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Polypous rhinosinusitis, according to the international classification of diseases, refers to diseases of the respiratory system (ICD code 10 J 01).

Against the background of decreased immunity, a long course of rhinosinusitis leads to swelling and proliferation of the mucous membrane of the paranasal sinuses and nasal cavity with the gradual formation of thickenings and the formation of polyps.

How does polypous rhinosinusitis manifest: symptoms

Benign formations of the nasal mucosa (polyps) prevent the normal discharge of mucus from the sinuses, which leads to characteristic symptoms of the pathology:

• headaches, aching in nature;
• pain in the lower part of the eye sockets;
• discomfort and nasal congestion;
• weakening or complete loss of sense of smell;
• feeling of a foreign body in the nasal cavity;
• scanty mucous or purulent thick discharge.

Attention

This condition develops over a long period of time, so the increase in severe symptoms and the nature of complaints are different at the beginning of the disease and throughout the entire period of progression.

The clinical picture is expressed in a combination of manifestations of intoxication of the body (increased body temperature, general malaise, febrile phenomena) and symptoms characteristic of the stage and localization of the pathology.

In addition to polypous rhinosinusitis with clinical manifestations, asymptomatic forms of the disease are also noted.

Causes of the disease

To date, there is no consensus on the causes of pathology of the nasal mucosa and paranasal sinuses. Scientists agree on one opinion - the presence of genetic predisposition and polyetiology of the disease.

The study of the mechanism of formation and histological picture of nasal polyps has led to the creation of several theories of pathogenesis:

The inflammatory process is caused the influence of eosinophils on the structure of the mucous membrane ( eosinophilic inflammation). A study of polyp tissue revealed an increased content of interleukin-5, albumin and other proteins that contribute to the activation of eosinophil transport and/or their apoptosis (extension of functioning).

These processes cause the accumulation of eosinophils and the resulting inflammatory process.

Allergic IgE-dependent reaction. This theory does not have reliable confirmation, since the pathology accompanies hay fever only in 10% of cases, which corresponds to the prevalence of an allergic reaction in the population as a whole. It has been proven that polyps do not change during the flowering period, which suggests that IgE-dependent allergy does not cause the disease, but is a concomitant pathology that aggravates the course of rhinosinusitis.

Impaired biotransformation of arachidonic acid. Salicylates in cellular biosynthesis trigger an alternative course of arachidonic acid metabolism, which results in the formation of leukotrienes (LTE-4; LTC-4; LTD-4), which are very active mediators of inflammation.

Bacterial cause. The role of bacteria in the development of polyp formation has not been fully studied. It is assumed that bacteria are a kind of superantigens capable of supporting the eosinophilic inflammatory process.

In support of the theory, the influence of enterotoxin on the growth and development of polyps as a superantigen was discovered. The role of bacteria in the etiology of the disease confirms the formation of “neutrophilic” neoplasms or polypous purulent rhinosinusitis.

The theory of fungal influence. It is assumed that the mycelium of pathogenic fungi that enters the inhaled air is attacked by T-lymphocytes. They activate eosinophils and cause them to migrate into the mucous contents of the paranasal sinuses.

There, eosinophils secrete toxic proteins from their cytoplasm, which destroy fungi, but at the same time there is an accumulation of toxic components and breakdown products. As a result, inflammation is stimulated in genetically predisposed individuals.

Pathogenic effects of viral respiratory infections. The experience of clinical observations of pathogenesis suggests a relationship between the viral infectious agent and the progression of rhinosinusitis and the growth of polyps.

Genetic factor. Scientists do not dispute the genetically determined nature of the pathology. Indirect confirmation may be the connection between polyploid rhinosinusitis and cystic fibrosis or Kartagener's syndrome.

This assumption is due to changes in the karyotype of patients. The gene responsible for the development of rhinosinusitis has not yet been isolated, but the connection can be traced.

Source: website

Violation of the anatomical structure of the nose and, as a consequence, a violation of aerodynamics. As a result of anomalies of various etiologies, irritation of the mucous membrane with air flow with various particles occurs, as well as morphological restructuring of the membrane, hypertrophy and blocking of the ostiomeatal complex.

Multifactor theory. According to the assumption, there is a relationship between rhinosinusitis and congenital or acquired pathologies in the body.

Anomalies can be localized at various levels - cellular, subcellular, organismal, etc. Some of the violations may never appear, since there is no corresponding influencing factor.

For diffuse disease the cause may be In this case, the occurrence of cystic polypous rhinosinusitis is secondary and the pathology is localized in the affected sinus.

It is obvious that in addition to the wide variety of exposure factors that cause the disease, there is also a variety of symptoms. All this significantly complicates the correct diagnosis and the prescription of effective treatment and implies a risk of complications.

How dangerous is this disease?

Typically, polypous rhinosinusitis does not have serious consequences, but its purulent forms can cause pathologies such as:

• osteomyelitis of the skull bones;
• meningitis and other intracranial purulent lesions;
• inflammatory and purulent pathologies of the visual apparatus.

Intracranial purulent pathologies caused by progressive purulent rhinosinusitis are accompanied in 15% of cases by such deadly diseases as meningitis, purulent meningoencephalitis and brain abscess.

Also, complications of the disease can be sepsis, subperiosteal abscess, rhinogenic thrombosis of the cavernous sinus, etc.

Complications caused by rhinosinusogenic pathology in the structures of the visual analyzer include many diseases and conditions:

• pseudotumor of the orbit of the eye;
• conjunctivitis;
• panophthalmitis;
• dacreoadenitis;
• retrobulbar neuritis;
• paralysis of the eyeball;
• abscess of the eyelid and others.

In addition, the pathology itself can occur with complications such as peritonsillar abscess and otogenic sepsis.

As a result, purulent rhinosinusitis can cause severe complications, which in 24% of cases lead to to death.

Diagnostics

To clarify the preliminary diagnosis, an external examination, collection and analysis of anamnestic data, and a study of the medical history are carried out. Often ultrasound and diaphanoscopy do not allow making a complete conclusion about the condition and function of the nose, therefore they use:

• rhinoscopy and endoscopy;
• computed tomography (CT);
• rhinomanometry;
• study of mucolytic transport;
• microbiological analysis and biopsy, etc.

CT is the most informative method and is recommended for all new patients. With multislice CT using multiplanar reconstruction, the image can assess the preservation of pneumatization of the paranasal sinuses.

The extent of the disease can be judged by the degree to which they are filled with dense mucin or pus. The method also allows you to detect anatomical disorders in intranasal structures.

It is worth noting

Computed tomography is the main diagnostic method and guide for surgical intervention.

To assess the microbiological composition of the intranasal cavities and sinuses, biological and biochemical research methods are used.

Laboratory studies indicate changes in blood rheology in patients with polypous rhinosinusitis, namely platelet aggregation, increased levels of fibrin fibers, characteristics of the osmotic and sorption abilities of erythrocytes.

These changes indicate the formation of microthrombi and impaired blood circulation in the capillaries. There is also an increase in the level of leukocytes in the blood, which indicates inflammatory processes.

Based on the analysis of laboratory and instrumental research data, the doctor develops an individual treatment strategy.

Treatment

In the treatment of polypous rhinosinusitis, both conservative and surgical methods are used. All types of pathology, except unilateral rhinosinusitis, can be treated with medications.

According to modern methods of treating polysinusitis, the first-line drugs are intranasal hormonal drugs. Preference is given to drugs that have high topical activity and low bioavailability, that is, the safest for long-term, sometimes lifelong use.

Among the licensed drugs, it best meets all requirements Mometasone furoate. It is prescribed in a therapeutically recommended dose in courses of 3-6 months or longer.

Its effectiveness has been proven in clinical studies. If nasal breathing is severely impaired due to polypous rhinosinusitis, allergic rhinitis, sinusitis and other nasal pathologies, Nasonex spray is prescribed, the active ingredient of which is momesonate furoate. An alternative to the drug are nasal sprays Beclomethasone and Budesonide.

When using systemic glucocorticoids, Prednisolone is used in short courses, since the medicine has a lot of side effects.

The medicine is used to prevent relapses, as well as in the presence of contraindications to surgery. Deposited glucocorticoids are not used in therapy due to their high bioavailability.

Among the treatment methods, irrigation therapy can also be called. Nasal irrigation is recognized as a safe and simple method of exposure. Usually, an isotonic or hypertonic solution of table salt, as well as sea water. The scientific literature contains documentary evidence of the effectiveness of the irrigation technique.

Special systems have been created and used that rinse the nose under various pressures or only irrigate the mucous membrane.

New alternative therapies are being developed and studied:

• treatment with low doses of macrolides;
• antimycotic therapy, local and systemic;
• desensitization with aspirin, etc.

Ketotifen is used to stabilize mast cell membranes. The drug has antihistamine and antianaphylactic properties and prevents the accumulation of eosinophils.

In order to increase local immunity, Polyoxidonium is used. Folk remedies used for local effects on pathology are thuja oil, which has antioxidant, reparative and immunomodulatory effects.

If conservative methods do not bring the expected result, surgical treatment is used.

Operation

The modern trend of using minimally invasive treatment methods also occurs in the treatment of polypous rhinosinusitis. For this use:

• laser coagulation, the operation is performed using a YAG-holmium and E-fiber laser;
• ultrasonic disintegration;
• submucosal vasotomy;
• electroacoustics;
• micro- and endoscopic methods;
• removal of polyps using polyp loops, etc.

Most often it is carried out using a shaver-microdebrider apparatus. The device is a thin nasal tube with rotating blades inside it and an attached microsuction.
Under the control of an endoscope, the tube is inserted into the nasal cavity and the polyp, and is suctioned to the end of the tube using a pump. The blades crush the tumor and its parts are sucked into the reservoir. After the operation, tampons are inserted into the patient, and then standard anti-relapse therapy is carried out.

The advantage of the method is its accuracy - the device operates only in the area of ​​the polyp, it is minimally invasive, and it is fast. The operation is performed on an outpatient basis under local anesthesia. The postoperative period is significantly shorter than after radical polypectomy.

The laser coagulation method also has good performance. As a result of testing the effectiveness of modern medical equipment for surgery, it was noted that laser exposure not only evaporates the polyp, but also relieves the inflammatory process and stimulates tissue regeneration. Thanks to the coagulating ability of the laser beam, the operation is bloodless.

Since polypous rhinosinusitis most often occurs in men, some patients of military age are interested in: “Are people with this pathology accepted into the army?” A conscript diagnosed with rhinosinusitis with persistent pathology of nasal breathing or with purulent sinusitis is given a deferment to undergo additional examination or surgery.

According to the international classification of diseases, chronic polyposis rhinosinusitis (ICD-10 code - J01) is considered one of the rarest diseases of the respiratory system. This pathology is characterized by partial or complete disruption of breathing through the nose due to the occurrence of polyps.

Description

Against the background of deterioration of the protective properties of the immune system, a prolonged course of rhinosinusitis provokes swelling and proliferation of the mucous membrane of the nasal cavity and paranasal sinuses with the slow formation of polyps. This disease usually develops in parallel with many other ailments and is accompanied by unpleasant purulent discharge. Much more often, chronic polypous rhinosinusitis is diagnosed in males.

Features of the disease

Polyps are benign tumors. Their occurrence is explained by the appearance of inflammatory foci that affect the soft tissues of the sinuses. This pathological condition prevents the penetration of nutrients, resulting in thinning and loss of plasticity of the mucosa. The body is trying to return it to its original state. Due to this, instead of thinning, new layers of tissue appear in the nasal cavity. As the pathological condition progresses, teardrop-shaped polyps filled with infiltrate appear in the sinuses.

Such tumors always appear as a whole scattering. They settle on the walls of the sinuses, creating groups. As a result, the full penetration of air and liquids there is disrupted. A complete blockage of the nasal cavity forces a person to inhale and exhale air through the mouth.

It should be said that chronic polypous rhinosinusitis (ICD-10 code J01), despite the similar clinical picture and causes of development, is a separate disease. Unlike the named pathology, with sinusitis, abnormal tumors appear in the area

Causes

The exact prerequisites for the development of chronic polypous rhinosinusitis are not yet known. Among the favorable conditions, experts highlight the following:

• cystic fibrosis;
• heredity;
• chronic sinusitis with purulent processes;
• fungal infection of the body;
• excessive sensitivity to salicylic acid;
• allergies, including rhinitis;
• acute rhinosinusitis not treated in time.

This pathology is infectious and develops as a result of infection of the body:

• chlamydia;
• streptococci;
• pseudomonas;
• Candida fungus;
• staphylococcus.

Pathogenesis

Of course, with so many triggers, there is a variety of symptoms and signs that make diagnosis and treatment challenging. Therefore, the clinical picture of the described disease should be known in detail.

Inflammatory foci in the nasal cavity and the polyps themselves are formed due to the influence of such factors:

• hypothermia;
• the presence of fistulas between the maxillary sinus and the oral cavity;
• weakened immune system;
• caries;
• hypovitaminosis;
• reflux esophagitis;
• deviated nasal septum.

Among other things, the hormonal factor plays an important role in the pathogenesis of chronic polypous rhinosinusitis. Disturbances in the functioning of the endocrine system invariably lead to a weakening of the immune system and disruptions in the functioning of other organs.

Conditions that cause the onset of chronic polypous rhinosinusitis include bad habits such as smoking and inhaling harmful chemicals.

Types of disease

Chronic polypous rhinosinusitis (according to ICD-10 code J01) is divided into categories according to severity, location and causes of neoplasms.

So, depending on the area of ​​location, the disease can be unilateral or bilateral. And according to the type of pathogen, pathology is divided into the following types:

• viral;
• bacterial;
• fungal;
• mixed.

According to the nature of the course, rhinosinusitis is divided into moderate, mild and severe.

Clinical picture

The initial symptom indicating the presence of tumors in the nasal cavity is difficulty breathing. This symptom is accompanied by a number of other phenomena:

• nasality;
• deterioration of sense of smell;
• the appearance of migraine;
• feeling of discomfort in the bridge of the nose;
• unpleasant odor from the mouth;
• purulent nasal discharge;
• unpleasant sensations behind the eye sockets.

As the pathology progresses and in the absence of proper treatment, abnormal tumors spread into the nasal cavities. At this stage, the patient has a feeling of increased pressure in the nose and the presence of a foreign object there. In the near future, if the patient does not take any action, he will be able to breathe exclusively through his mouth.

Possible complications

The medical history of chronic polypous rhinosinusitis continues with the development of disturbances in the functioning of the patient’s cardiovascular system, as a result of which his tachycardia progresses. And this happens as a result of the supply of insufficient oxygen. Sometimes there are problems with swallowing. And due to general malaise, the patient may become overly irritable and conflictual.

In the absence of necessary therapy, various complications may occur, including:

• lack or deterioration of appetite;
• oxygen starvation of the brain, as a result of which performance decreases, memory and concentration deteriorate.

The danger of chronic polypous rhinosinusitis lies in the fact that pus gradually accumulates in the nasal sinuses, which creates favorable conditions for the proliferation of bacteria. As a result, germs spread to nearby organs, even damaging the ears and eyes. In many cases, due to chronic purulent polypous rhinosinusitis, pathogenic microflora penetrates the brain, causing the patient to develop meningitis.

Other consequences

Subperiosteal abscess, sepsis, and rhinogenic sinus thrombosis may also occur as complications. As for the risk to the visual organs, this system is susceptible to:

• pseudotumors of the eye orbits;
• dacreoadenitis;
• abscess of the eyelid;
• conjunctivitis;
• retrobulbar neuritis;
• panophthalmitis;
• paralysis of the eyeball.

In addition, the disease itself can be complicated by peritonsillar abscess and otogenic sepsis. As a result, purulent rhinosinusitis can provoke severe pathologies, which in 25% of cases lead to death.

Diagnostics

To make a diagnosis, the specialist will first examine the patient’s cheeks, nose and forehead by palpation, after which he will give a referral for a general blood test. In addition, additional studies may be prescribed:

• endoscopy;
• rhinoscopy;
• biopsy;
• rhinomanometry;
• microbiological analysis;
• radiography.

The second survey option provides the most accurate results. Endoscopy is considered a minimally invasive procedure that allows you to assess the general condition of the mucous membrane of the nasal cavity and adjacent tissues.

Computed tomography is considered the main diagnostic technique and a guideline for surgical intervention.

To assess the microbiological flora of the nasal sinuses, biochemical and biological analysis is used.

During laboratory tests, patients with rhinosinusitis show changes in blood composition, including platelet aggregation, high levels of fibrin and sorption properties of red blood cells.

Taking into account the fact that this disease is characterized by signs characteristic of other pathologies, differentiated diagnosis is carried out. And the treatment strategy is developed individually based on hardware and laboratory studies.

Treatment of chronic polypous rhinosinusitis

To get rid of the described disease, two methods are used:

• conservative;
• surgical

However, according to numerous reviews, treatment of chronic polypous rhinosinusitis without surgery does not allow achieving complete recovery. The use of medications makes it possible to slow down the progression of pathology and increase the distance between existing tumors. And most often, conservative treatment is used to increase the duration of remission. In all other cases, the patient is sent for surgery, during which tumors in the nasal sinuses are removed.

Modern medicine offers patients with this diagnosis the use of drugs that promote the immediate death of growth cells. In the future, tumors are eliminated from the body naturally.

In addition, to treat chronic polypous rhinosinusitis, you can resort to systematic rinsing of the nasal sinuses with an ordinary salt solution or special means, such as “Quix” or “Aquamaris”. These drugs make it possible to remove purulent accumulations, thus reducing the risk of the development and growth of pathogenic microflora.

Drug treatment

Elimination of the causes of the disease is considered a prerequisite for effective therapy. In this case, it is necessary to avoid the use of anti-inflammatory non-steroidal medications. In addition, it is very important to prevent allergens from entering the nasal cavity. Drug therapy consists of several stages:

1. Local anti-inflammatory drugs. To treat rhinosinusitis, corticosteroids are usually used, for example: Rinoclenil, Beconase and Aldecin. After using these drugs, the tumors die off in just a couple of weeks. And due to the fact that the medications used do not enter the blood vessels, side effects from this treatment method are extremely rare. Just a few days after the administration of these drugs, the patient feels a significant improvement.
2. Antihistamines. For the described pathological condition, second-generation medications similar to Cetirizine, Fexofenadine or Loratadine are used. These drugs bring fairly quick results. It is noteworthy that they do not in any way affect the central nervous system, which is why they are not addictive. Antihistamines prevent and eliminate swelling of the nasal cavity and effectively combat smooth muscle spasms.
3. Stabilizers of neoplasm membranes. One of the most popular drugs in this category is Ketotifen. It inhibits the activity of histamine receptors, thereby eliminating the risk of accumulation of eosinophils in the nasal cavity.
4. Immunostimulants. Necessary for overall strengthening of the immune system. Thanks to their use, infectious and viral diseases disappear. In addition, these drugs help eliminate swelling and promote faster tightening of the mucous membrane.

Surgical intervention

Surgeries for chronic polypous rhinosinusitis involve the use of local anesthesia and a microdebrider shaver. This device, in addition to the hollow tube, is equipped with a special endoscope with a micro-camera, which makes it possible to fully control all manipulations. After entering the nasal cavity, the machine creates negative pressure, after which the working handle with small blades is sucked onto the tumor.

After surgery, cotton swabs must be inserted into the nose to stop bleeding. In addition, the patient is prescribed medications as rehabilitation therapy that will prevent relapses.

Conclusion

To treat rhinosinusitis and prevent it, you can resort to traditional medicine recipes. To do this, you can use steam inhalation over boiled potatoes, the famous “Star” balm, garlic or menthol. You can also use a compress of boiled eggs, heated river sand or sea salt.

When treating pathology, several rules should be taken into account:

• the patient needs to undergo allergy tests to detect the pathogen;
• it is advisable to systematically observe a special drinking regime;
• Vasoconstrictor medications should not be used for more than a week.

Nasal polyps are soft, painless growths that arise in the mucous membrane lining the nasal passages and sinuses. The appearance of such growths occurs against the background of prolonged inflammation with chronic rhinosinusitis in 25-30% of patients, but there may also be other reasons, including allergic rhinitis and asthma.

Most often, polyps grow in the ethmoid sinus and protrude into the middle turbinate. If delimited foci are detected in the nasal cavities, a suspicion of oncology arises, since this is not typical for rhinosinusitis. Another important feature of the disease is damage to the sinuses on both sides.

It is noteworthy that the disease mainly occurs in middle-aged people (40-60 years old), slightly more often in men. Polypous rhinosinusitis in children and young people under 20 years of age is a very rare occurrence, so the discovery of polyps should be alarming, because they may be associated with other diseases, for example, encephalocele or cystic fibrosis.

Types and forms of polypous rhinosinusitis

Classification of polypous rhinosinusitis is carried out based on which sinus the formations appear in. In more than 92% of cases, polyps affect the ethmoid sinus. This type of polypous rhinosinusitis is called ethmoidal.

Only 6% is in the maxillary sinus, and the remaining 2% is in the frontal and sphenoid sinuses. Unlike the ethmoid type, maxillary polyps are almost always unilateral and larger in size.

Depending on the etiology, the following types of polypous rhinosinusitis are distinguished:

• bacterial (occurred against the background of chronic purulent inflammation);
• allergic;
• fungal.

There are also 2 forms of polyp growth: diffuse (bilateral damage to the nose and sinuses) and solitary (damage to one sinus).

What causes polypous rhinosinusitis?

Polyposis rhinosinusitis is often associated with asthma, sleep apnea, chronic and allergic rhinitis, and sinusitis, but the cellular and molecular mechanisms that contribute to the development of the disease are not fully understood.

It is believed that an important role in the pathogenesis of the disease is played by:

• defects in the sinonasal epithelial cell barrier;
• increased exposure to pathogenic and colonized bacteria;
• dysregulation of the human immune system.

In healthy conditions, the epithelial cells that make up the nasal mucosa form a physical barrier to protect humans from inhaled pathogens and particles and also play an important role in mucociliary clearance. With polypous rhinosinusitis, defects are found in the sinonasal epithelial barrier, which leads to an increase in tissue permeability, a decrease in their resistance, and ultimately to degenerative changes in the cells of the epidermis.

Why the epithelial barrier defect occurs remains unclear. Among the assumptions are genetic characteristics, decreased antimicrobial protection, physical trauma, and the influence of bacteria such as Pseudomonas aeruginosa and staphylococcus.

Other risk factors that contribute to the formation of polyps include:

• Kartagener's syndrome;
• Young's syndrome;
• abnormalities in the structure of the nose;
• eosinophilic granulomatosis with polyangititis;
• cystic fibrosis.

Additional research is needed to further determine the causes of polypous rhinosinusitis. They can help invent new approaches to the prevention and treatment of this ENT disease.

Symptoms and signs of polypous rhinosinusitis

Symptoms of polyposis rhinosinusitis include anterior or posterior rhinorrhea, nasal congestion, hyposmia, and facial pressure or pain that lasts more than 12 weeks. Nasal discharge is usually thick, mucous or mucopurulent, not profuse. They can flow down the throat, causing discomfort and a nasal voice. Headache may be present.

These manifestations are not specific, since the same picture is observed with ordinary chronic rhinosinusitis. However, studies have shown that patients with nasal polyps have more severe symptoms.

Important! Signs such as sneezing, itching and watery eyes indicate an allergic origin of the disease.

To better distinguish between chronic rhinosinusitis with and without polyps, several studies have compared symptoms among different patients. Doctors have found that nasal obstruction, discharge and hyposmia/anosmia are more often associated with polyposis rhinosinusitis, while facial pain and pressure are more common in the non-polyposis chronic form.

Depending on the severity of the disease, symptoms may be mild or severe. In advanced cases, polyps completely block the nasal passage and interfere with breathing.

Diagnosis of the disease

A preliminary diagnosis can be made by the characteristic symptoms of polypous rhinosinusitis, as well as conventional rhinoscopy. But often it cannot be distinguished from ordinary chronic inflammation, so it is necessary to use additional examination methods, and also pay attention to the patient’s history of asthma or rhinitis.

Diagnosis of polypous rhinosinusitis is based on computed tomography (CT) or nasal endoscopy. These techniques make it possible to very accurately determine the presence of polyps, their location and size. A CT scan uses X-rays and a scanner to produce layer-by-layer images of the soft tissue and bones that make up the structures of the nose. Endoscopy allows you to examine the nasal passages and sinuses from the inside. For this purpose, a probe with a camera is used, which transmits an image to a computer screen.

Additionally, before starting treatment, a cytomorphological examination of smears from the mucous membrane may be performed, and in rare cases, a polyp biopsy for histological examination. This analysis helps to exclude more serious pathologies such as cancer, papilloma or fungi.

How and with what to treat polypous rhinosinusitis in adults and children?

Treatment options for polyposis rhinosinusitis remain limited.

• anti-inflammatory drugs. Intranasal corticosteroids reduce inflammation and the size of the nasal polyp, as well as associated symptoms (including allergy symptoms), improving patients' quality of life. The course of treatment with such drugs is 3-6 months. After which remission occurs. They are also prescribed to patients before and after surgery.

Anti-inflammatory tablets (Prednisolone) can be used, but this should be done with caution, taking into account serious systemic side effects.

List of anti-inflammatory nasal sprays:

1. "Nasonex" (active ingredient - mometasone);
2. "Avamys" (fluticasone);
3. "Beconase" (beclomethasone);
4. "Dimista" (contains a combination of a corticosteroid and an antiallergic agent).

• decongestants. To combat nasal congestion and runny nose, you can use vasoconstrictor drops or spray (Nazol, DlyaNos, Rinazolin, Otrivin, Galazolin, etc.), but it is important to remember that they do not cure the disease, but give only short-term relief.

There are also combination drugs suitable for the treatment of polyposis rhinosinusitis. For example, spray "". It contains the corticosteroid dexamethasone, 2 antibiotics and a vasoconstrictor - phenylephrine. Due to this, “Polydex” has anti-inflammatory, anti-edematous and antibacterial effects.

Another good method for relieving the symptoms of polypous rhinosinusitis is irrigation, that is, rinsing the nasal cavity. For this purpose, it is recommended to use pharmacy or homemade saline solutions. They perfectly moisturize and cleanse the mucous membrane. The procedure is best carried out using special devices: “Dolphin”, “AquaMaris”, etc. The advantages of flushes are ease of use, safety and accessibility. They are useful to carry out before and after surgery.

Antibiotics may be useful in the treatment of infectious exacerbations of purulent polyposis rhinosinusitis, but they have no clinical effect (i.e. shrinkage of polyps). As a rule, antibiotics are prescribed orally for a course of 4-12 weeks.

In severe cases, when the patient does not respond to corticosteroids, therapy with targeted drugs is practiced: Omalizumab, Mepolizumab. They affect receptors that cause inflammation and turn them off.

Important! Treat your allergies and asthma if you have allergic rhinosinusitis;

Surgery

In advanced cases or when drug treatment does not help, surgery is used. Doctors recommend surgery no later than 12 months after confirmation of the diagnosis, since later removal of polyps is associated with an increased need for additional postoperative therapy. The risk of recurrence of polyps also increases.

For polypous rhinosinusitis, endoscopic surgery is indicated, during which the polyps are removed, as well as the surrounding inflamed mucous membrane. In addition, all anomalies are eliminated: curvature of the nasal septum, hypertrophy of the nasal turbinates, etc. This not only eliminates the obstacles caused by the polyps themselves, but allows for more effective use of medications such as saline irrigations and steroids. The operation lasts from 45 minutes to 1 hour and can be performed under general or local anesthesia.

Note! Polypous rhinosinusitis has a high rate of relapses, which occur even after surgical treatment.

Anti-inflammatory medications and nasal irrigation should be continued after surgery. In some cases, a course of antibiotics is prescribed. Then you need to periodically visit a doctor and get examined.

Interesting! In many modern centers, a stent containing a corticosteroid is placed after surgery. The drug is released within 30 days, increasing the effectiveness of surgery and reducing the risk of relapse.

Also, in addition to standard surgery, laser is now used. It quickly and painlessly removes all pathological growths.

Treatment of polypous rhinosinusitis at home

Among the traditional methods of treating nasal polyps you can find the following recipes:

• instill fresh celandine juice into the nose (2-3 times a day) for 2 weeks in a row;
• stir 50 ml of boiled water, 2 g of mumiyo (in tablets) and 1 tsp. glycerin. Soak a cotton swab in this solution and insert it into the nostril for 10-15 minutes;
• lubricate the sinus areas with May honey once a day for a month;
• rinse your nose with horsetail decoction;
• place a gauze swab soaked in propolis ointment in the nostrils.

Remember that folk remedies do not replace drug treatment, but only complement it!

Why is polypous rhinosinusitis dangerous?

Nasal polyps can cause complications because they block the flow of air and drainage of fluid from the sinuses, and because of the chronic inflammation that underlies their development.

Possible consequences include:

• obstructive sleep apnea. In this potentially serious condition, you often stop breathing while you sleep;
• asthma outbreaks;
• sinus infections. Nasal polyps can make you more susceptible to sinus infections that recur frequently or become chronic;
• deformation of the nose (occurs when the size of the polyp increases);
• bone destruction.

A bacterial infection can also get inside the brain and cause other serious complications, but this is rare.

Disease prevention

You can reduce your chances of developing nasal polyps, as well as the likelihood of recurrence, by practicing the following prevention tips:

• Avoid inhalation of irritants (aerosols, tobacco smoke, chemical fumes, dust).
• Wash your hands regularly and thoroughly. This is one of the best ways to protect against bacterial and viral infections;
• humidify your home. Use a humidifier if the air in your home is too dry. This can help moisten your airways, improve the flow of mucus from your sinuses, and help prevent blockages and inflammation;
• rinse your nose with saline or saline solution. This can improve mucus flow and remove allergens and other irritants.

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GOU VPO First Moscow State Medical University named after. THEM. Sechenov

Department of Otorhinolaryngology

Disease history

Executor:

Dzhanchatova B.A.

Teacher:

Kochetkov P.A.

Moscow 2013

1. PASSPORT PART

FULL NAME: Albina Grigorievna M.

Age: 59 years old

Floor: female

Profession: pensioner

Date of application to the department: 23.09.13

Diagnosis on admission: chronic polypous rhinosinusitis, acute stage.

Complaints: for difficulty in nasal breathing, breathing through the mouth, dry mouth and discharge from the nasal cavity of a white mucous consistency, persistent difficulty in nasal breathing and nasal congestion; pain in the projection of the nasal sinuses; complete loss of smell; feeling of constant discomfort in the nose, headaches.

2. HISTORY OF DISEASE (Anamnesismorbi)

chronic polypous rhinosinusitis septoplasty

Main disease: For 15 years, the patient has been complaining of impaired nasal breathing, nasal congestion, decreased sense of smell, and scanty mucous discharge. During the first 7 years, these symptoms were seasonal with aggravation in the autumn-spring period, lasting 2 weeks with the need for daily use of local vasoconstrictor drops. She did not seek medical help. Since 2006, the symptoms have become persistent. There was a need for daily use of vasoconstrictor drops in the morning and evening. In May 2012, she applied to the Department of Otrinolaryngology of the First Moscow State Medical University named after. THEM. Sechenov, where anterior rhinoscopy and computed tomography of the nasal cavity and paranasal sinuses revealed numerous polyps of both nasal passages. A bilateral polypectomy was performed. After the operation, nasal breathing was restored. It was recommended to use intranasal glucocorticosteroids, 2 applications in each nasal passage, 2 times a day. The real deterioration of the condition began in August 2013, when nasal breathing worsened again and the need for daily use of local vasoconstrictor drops arose.

3. LIFE STORY (Anamnesisvitae)

She was born on time and grew and developed according to her age. She did not lag behind her peers in physical and mental development. Higher education in economics. Denies occupational hazards.

Family history: Married. Has two children.

Denies smoking, drinking alcohol or using drugs.

Past diseases: childhood infections (chicken pox, rubella). ARVI - up to 2 times a year.

Allergological history: Denies allergic skin rashes, angioedema (Quincke's edema), urticaria, hay fever, anaphylactic shock when taking various food and medicinal substances. Heredity: not burdened. Sister - 44 years old, healthy. Brother - 51 years old, healthy. Children: son 31 years old - healthy, son 35 years old - healthy.

Status praesens objectivus .

General condition is satisfactory. Position active. Consciousness is clear. The physique is correct. The skin is clean. The submandibular lymph nodes are not enlarged. Vesicular breathing. Heart sounds are rhythmic and muffled. Blood pressure 130/80 mm Hg. Art., heart rate 72 per minute. The abdomen is soft and painless.

Status of ENT organs :

NOSE: Nasal breathing is difficult. The septum is deviated. The middle nasal passage on the left is obstructed by large polyps. Mucous membrane the nasal cavity is pink, with a cyanotic tint. There is mucous discharge in the nasal cavity.

PHARYNX: The mucous membrane of the posterior pharyngeal wall is pink. The tonsils are behind the arches, fused to them, there is no tonsil discharge.

Nasopharynx: With posterior rhinoscopy, the dome of the nasopharynx and the mouths of the auditory tubes are free.

LARYNX: The vestibule of the larynx is not changed. The vocal cords are white, smooth along the edges, their excursion is symmetrical, in full. The subglottic space is free.

EARS: HELL-AS. In the ear canals There is no discharge, the eardrums are gray. Identification points are clear

Hearing test	Study of the vestibular apparatus
			There are no spontaneous subjective and objective vestibular symptoms
	Whispered speech
	Colloquial speech
	Loud speech O. Weber O. Federici		There is no dizziness, nausea, or vomiting. The balance is not broken
			No spontaneous nystagmus
			The finger-nose test is normal. She is stable in the Romberg position.
			Adiadochokinesis absent
Within normal limits		Within normal limits	The pressor test is negative.

General state.

The general condition is relatively satisfactory. Consciousness is clear. Position active. The facial expression is calm. Body temperature - 36.6 C. Height - 164 cm, weight - 65 kg.

Skincovers: normal humidity and color, clean. The color of visible mucous membranes is pale pink. Nail plates are of normal shape.

Subcutaneous fat: moderately developed. There is no visible swelling (on the face, legs, in the sacrum area).

Lymphatic system: Lymph nodes (submandibular, occipital, parotid, anterior and posterior cervical, supraclavicular, subclavian, axillary, cubital, periumbilical, inguinal, popliteal) could not be palpated.

Muscular system: moderately developed, symmetrically. No hypertrophy or atrophy of individual muscles was detected. The muscles are painless on palpation and have normal tone.

Skeletal system: No visible pathological changes were detected. Movements in the limbs are free and painless. The joints are not changed in shape. The range of active and passive movements is preserved. An increase in skin temperature over the joints is not detected.

Respiratory system:

Examination of the chest: The chest is symmetrical, normosthenic type, cylindrical in shape. The respiratory rate at rest is 17 per minute. There is no shortness of breath. The breathing rhythm is correct.

Palpation of the chest: painless, elastic. Voice tremors: detected with equal strength over symmetrical parts of the lungs. No focal changes in vocal tremor were detected.

Auscultation of the lungs: vesicular breathing. Adverse respiratory sounds (wheezing, crepitus, pleural friction noise) are not detected. Bronchophony is not changed, it is the same on both sides.

Circulatory system:

When examining the vessels of the neck, normal pulsation of the carotid arteries is noted (inside the sternocleidomastoid muscle). Pulsation of the jugular veins is not visible. Percussion of the borders of the heart is normal.

Auscultation: tones are muffled, rhythmic. No heart murmurs are heard. The pericardial friction rub is not detected.

Pulse examination: symmetrical on both hands. There is no pulse deficit. Frequency 70 per minute, satisfactory filling, moderate tension, normal height, amplitude, speed and magnitude.

Blood pressure 130 and 70 mmHg. Art. on both hands.

Digestive system.

The tongue is moist, not coated. The mucous membrane is pale pink. Gums: pink, do not bleed. Teeth: sanitized. Swallowing is free.

Abdominal examination: involved in the act of breathing. Round in shape, not increased in volume.

Percussion of the abdomen: a tympanic sound of varying severity is heard in all parts.

Palpation of the abdomen:

The abdomen is soft and painless. No tension in the muscles of the anterior abdominal wall was detected. Shchetkin-Blumberg's symptom is negative.

Liver examination: the boundaries and dimensions of the liver are normal.

Palpation of the spleen: not palpable.

Urinary system.

No hyperemia or swelling in the kidney area was detected. Urination is free and painless. Pasternatsky's symptom is negative on both sides. The kidneys are not palpable.

Endocrine system.

There is no thirst. Female pattern hair growth. There is no tremor of the fingers, eyelids, or tongue. The thyroid gland is not enlarged. Symptoms of Stellwag, Graefe, Mobius, Marie are negative.

Neurological status:

The patient is conscious, there is no headache, nausea, or vomiting.

Meningeal signs: Kernig's sign (direct, crossed), Brudzinski's sign (upper, middle, lower), rigidity of the occipital muscles - negative.

Additional clinical and laboratory tests:

1) General and biochemical blood tests.

2) X-ray of the nasal cavity and sinuses;

3) CT scan of the nasal cavity and sinuses.

4. FINAL DIAGNOSIS AND ITS RATIONALE

Curvature of the cartilaginous part of the nasal septum with deviation to the left. Chronic polypous rhinosinusitis (unilateral), acute stage.

The diagnosis is based on:

· patient complaints (difficulty in nasal breathing, nasal congestion, rhinorrhea, cough, sputum; pain in the projection of the sinuses, headache, decreased sense of smell).

· medical history data (for 15 years the patient has complained of impaired nasal breathing, nasal congestion, decreased sense of smell, scanty mucous discharge)

· examination data of the ENT organs (nasal breathing is difficult, the septum is curved, the middle nasal passage on the left is obstructed by large polyps, the mucous membrane the nasal cavity is pink, with a cyanotic tint, there is mucous discharge in the nasal cavity)

· data from additional research methods (CT CT): deviated nasal septum, darkening of the nasal sinuses??

5. DIFFERENTIAL DIAGNOSIS

Purulent rhinosinusitis - purulent aspirate from the sinus cavity (not observed in the patient).

Benign tumor formations - deformations and destruction of the walls of the sinuses on CT.

Malignant tumor formations - deformations and destruction of the walls of the sinuses on CT, infiltration of surrounding tissues.

6. TREATMENT PLAN

Endoscopic unilateral polypectomy, septoplasty.

The operation to remove nasal polyps is performed under general or local anesthesia. The operation involves excision of polyps using surgical instruments or a laser. In this case, the incisions are made from the inner surface of the nasal cavity, that is, there are no scars left after the operation. During the operation, the paranasal sinuses are also washed, which helps prevent the re-formation of nasal polyps. To stop bleeding from the wound after surgery, gauze swabs are inserted into the nasal passages. After a few days they are removed. After surgery, antibiotics and analgesics are prescribed. Correction of the nasal septum is usually performed endonasally. The incision is made inside the nose, the scar is subsequently not visible. Surgery to correct the nasal septum involves removing crooked sections of cartilage and bone. In this case, the mucous membrane covering the nasal septum is preserved, and after surgery there is no hole left on the septum. If the polyps recur, we prescribe a long course of treatment with topical corticosteroids; beclomethasone, flunisolide, mometasone.

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DISEASE HISTORY

Main disease: Bilateral polyposis-purulent rhinosinusitis

rhinosinusitis polyposis diagnosis

1. Initial examination of the patient upon admission

Complaints about the state of ENT organs:for nasal congestion, the presence of purulent discharge from the nasal cavity

Complaints about the condition of other organs and systems: in spring and summer there are attacks of suffocation, shortness of breath, cough with scanty mucous sputum.

History of the present disease is subjective: nasal congestion has been bothering me for 8 years; in 2008, bilateral polypoethmoidotomy was performed; a year after it, nasal congestion reappeared; cloudy white discharge from the nose appeared. She was treated by rinsing the nose with Aqualor solution, Xymelin spray, Ketotifen tablets.

Objective history of the present disease: 2008 - bilateral polypoethmoidotomy; MRI dated January 20, 2011 - the paranasal sinuses and cells of the mastoid processes of the temporal bones are developed correctly, the maxillary and frontal sinuses against the background of thickened mucosa are filled with liquid contents, the mucous membrane of the cells of the ethmoidal labyrinth is thickened, the mucous membrane of the main sinuses is slightly thickened, signs of acute rhinosinusitis; MRI dated October 20, 2014 - bilateral chronic pansinusitis (polypous? purulent?).

Anamnesis of life: grandfather, aunt, niece, granddaughter - bronchial asthma; denies tuberculosis, hepatitis, sexually transmitted diseases, HIV in himself and close relatives; chronic diseases - bronchial asthma; denies surgery or injury; living conditions - lives in a comfortable house, working conditions - there were no occupational hazards at the former place of work.

Allergy history:bronchial asthma; allergies to acetylsalicylic acid, plant pollen, pet hair; She was treated in a hospital for bronchial asthma and received treatment with glucocorticosteroids (prednisolone).

. The present condition of the patient (Status Praesens)

The general condition is moderate. Position active. Consciousness is clear. The gait is free. The facial expression is calm. Calm behavior. The constitutional type is normosthenic. Orients himself in place, time and situation. The food is ok. The skin is of normal color and moisture, there are no scars, pigmentation, rashes, or hematomas. The oral cavity is without pathology: the gums tightly grip the necks of the teeth, are pale pink in color, compact, and do not bleed when touched; there is a slight gray-white coating on the tongue, wet; The hard palate is gently sloping and covered with unchanged mucous membrane. Peripheral lymph nodes are not palpable. Changes in the respiratory system are noted: percussion sound with a slight boxy tint, auscultation - vesicular breathing, no side respiratory sounds are heard.

3. Data from an objective examination of ENT organs

Nose and paranasal sinuses (anterior rhinoscopy):external nose of regular shape; palpation at the projection points of the paranasal sinuses is painless; the vestibule of the nose is covered with unchanged skin with small hairs; mucous membrane is pale pink, swollen; the common nasal passages are narrowed due to swelling of the mucous membrane; in both halves of the nose there are smooth, gray, non-bleeding polyps that are movable when touched; the nasal septum is slightly curved in both directions; pale yellow discharge is detected in the middle and lower nasal passages; nasal breathing is difficult; sense of smell is weakened.

Oropharynx (mesopharyngoscopy): mucous membrane is moist, pink, shiny; the palatine arches are not changed; the palatine tonsils behind the arches are smooth, the lacunae are not expanded, there is no discharge from the lacunae.

Nasopharynx (epipharyngoscopy):vault the nasopharynx is dome-shaped, covered with unchanged mucous membrane; the mouths of the auditory tubes are free, polypous tissue is visible in the lumen of the right choana.

Hypopharynx (hypopharyngoscopy):the pyriform sinuses are symmetrical, there are no foreign bodies, the lingual tonsil is not changed, the swallowing function is not impaired.

Larynx and hypopharynx:upon external examination and palpation of the skeleton of the larynx, there are no pathological changes; the epiglottis looks like an unfolded pink petal; vocal folds are gray, symmetrical during phonation, completely closed; the voice is clear, loud, appropriate for age and gender; breathing is not difficult.

Ear:the auricles are of regular shape, the mastoid process is covered with unchanged skin, painless on palpation;

Otoscopy:the external auditory canal is wide, on its walls in the cartilaginous section there are lumps of sulfur, the eardrum is pearl-gray in color with all 5 identification points (anterior and posterior folds, short process, malleus handle and light reflex).

Right ear ADTestsLeft ear AS-S.Sh.-6 mW.R.6 m>6 mR.R.>6 m60 S128 /B/60 30S128 /K/30 +R+←W→Passability of the auditory tube I, II, III stages.

Vestibular passport

Right ear ADTestsLeft ear ASFinger-nose testPerformsFinger-index testPerformsRomberg testStableFlank gaitPerformsSpontaneous nystagmusAbsentPressor testNegative Otolith test (5, 10, 30)5

4. Laboratory research

Blood analysis:

Leukocytes 7.8*10 9/l

Lymphocytes 31.9%

Neutrophils 44.6% p/y 5 s/y 44

Eosinophils 5%

Basophils 1%

Hemoglobin 142 g/l

Red blood cells 4.35*10 12/l

Platelets 235*10 9 /l

The CBC shows a slight shift of the leukoformula to the left, which indicates an inflammatory process; eosinophilia indicates an allergic process.

Analysis of urine:

Color: light yellow

Reaction: sour

Density: 1020

Protein: ot.

Epithelium: absent.

Red blood cells: absent.

Bacteria: negative

No deviations from the norm were identified in the TAM.

X-ray examination: MRI dated October 20, 2014 - both frontal, maxillary sinuses, cells of the ethmoidal labyrinth are filled with liquid-soft tissue contents, spreading into the nasal cavity; in the sphenoid sinuses there is uneven parietal thickening of the mucous membrane; the nasal septum is located normally; the middle nasal passages are blocked by pathological contents spreading into the nasal cavity (more pronounced on the right); the middle turbinates are not clearly differentiated; surrounding tissues and nasopharynx without features; conclusion - bilateral chronic pansinusitis (polypous? purulent?).

5. Rationale for clinical diagnosis

The diagnosis is based on:

)Complaints: nasal congestion, purulent discharge from the nasal cavity.

)History of the present disease: the patient has been diagnosed for 8 years; in 2008, surgical treatment was performed (bilateral polypoethmoidotomy).

)Objective examination data: anterior rhinoscopy reveals smooth, gray, non-bleeding polyps in both halves of the nose that are movable when touched; pale yellow discharge is detected in the middle and lower nasal passages; nasal breathing is difficult; sense of smell is weakened.

)Data from laboratory and instrumental research: conclusion based on MRI data dated October 20, 2014 - bilateral chronic pansinusitis (polypous? purulent?).

6. Differential diagnosis

At chronic ethmoiditissymptoms depend on the active process. During the period of remission, the patient is periodically bothered by a headache, often in the area of ​​the root of the nose, bridge of the nose, sometimes diffuse. In the serous-catarrhal form, the discharge is light and copious. The purulent form is accompanied by scanty discharge, which dries out and forms crusts. Often nasal discharge has an odor. Involvement of the posterior cells of the ethmoidal labyrinth in the process leads to the accumulation of nasopharyngeal discharge more often in the morning, and it is difficult to expectorate. The sense of smell is usually impaired to varying degrees. Rhinoscopy reveals catarrhal changes mainly in the middle sections of the nose, and polypous formations are also localized there.

The general condition of patients remains satisfactory, but irritability, general weakness, and increased fatigue may be noted. During an exacerbation, symptoms of acute inflammation appear (profuse nasal discharge, difficulty breathing, pressing pain in the dorsum of the nose, fever).

Chronic rhinitis- this is a fairly large group of diseases with common symptoms: the main ones are nasal discharge, difficulty in nasal breathing, decreased sense of smell. Patients may be concerned about the following symptoms: itching and burning in the nose, headache, sneezing, fatigue and drowsiness, crust formation, dry nose, unpleasant odor, minor nosebleeds, irritation of the skin of the wings of the nose and upper lip, accumulation of thick mucus in the nasopharynx, snoring and poor sleep quality .

Acute sinusitis.The most common cause of acute sinusitis is acute respiratory viral infections (ARVI), which can be caused by influenza viruses, rhinoviruses, adenoviruses, staphylococci and other pathogens.

In acute inflammation of the paranasal sinuses, as a result of swelling of the mucous membrane of the sinuses, the sinus outlet closes and the infection accumulates in the sinus, without having a free outlet, which leads to the development of inflammation in the paranasal sinuses.

Acute sinusitis is manifested by headache, fever, congestion and purulent discharge from the nose, swelling of the soft tissues of the face in the area of ​​the affected sinus.

7. The need for surgical treatment

Bilateral ethmoidopolypotomy is recommended. Indications for polypotomy are serious nasal breathing disorders, purulent-inflammatory diseases of the nasal cavity, as well as the lack of effect of conservative treatment. Surgical treatment of polyps is contraindicated in case of: exacerbation of chronic obstructive bronchitis or bronchial asthma, during the flowering season of allergenic plants in the surgical and postoperative period.

8. Drug treatment

Rp.: Tab. Amoxiklav №14

D.S. one tablet 2 times a day for 7 days

For antihistamine purposes:

Rp.: Tab. Cetrini 0.01 No. 5

D.S. 1 tablet 1 day per day for 5 days

To relieve nasal congestion:

Rp.: Aer. Rinofluimucili - 10ml

D.S. one injection into each nasal passage strictly as needed, no more than three times a day

For irrigation purposes, irrigation of the nasal cavity with saline solutions (Aquamaris, Aqualor, Salin) is used.

List of used literature

1. Palchun V.T., Magomedov M.M., Luchikhin L.A. Otorhinolaryngology - M., 2011

Ovchinnikov Yu.M. Diseases of the nose, pharynx, larynx and ear: a textbook for students of medical universities - M., Medicine, 2003