatorium treatment, the patient is issued a medical book with the data of preliminary clinical examination and treatment. It should be noted that there are no specialized sanatorium-resort institutions of the Ministry of Defense of the Russian Federation for the treatment of ENT diseases. The vast majority of otolaryngological diseases can be treated in general therapeutic sanatoriums, mainly of a climatic profile (more appropriate in the summer). These include sanatoriums in various climatic zones: “Volga” - on the banks of the Volga (Samara), “Ocean” - on the banks of the Amur Bay (Vladivostok), Sochi (named after Fabrizius, named after K. Voroshilov), “Paratunka” "(Petropavlovsk-Kamchatsky), Chebarkulsky (Chelyabinsk)," Chemitokvadzhe "(Sochi), etc. Staying on the beach helps to increase the secretion of the mucous membrane of the respiratory tract. The climate of the forests of central Russia is characterized by clean air with a high density of oxygen, aero ions, aromatic substances, and volatile products. A warm, dry steppe climate also has a healing property: intense solar insolation, low humidity, clean air, and the growth of healing flowers and herbs.

In almost every military sanatorium, patients with chronic pharyngitis and laryngitis (subatrophic, atrophic and hypertrophic), chronic tonsillitis (compensated and decompensated), chronic rhinitis (vasomotor, allergic, atrophic), chronic sinusitis, chronic middle otitis media ( , sensorineural hearing loss, otosclerosis (including the condition after hearing-improving surgery). A contraindication to referring to diseases in the MO sanatorium among ENT diseases is all diseases of the ear, throat and nose in the acute stage, complicated by purulent processes, chronic purulent epithympanitis, as well as general contraindications that exclude the referral of patients to the sanatorium.

The main therapeutic measures in the rehabilitation of ENT organs in sanatoriums are:

1. Climatotherapy (aerotherapy, heliotherapy - solar exposure, thalassotherapy - sea bathing). Therapeutic effect: mycocidal, bactericidal, secretory, neuro-regulatory, actoprotective, sedative, bronchodraining, metabolic, reparative-regenerative.

2. Balneotherapy. Mineral baths (chloride, iodide-bromine, carbon dioxide, hydrogen sulfide, radon). Therapeutic effect: analgesic, vasodilator, metabolic, immunostimulating, anti-inflammatory, secretory, coagulocorrective, detoxification. Mineral drinking water (bicarbonate, bicarbonate-sulphate, sulphate, bicarbonate-chloride, sulphate-chloride, chloride, weakly mineralized ferruginous waters). Therapeutic effect: antispastic, acid-regulating, secretory stimulating, anti-inflammatory, metabolic, motor-correcting, bronchodraining. For diseases of the upper respiratory tract - laryngitis, tracheitis, bronchitis, pharyngitis - hydrocarbonate-sulfate water is most effective.

3. Peliodotherapy (mud therapy - sulphide mud, sapropelic, peat, sopropny, hydrothermal). Therapeutic effect: anti-inflammatory, decongestant, reparative-regenerative, metabolic, trophic, immunomodulating, bactericidal, biostimulating, coagulating, keratolytic.

In addition to these therapeutic and recreational activities in the sanatoriums of the Moscow Region, as a rule, widely equipped physiotherapeutic departments (rooms) are deployed. Methods of physiotherapeutic treatment of ENT organs may include: electrotherapy (galvanic current, drug electrophoresis, constant, pulsed, low and high frequency currents, alternating and constant magnetic field, phonotherapy), light therapy (infrared and ultraviolet radiation), ultrasound therapy, therapeutic massage, hydroionotherapy, aerosol therapy, heat therapy, barotherapy, etc.
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DISPENSARY DYNAMIC OBSERVATION OF PATIENTS WITH OTORINOLARYNOLOGICAL PROFILE AND SANATORIORAL TREATMENT

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  15. Динамическое наблюдение
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  16. Приложение № 6 Журнал динамического наблюдения за лицами с признаками нервно-психической неустойчивости
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  17. Журнал динамического наблюдения за лицами с признаками нервно-психической неустойчивости
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  18. ОСОБЕННОСТИ ИНТЕНСИВНОЙ ТЕРАПИИ У БОЛЬНЫХ ТЕРАПЕВТИЧЕСКОГО ПРОФИЛЯ
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  19. НАБЛЮДЕНИЕ ЗА БОЛЬНЫМИ С ДМК
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