Comparative analysis of some methods of surgical treatment of vasomotor rhinitis

Abstract

Among chronic forms of rhinitis of great importance is vasomotor rhinitis, which is the most common form of chronic non-allergic rhinitis and the clinician has to deal with it constantly. Treatment of vasomotor rhinitis is a complex and largely unresolved problem, which puts this disease among the important problems of modern rhinology. The variety of methods used in the treatment of patients with vasomotor rhinitis confirms the complexity of the task of choosing the optimal method for clinicians and the difficulty of obtaining a sustainable result from the chosen method. Surgical treatment of patients with of patients with various forms of chronic rhinitis is sometimes the only effective. Currently, the arsenal of methods and means of surgical treatment of the nasal concha is quite wide and varied. The purpose of this study – to study in a comparative aspect the functional state of the nasal cavity after carrying out some methods of surgical treatment ofvasomotor rhinitis. Materials and Methods: The study was conducted in the clinic of the Department of Otorhinolaryngology of the Tashkent institute of postgraduate medical education on 43 patients with vasomotor rhinitis in age from 20 to 46 years, average age 28,0±1,3 years. All patients with BP included in our study, after collecting complaints and anamnesis, underwent an endoscopic examination of the nasal cavity and nasopharynx, a computerized tomogram of the nose and paranasal sinuses, standard laboratory tests and microscopy of a smear from the nasal cavity on eosinophils.Investigated the respiratory (computer rhinopneumocotachometry), transport (saccharin test) functions of the nasal mucosa, performed an adrenaline test and the Flour test (determination of the consistency of inferior nasal concha and the response to pushing with a push-button probe). Results: Studies have shown the highest efficiency of laser coagulation with vasomotor rhinitis. After laser surgery, a long-lasting and sustained improvement in the functions of the nasal cavity was noted, while there was no adverse effect on the mucous membrane of the nasal cavity, which was reflected in the recovery rates of both nasal breathing and mucociliary clearance. Given the well-tolerated laser coagulation, the lack of the need for observation and care of the nasal cavity in the postoperative period, the possibility of outpatient treatment, allows us to recommend this type of exposure as the method of choice in the surgical treatment of patients with vasomotor rhinitis. The simplicity of submucosal vasotomy, the availability of instruments for carrying out, the restoration of free nasal breathing and the positive effect on the functional state of the nasal cavity, although slower than laser coagulation, minimal side effects put it on a par with the laser effect. The need to use tampons after surgery reduces the quality of life of patients, hospital stays and the need to monitor patients in the early postoperative period makes this operation strictly inpatient. Electrocautery of inferior nasal concha demonstrated in our study a negative effect on the function of the nasal cavity, although, of course, there was a definite improvement in nasal breathing, but the severity and speed of improvement was significantly less than during laser exposure and submucosal vasotomy. The slowest and most incomplete restoration of the mucociliary clearance of the nasal cavity once again underlines the disadvantage of this method. Conclusion: Evaluation of the long-term results of surgical treatment based on the combination of effects on the respiratory and transport functions of the nasal cavity, as well as on the clinical manifestations of BP, makes it possible to recommend laser coagulation as the most optimal method providing a long-lasting effect in treating patients with vasomotor rhinitis. Alternatively, you can take a submucosal vasotomy of the inferior nasal concha.