Long-term results of endoscopic operations in chronic sinusitis

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Long-term results of endoscopic operations in chronic sinusitis

Abstract

About 2 million Greeks suffer from at least one infection of the paranasal sinuses (acute sinusitis) every year. Many people suffer several episodes of the disease during the year, resorting to the use of antibiotics. Treatment of each case of infection lasts up to 3-4 weeks, and so several times a year. Along with allergies, infections of the paranasal sinuses affect people's social life, interfering with their work and learning. Especially often infections of the paranasal sinuses occur with a decrease in immunity, especially in the spring, when allergic symptoms join, further weakening the body. Today, new and more effective medical and surgical methods for the treatment of exacerbations of chronic sinusitis have appeared.

Keywords: chronic rhinosinusitis, endoscopic surgery, long-term results.

Аннотация

ОТДАЛЕННЫЕ РЕЗУЛЬТАТЫ ЭНДОСКОПИЧЕСКИХ ОПЕРАЦИЙ ПРИ ХРОНИЧЕСКИХ СИНУСИТАХ

Абдумуталипов У.Ш.¹, Косимов К.К.²

Около 2 миллионов греков каждый год страдают, по крайней мере, от одной инфекции придаточных пазух носа (острый синусит). Многие в течение года переносят несколько эпизодов заболевания, прибегая к применению антибиотиков. Лечение каждого случая инфекции длится до 3-4 недель, и так несколько раз за год. Наряду с аллергией, инфекции придаточных пазух носа влияют на социальную жизнь людей, мешая их работе и обучению. Особенно часто инфекции придаточных пазух носа случаются при снижении иммунитета, особенно весной, когда присоединяются аллергические симптомы, дополнительно ослабляющие организм. Сегодня появились новые и более эффективные медико-хирургические методы лечения обострений хронического синусита.

Ключевые слова: хронический риносинусит, эндоскопическая операция, отдаленные результаты.

Introduction

Relevance. The term "minimally invasive" refers to surgery with minor trauma for the purpose of a quick recovery after the procedure. The surgeon uses an endoscope to reach the problem area through the nostrils. With the help of special surgical instruments, bottlenecks are expanded, inflamed mucous membranes or formations such as nasal polyps are removed [3].

Thus, adequate ventilation and effective drainage of sinus secretions must be restored so that the mucosa can heal [3, 4]. At the same time, a deviated nasal septum can also be corrected endoscopically.

Inflammatory diseases of the paranasal sinuses still occupy one of the leading positions in the structure of the pathology of the ENT organs, which is due to the high incidence and frequent recurrence of sinusitis with the transition of inflammation to a chronic form. This cannot but affect the increase in the number of patients requiring surgical treatment [2].

Among the numerous reasons for the development and recurrence of chronic inflammation in the paranasal sinuses, a violation of the architectonics of the nasal cavity is the most significant, since it leads to an imbalance in the ventilation and drainage functions of the paranasal sinuses [1].

In the absence of positive dynamics against the background of conservative therapy, surgical intervention is usually resorted to. The Caldwell-Luke procedure, proposed in 1887, has long been considered the gold standard for the surgical treatment of chronic maxillary sinusitis. However, in recent years, rhinosurgeons have given preference to functional endoscopic rhinosurgery [5], including minimally invasive methods of surgical treatment, which include balloon sinusoplasty.

The fundamental difference between balloon sinusoplasty is the complete preservation of the architectonics of the nasal cavity, namely the structures of the ostiomeatal complex, which does not disturb the aerodynamics of the nasal cavity in the postoperative period and contributes to the restoration of the function of mucociliary transport [6].

Purpose of the study.To conduct a comprehensive assessment of the effectiveness of endoscopic operations on the paranasal sinuses in chronic rhinosinusitis in the late postoperative period.

Materials and research methods.We examined 76 patients suffering from chronic rhinosinusitis in order to fulfill our task and to comprehensively assess the effectiveness of endoscopic operations in the long-term period after surgery.

Research results

Modern objective research methods: endoscopy of the nasal cavity, computed tomography of the paranasal sinuses, assessment of the functions of the nasal cavity using anterior active rhinomanometry, polymer stained films, supplemented by the method of assessing the quality of life of patients in total, make it possible to reliably assess the long-term results of treatment.

The main criteria for the effectiveness of surgical treatment of patients with chronic purulent maxillary sinusitis were the endoscopic picture of the nasal cavity, the evaluation of computed tomography (CT) data of the paranasal sinuses, and the determination of the transport function of the ciliated epithelium.

Comprehensive assessment criteria:

“unsatisfactory”: recurrence of the disease, the presence of undesirable results of surgical treatment (edema, hematoma of the soft tissues of the face and / or impaired sensitivity), the absence of positive dynamics according to the results of CT, an increase in the rehabilitation period after surgery;

"satisfactory": the presence of undesirable results of surgical intervention, improvement in CT parameters, an increase in the period of rehabilitation after surgical intervention;

"good": no undesirable results of surgical treatment, relapse of the disease, significant positive dynamics according to CT data, reduction in the length of the patient's stay in the hospital (reduction of rehabilitation).

Criteria for endoscopic evaluation:

"unsatisfactory": synechia in the nasal cavity, fistula stenosis and / or cicatricial deformity of the maxillary sinus;

"satisfactory": the presence of reactive postoperative changes, the preservation of the "open" natural fistula of the maxillary sinus, the approximation of transport function indicators to normal values, or the first degree of mucociliary clearance impairment;

"good": no reactive postoperative changes, functioning fistula of the maxillary sinus, normalization of mucociliary transport parameters.

A good result was recorded in 92.5% of patients in the main group, in 60% of patients in the first comparison group and in 73.3% of patients in the second comparison group. A satisfactory result was shown by 7.5% of patients in the main group, 26.7 and 16.7% of patients in the first and second comparison groups, respectively. An unsatisfactory result was obtained in both comparison groups - 13.3% in the first and 10% in the second (Table 1).

In endoscopic evaluation (Table 2), a good result was observed in 87.5% of patients of the main group, 60% of patients in the first comparison group and 70% of the second comparison group. A satisfactory result was obtained in 7.5% of patients of the main group, 23.3% and 20% of patients in the first and second comparison groups, respectively. An unsatisfactory result was recorded in 5% of patients of the main group, 16.7 and 10% of patients in the first and second comparison groups, respectively. sinusitis infection surgical

Good and satisfactory results prevailed in the main group of patients. The percentage of unsatisfactory results in the main group was also less (5%) than in the first and second comparison groups (16.7 and 10%, respectively).

A detailed analysis showed that unsatisfactory results in the main group were associated with significant stenosis of the natural fistula of the maxillary sinus in one patient and narrowing of the natural fistula to 0.3 cm with signs of a sluggish inflammatory process, but in the absence of obvious clinical symptoms and complaints - in another.

Patients of the first and second comparison groups were also diagnosed with unsatisfactory results in the late postoperative period in five (16.7%) and three (10%) cases, respectively. Such results are due to cicatricial changes in the region of the middle nasal passage (between the medial wall of the nose and the middle nasal concha, between the middle nasal concha and the nasal septum) and the large size of the natural anastomosis (up to 1 cm).

The indicators of the transport function in the main group in the late postoperative period were significantly lower than in the comparison groups, which indicated the restoration of the ciliated epithelium, and, consequently, a higher functional result after balloon sinusoplasty.

Based on the examination complex used, it was shown that endoscopic functional rhinosinus surgery allows obtaining good and satisfactory long-term results in 89.8% of patients with polypous rhinosinusitis and in 97.7% of cases in patients with chronic purulent rhinosinusitis.

Unsatisfactory results in the treatment of patients with chronic rhinosinusitis (6.8% of patients) are due to a number of factors, in particular: the presence of concomitant general diseases (bronchial asthma); underestimation of existing changes in intranasal structures (curvature of the nasal septum, hypertrophy of the turbinates); insufficient treatment in the postoperative period with dynamic monitoring of the patient.

In patients with chronic rhinosinusitis, the main representatives of the microflora were staphylococci (60.9%). The presence of pathogenic microflora requires appropriate antibiotic therapy in the postoperative period.

The integral indicator of the quality of life in patients after endoscopic surgery (125.7) is higher than before surgery (116.4), but does not reach the level of healthy individuals (140.4).

Conclusion

The work carried out made it possible to scientifically substantiate the expediency of using rhinomanometric, endoscopic, functional research methods, as well as the method of computed tomography in the examination of patients with chronic rhinosinusitis in the late postoperative period.

The developed examination complex allowed to improve the tactics of managing patients in the late postoperative period, which helps to prevent the recurrence of the disease and improve the quality of life of the patient.

References

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2. Kozlov B.C., Shilenkova V.V., Azatyan A.S., Kramnoy A.I. Mucociliary transport and motor activity of the ciliary apparatus of the nasal mucosa in patients with chronic polypous rhinosinusitis. Bulletin of Otorhinolaryngology, 2008. № 1. Р. 10-13.

3. Piskunov G.Z. Postoperative period in patients with polyposis polysinusitis after endoscopic surgery on the paranasal sinuses // Ros. rhinology. № 2(5), 2003. Р. 141-145.

4. Eljamel M., Foy P. Non-traumatic CSF fistulae: clinical history and management// British Journal of Neurosurgery, 1991. № 5. Р. 275-279.

5. Hopcins et al. Complications of surgery for nasal polyposis and cronic rhinosinusitis: the results of a national audit in England and Wales // Laryngoscope, 2006. Aug. 116 (8): 1494-9.

6. Stierna P. Physiology, mucociliaryclearans and neural control., Diseases of sinuses: diagnosis and management / Hamilton, Ontario: B.C. Decker, 2001. Р. 35-46.

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