Abstract
Treatment of polyposis rhinosinusitis is currently an urgent problem of modern otorhinolaryngology. A significant increase in the prevalence of the disease with polypous rhinosinusitis (from 5 to 20%) and a high frequency of relapses are due to insufficiently studied pathogenetic mechanisms for the development of the polypous process and the lack of effective methods of treatment. The combination of this disease with bronchial asthma, the asthmatic triad and the addition of a purulent process significantly complicate the course and treatment of patients with polypous rhinosinusitis. In accordance with the multifactorial theory, the development of polyposis rhinosinusitis occurs as a result of mechanical, physical factors, as well as the penetration of microbial, fungal and viral agents on the surface of the nasal mucosa. This leads to the activation of the mechanisms of local immunity, which is a whole complex of specific and non-specific reactions that provide the barrier function of the mucous membrane. Long-term exposure to various agents leads to a decrease in the activity of the protective barrier of the nasal mucosa and stimulates the development of an infection-dependent allergic process. The latter is accompanied by a violation of immune homeostasis in the form of secondary immunodeficiency, the formation of persistent immune eosinophilic inflammation, leading to remodeling of the nasal mucosa and the development of polypous rhinosinusitis.
Highlights
The chronic course of the inflammatory process in the paranasal sinuses leads to significant changes in the state of humoral immunity, changes in the concentration of class A, M, and G immunoglobulins, suppression of the phagocytic activity of neutrophils and macrophages [1–4]
The level of immunoglobulin E in the blood serum is a marker of "preclinical" registration of allergy in nasal polyposis, which can serve as a background for changes in the level of reactivity of the body [10-11]
We examined 128 patients with polypous rhinosinusitis aged 18 to 50 years, including 83 men and 45 women
Summary
The chronic course of the inflammatory process in the paranasal sinuses leads to significant changes in the state of humoral immunity, changes in the concentration of class A, M, and G immunoglobulins, suppression of the phagocytic activity of neutrophils and macrophages [1–4]. According to a number of authors, dysfunction of the mucous membrane of the nasal cavity and paranasal sinuses is accompanied by metaplasia, desquamation of the epithelium and, as a result, a violation of its motor activity [5-9]. The appointment of short courses of systemic corticosteroid therapy in the treatment of polypous rhinosinus, combined with bronchial asthma or the asthmatic triad, accompanied by frequent relapses of the polyposis process, allows achieving long-term remission and significantly improving the quality of life of patients [13-16]. Long-term use of these drugs, due to a pronounced immunosuppressive effect, weakens the protective immune responses of the body due to inhibition of production and increased apoptosis of immature or activated T- and B-
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