Our experience in the treatment of Polypoid rhinosinusitis
Formation and growth of recurrent polyps, consisting mainly of edematous tissue infiltrated by eosinophils. Chronic disease of the nasal cavity and paranasal sinuses. Preconditions for the widespread use of laser therapy in the treatment of ENT diseases.
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Our experience in the treatment of Polypoid rhinosinusitis
Today, chronic rhinosinusitis in many countries is one of the most common ailments among all chronic human diseases. Over the past 10 years, the incidence has increased by 2 times .
One of the most complex forms of chronic rhinosinusitis, both in terms of clinical course, and in terms of the treatment is polypoid rhinosinusitis (PRS).
Polypoid rhinosinusitis (PRS) - a chronic inflammatory disease of the mucous membrane of the nasal cavity and paranasal sinuses characterized by the formation and growth of recurrent polyps, consisting mainly of edematous tissue infiltrated by eosinophils .
In accordance with the normative document EP3OS, adopted in 2012, ORS - a chronic disease of the nasal cavity and paranasal sinuses characterized by two or more necessarily present symptoms: block (obstruction), nasal congestion and runny nose (rhinorrhea), and accompanying symptoms (pain or voltage in the forehead and the nose, and reduced loss of smell), continuing for more than 12 weeks.
Filed EP3OS about 1% of the world's population suffer from CP .
The frequency of the CP has a clear upward trend, the proportion in the structure of the incidence of upper respiratory tract is 5-20% .
At the present time, despite the large number of studies and proposed treatments, including conservative medical treatment, will limit and postpone the surgery, the PRS is one of the most problematic and unresolved pathologic conditions in modern otolaryngology .
One of the main preconditions for the widespread use of laser therapy in the treatment of ENT diseases is the fact that this method of exposure has virtually no contraindications . polyp nasal cavity therapy
Material and Methods. In the ENT clinic Khorezm Regional Multidisciplinary Center Hospital conducted a retrospective analysis of 2930 patient records for 2011-2013. and in the period from 2013 to 2016. investigated the state of the nasal cavity in 60 patients with CP aged 14 - 60 years. CP diagnosis is put on common criteria on the basis of complaints, anamnesis, data front, rear rhinoscopy, radiography of the paranasal sinuses. Determines the general condition of patients, the presence of comorbidities. Patients IRS investigated the respiratory, olfactory function of the nasal cavity by methods VI Voyachek.
To solve the problem of allergic status of the patients and find out your own family allergic history, we explored the eosinophilia of peripheral blood. Of the total number of examined patients with nasal pathology and SNPs detected in 1110 patients, accounting for 38%. The frequency of PRS was 3.2% of the total number of patients and 8.3% among patients with nasal pathology and SNPs were detected in 92 patients. In recent years we have seen an increase in uptake of patients on the IRS from 5.8% in 2011 to 10.4% - in 2014 the number of patients with nasal pathology and SNPs (Figure 1).
Figure 1 Proportion of CP among patients with nasal disease and ED
Of the 40 surveyed (66.6%) patients were males, 20 (33.4%) - female, combined with those of other authors. Basically, the prevalence of CP was the same in all age groups (Table. 1).
The vast majority of patients - 53 (89.2%) were from patients with polypous etmoidita (PE), so only those patients were included in our study. In 32% of patients with polyps in the nasal cavity were found on both sides, in 68% of cases of polyposis has been one-sided.
General condition of PE observed patients was satisfactory. Patients complained of shortness of nasal breathing, headache, fatigue, poor sleep. In 17 patients the complaints were observed 6 months, 12 - 1year, from 23 - 1-3 years, from 8 - more than 3 years. 28 patients had a history of provedna polipotomiya 1 time, 32 patients had polipotomiya 2 or more times. The period of relative remission in these patients averaged 1.7 years. At the front of the nasal cavity rhinoscopy in small polyps detected in the form of bunches of grapes or a single large polyps, which prevents review of the nasal cavity, originating from the upper nasal cavity. At the rear rhinoscopy with a large duration of the disease polypous fabric reaches the posterior nares, nasopharynx but not performed. Nasal breathing is difficult or absent; hyposphresia degree depended on the degree of nasal breathing and fullness of the nasal cavity polypous cloth. Radiographs of the sinuses stated homogeneous veil ethmoid sinus. In 8 patients (13%) revealed a positive allergic history. Hemogram were within normal limits. Patients with moderate positive allergenic status eosinophilia was detected in the peripheral blood. In 36 patients (61%) (I group), resorting to surgical removal of polyps, we have not performed a wide opening of ethmoid sinus cells, as Today it is believed that in the widely exposed ethmoid sinus cavities inevitably newly formed polyps, probably as a result of the mechanical action of the air stream, causing a productive inflammation of the mucous membrane and its polypoid degeneration . All patients who underwent nasal polipotomiya postoperative Flutineks administered in a daily dose of 400 micrograms (2 x double injection into each nostril) during 3 months from 4 days after surgery. In group I patients, along with Flutineksa since 4 days after surgery topically applied photodynamic laser therapy apparatus "East" of the radiation range of 0.89 microns, the power unit of 3.0 mW, the radiation frequency - 4000 Hz, 2.4 Hz pulse modulation daily, a course of 10 treatments.
In 16 patients (26%) (II group) conducted conservative therapy local corticosteroids Flutineks (fluticasone propionate, «Asfarma») a daily dose of 400 mg (2 x double injection in each half of the nose) for 6 months and photodynamic laser therapy from the very first Flutineksa days of application in the same way. In both groups of patients subsequently administered 200mkg Flutineksa (1x double injection into each nostril), 2 times per year for 2 months with photodynamic laser therapy every time course of 10 treatments the first day of preparation.
The result of treatment in both groups were evaluated at 6 and 12 months, encouraging patients to be receiving every subsequent 6 months. For a good treatment of the effectiveness of the condition of patients with complete absence of polyposis in the nasal cavity at the front rhinoscopy and smell in full; for satisfactory effect - in the absence of nasal polyposis at the front rhinoscopy and hyposphresia I and II degree; for the lack of effect - in the presence of nasal polyposis at the front rhinoscopy. In group I, the good treatment efficacy is ascertained in 32 patients (78.2%) at 6 months and in 28 patients (74.4%) at 1 year.
In group II, a good effectiveness of treatment was in 17 patients (53.1%) at 6 months and 6 patients (18.8%) at 1 year.
The effectiveness of treatment in both groups displayed in Figure 2.
1. Conduct directed medical treatment of TCS in the background photodynamic laser therapy allows you to limit and delay the recurrence of nasal polyps, and improve patients' quality of life
2. Complex treatment with dynamic dispensary observation can guarantee rarer relapse rate and thus a longer period of disability of patients.
3. The effectiveness of complex treatment of CP after surgical treatment is maintained for a longer period, extending the period of a satisfactory quality of life.
1. Volkov AG Trofimenko SL On the problem of drug treatment of chronic polypoid rhinosinusitis // Herald of otorhinolaryngology, 2010. №4. with 41-44.
2. Lopatin AS Modern theories of the pathogenesis of polypoid rhinosinusitis. // Pulmonology. 2003. №5. S. 110-116
3. LG Petrov Principles of treatment of polypoid rhinosinusitis c using intranasal steroid "Nasonex" preparation // Medical news. 2008. №5. S. 58-63
4. Sviridenko LY Experience in the treatment of frequently ill children with the use of laser therapy and speleotherapy // Photobiology and photomedicine. 2010. T.VIІ, number 1, 2. P. 47-50.
5. EP3OS Primary Care Guidelines: European Position Paper on the Primary Care Diagnosis and Management of Rhinosinusitis and Nasal Polyps 2012 - a summary. Prim Care Respir J 2012; 35: 3: 64-69.
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