Evaluation of the results of complex medical rehabilitation of patients with polyposis rhinosinusitis in the long-term period

Abstract

BACKGROUND: Previous studies on the comparative evaluation of the effectiveness of the course application of therapeutic physical factors during the complex medical rehabilitation of patients with polypous rhinosinusitis showed a rather high efficiency of the additional use of complex physiotherapy (alternating magnetic field and low-intensity laser therapy) in enhancing the regression of the main clinical manifestations of polypous rhinosinusitis and improving the quality of life (QoL) of patients. Considering the chronic and often recurrent nature of polypous rhinosinusitis, along with the relief of the main clinical manifestations of the disease and improvement in the quality of life of patients after treatment, medical rehabilitation of patients should also cover the long-term period.
 AIM: Evaluation of the results of complex medical rehabilitation of patients with polyposis rhinosinusitis in the long-term period (after 6, 12 and 18 months) and determination of the optimal time parameters for a repeated course of physiotherapy aimed at maintaining the achieved clinical effect and the level of quality of life of patients.
 MATERIALS AND METHODS: The study was performed with the participation of 120 patients with moderate to severe polypous rhinosinusitis and uncontrolled course. All patients were divided into 4 groups by simple fixed randomization. The first group (control, 30 patients) received only basic therapy, including endonasal application of Nasonex 2 doses 2 times a day and daily twice daily lavage of the nasal mucosa. Patients of the second group (comparison group 1, 30 patients) were additionally injected subcutaneously with dupilumab at a dose of 300 μg once every two weeks. In the third group (comparison group 2, 30 patients), against the background of the administration of dupilumab, exposure to an alternating magnetic field was performed. using the apparatus MAGNIT Med TeCo. Patients of the fourth group (main group, 30 patients), in addition to the volume of treatment of patients of the third group, received low-intensity laser radiation of the red spectrum (633 nm) using the AZOR-2K-02 apparatus.
 RESULTS: Positive dynamics in terms of assessed clinical indicators throughout the entire observation period was noted only in the comparison groups and the main group. The maximum severity of positive changes was determined in the main group after 6 and 12 months of rehabilitation, exceeding the achieved values in the group with dupilumab. The follow-up period made it possible to establish that 18 months after the start of rehabilitation, there were no significant differences between these groups. The dynamics of the parameters of the microcirculatory tissue system in the comparison groups and the main group in the long-term period indicated the formation of compensatory-adaptive processes aimed at eliminating congestion in the nasal mucosa and associated hypoxia, as well as the normalization of oxygen metabolism and trophism of tissues prone to chronic inflammation.
 CONCLUSION: The results obtained convincingly prove the effectiveness of additional course use of an alternating magnetic field in combination with low-intensity laser therapy. The use of this technology, implemented against the background of ongoing biological therapy, shows its increased efficiency up to 12 months after the start of medical rehabilitation. It is advisable to conduct a second course of physiotherapy based on the complex use of an alternating magnetic field and low-intensity laser radiation 9–12 months after the start of medical rehabilitation.