The mechanism of development and improvement of treatment of acute sinusitis occurring with a block of natural anastomosis

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The mechanism of development and improvement of treatment of acute sinusitis occurring with a block of natural anastomosis

Ulmasov B.B.¹, Arifov S.S.²

Abstract

Keywords: acute sinusitis, natural anastomosis, treatment, mechanism of development.

Аннотация

МЕХАНИЗМ РАЗВИТИЯ И СОВЕРШЕНСТВОВАНИЕ ЛЕЧЕНИЯ ОСТРЫХ СИНУСИТОВ, ПРОТЕКАЮЩИХ БЛОКОМ ЕСТЕСТВЕННОГО СОУСТЬЯ

восстановление нормальной аэрации пазух позволит компенсировать неблагоприятное патогенетическое действие гипоксии и обеспечить дренажную функцию околоносовых пазух через естественные соустья. Постоянное многодневное раздражение воспаленной слизистой оболочки данным инородным телом может свести на нет все очевидные преимущества метода катетеризации. Метод диализа околоносовых пазух пытался компенсировать недостатки очень быстрой самопроизвольной эвакуации сложных лечебных смесей через естественные соустья. Существуют специальные формы антибиотиков, предназначенных для эндоназального введения в виде спрея. В случае катарального синусита они могут проникать через соустья околоносовых пазух и непосредственно контактировать с возбудителем в очаге воспаления. Верхнечелюстная и лобная пазухи, а также передние клетки решетчатого лабиринта своими соустьями или же устьями выводного прохода открываются в средний носовой ход, расположенный под средней носовой раковиной. Клиновидная пазуха и задние клетки решетчатого лабиринта открываются в верхний носовой ход.

Ключевые слова: острый синусит, естественные соустья, лечения, механизм развития.

Relevance

Acute rhinosinusitis is one of the most common diseases not only in otorhinolaryngology, but also among therapists, pediatricians and general practitioners [3, 7].

It is believed that rhinosinusitis in Europe annually occurs in every seventh person. In the USA, 31 million cases of rhinosinusitis are registered per year, and in Russia - over 10 million cases per year.

Inflammatory diseases of the paranasal sinuses are one of the most urgent problems of otorhinolaryngology. Among patients being treated in otorhinolaryngological hospitals, 15 to 36% are people suffering from sinusitis [6].

The 2008 US National Population Health Survey found that approximately one in seven (13.4%) adults > 18 years of age had had rhinosinusitis in the previous 12 months. Incidence among adults In the US, women are higher than men (approximately 1.9 times), with the peak incidence occurring in adults aged 45-74 years [8].

In Germany, between 7 and 10 million diagnoses of acute and chronic sinusitis have been made in the last decade.

Acute rhinosinusitis is understood as inflammation of the mucous membrane of the nasal cavity and paranasal sinuses lasting up to 4 weeks. Rhinosinusitis can be caused by various factors, such as allergens, environmental irritants, and it can also have an infectious etiology: viral, bacterial or fungal. Acute rhinosinusitis most often has a viral etiology associated with URTI or the common cold [1, 5].

A prospective study in children aged 6-35 months showed that the frequency of viral URTI was 6 episodes of infection per child per year [2]. Among adults, the value of this indicator is 2-3 episodes per 1 patient per year. Secondary bacterial infection of the paranasal sinuses after a viral URTI develops in 0.5-2% of adults and 5% of children. Acute rhinosinusitis in 2-10% of cases has a bacterial etiology, and in 90-98% of cases it is caused by viruses [6]. Despite this, rhinosinusitis ranks 5th among the reasons for prescribing AMPs by general practitioners.

The development of inflammation of the mucous membrane of the paranasal sinuses is facilitated by conditions, both general and local. The general includes the state of individual reactivity, constitutional prerequisites, the body's immune forces, as well as various unfavorable environmental factors. Among the local factors most often inflammation in the sinuses is promoted by those in which the drainage function of the excretory openings, the ventilation of the sinuses and the function of the mucociliary transport system are disturbed [3].

Causes of impaired function of the paranasal sinuses can be systemic (eg, allergies) and local (eg, turbinate hypertrophy). Local, in turn, are divided into anatomical and pathophysiological. The former include curvature, spikes and ridges of the nasal septum, hypertrophy of the turbinates, hyperplasia of the mucous membrane or polyps, and various tumors. It has been established that the listed factors not only violate the drainage and ventilation function of natural fistulas, but during long-term existence, especially in childhood, contribute to the abnormal development of the paranasal sinuses themselves (shape, size, diameter of fistulas and their course).

The pathophysiological factors contributing to the progression of the inflammatory process in the paranasal sinuses include: dysfunction of the glands of the nasal mucosa, leading to excessive accumulation or lack of secretions; a change in the direction of the jet of inhaled and exhaled air in the nasal cavity, leading to a violation of gas exchange in the paranasal sinuses; inhibition of the function of the ciliated epithelium of the mucous membrane [1, 4].

Difficult or, conversely, more free than normal, the passage of air through the nasal cavity leads to a change in ventilation in the sinuses. In turn, impaired ventilation of the paranasal sinuses and air pressure in them lead to edematous inflammatory changes in the mucous membrane, which further affects the air exchange and drainage of the sinuses. Such changes, of course, are a favorable background for the development of various forms of sinusitis.

In the paranasal sinuses, due to the closure of natural fistulas, there is a stagnation of the secretion of the mucous glands, a change in pH, a metabolic disorder in the mucous membrane, a dysfunction of the ciliated epithelium; activation of opportunistic microflora is possible.

Purpose of the study. To create an adequate treatment and diagnostic algorithm for the block of natural fistulas of acute rhinosinocytes, including regional indirect endolymphatic introduction of functional endoscopic surgery of the rhinosinus, hyperbaric oxygenation and antibacterial drugs, as well as to ensure early and most accurate diagnosis and study of the etiopathogenetic influence on the main factors for the occurrence and development of these complications.

Materials and methods. To accomplish our task, we selected a total of 65 patients with acute rhinosinocytes, suffering from blockade of natural fistulas, who received medical care and underwent examination.

Research results

blockade fistula acute rhinosinocyte

Anatomical anomalies of the nasal cavity Blockade of the walls of acute rhinosinusitis plays an important role in the development of phonatory pathologies (it is considered a risk factor).

Based on the conducted microbiological studies, it was found that the most common pathogens causing paranasal sinuses and mainly acute rhinosinusitis in this process were Haemophilus influenzae (101 (25.4%), pneumococci (89 (22.4%)), Staphylococcus aureus (75 (18.9%)), and they were studied against the background of a natural fistula block in patients undergoing examination.

Based on the correlation analysis of immunological parameters in patients with acute rhinosinusitis and complications against the background of a natural fistula block, the general nature of immunosuppression was determined, based on the onset and development of a purulent-inflammatory process in this pathology, which allows the use of a single therapeutic algorithm.

Therapeutic and diagnostic algorithm for the non-traditional treatment of acute rhinosinusitis against the background of a natural blockade of the anastomosis includes the most optimal interrelated and additional components: endoscopic examination of the nasal cavity on the first day of hospitalization and computed tomography of the paranasal sinuses in the axial and coronary projections, emergency functional endoscopic rhinosinogyrosurgical intervention in the affected sinuses nose, antibiotic therapy of nasal structures and HBO.

After using the diagnostic and treatment algorithm developed in the main subgroup of patients unsuitable for conventional treatment of acute hepatitis C, compared with the control, clinical recovery was recorded more often in 21.2% of cases, the average time spent in bed decreased to an average of 2.1 days. In the injection mode, a decrease in nasal congestion was observed by 2.6 times, the number of patients with normosmia increased by

1.8 times more than in the control, the normalization of the transport activity of the eyelash epithelium was 21.8% more, according to cytological studies, the normalization of the cellular composition smear prints were observed by 34.9% more, hyperemia, the level of immunoglobulins SI and iga in nasal secretions coincided with the norm only in the main subgroup.

In the main subgroup of cases of clinical recovery, the duration of hospitalization was reduced to 4.8 days, which is 13.6% more after applying the diagnostic and treatment algorithm developed in patients with non-traditional treatment of HSV. The decrease in the level of nasal congestion in the injection mode was 2.1 times, the number of patients with normosmia was 1.4 times, the cases of normalization of the transport activity of the eyelash epithelium were 20.5% more, the cases of normalization of the cellular composition of imprint smears were determined 1.6 times more often, according to research findings. In the absence of T-cell type immunodeficiency, the normalization of IGA and IGA immunoglobulins in the discharge from the paranasal sinuses, the restoration of phagocytosis activity in the absence of normalization in the control subgroup were determined.

Evaluation of the effectiveness of the developed diagnostic and treatment algorithm in patients with acute respiratory syndrome showed that in the main small group, compared with the control group, the frequency of clinical recovery was 23% higher, the length of stay in the hospital was reduced to 6 days, the number of people with visual acuity increased in

2.9 times. The level of nasal congestion in the injection mode decreased by 1.3 times, the number of patients with normosmia increased by 1.5 times, 21.6% of cases of normalization of the transport activity of the eyelash epithelium were registered, normalization of the cellular composition of imprint smears was determined 1.6 times more often, a weak level of fibrinous plaque and crusts during endoscopic examination differed from the control, there was no T-cell type immunodeficiency, normalization of SI and iga levels in the discharge from the paranasal sinuses, restoration of phagocytosis activity.

In the long-term period after the application of the proposed diagnostic and treatment algorithm, the frequency of relapses of ACS decreased by 4 times, HSV - by 4 times, oro - by 3 times.

Conclusion

In case of suspected acute rhinosinusitis in the natural fistula block, the need to use an additional diagnostic complex as part of an endoscopic and computed tomography examination of the nasal cavity and paranasal sinuses is based on other instrumental methods used by an otolaryngologist on the first day of seeking medical help for non-traditional patient treatment.

In the case of a diagnosis of acute rhinosinusitis in the natural fistula block, it was found that there is a need for urgent functional endoscopic intervention in the paranasal sinuses and orbit.

In the natural fistula block, in acute rhinosinusitis, it is proposed to cooperate with functional rhinosinus surgery interventions, including hyperbaric oxygenation and regional indirect endolymphatic antibiotic therapy in one complex.

Within the framework of the developed diagnostic and treatment algorithm, the tactics and methods of using hyperbaric oxygenation in acute rhinosinitis in the natural fistula block are substantiated.

In the experimental part of the work, a method of regional indirect endolymphatic dispatch was developed as part of systemic antibiotic therapy with cephalorin III generation ceftriaxone in the treatment of patients with complications of acute rhinosinusitisarinosinusogen in the natural fistula block.

References / Список литературы