Hypertrophic Rhinitis Research Articles

ANALYSIS OF UNSUCCESSFUL EXTERNAL DACRYOCYSTORINOSTOMY IN PATIENTS WITH CHRONIC DACRYOCYSTITIS AND WAYS TO ELIMINATE THEM

The purpose of this study is to analyze the causes of relapses of chronic dacryocystitis. Material and methods. The research included 24 patients who were operated in our clinic from January 2018 to September 2022. All patients had been previously operated on for external dacryocystorhinostomy. 14 patients underwent endonasal dacryocystorhinostomy surgery resulted from traumatic dacryocystitis. All patients received a standard ophthalmologic and dacryologic examination, including functional tests to assess the patency of the lacrimal drainage system. All patients were prescribed endonasal dacryocystorhinostomy. All patients also underwent intraoperative examination and, if necessary, CT scan. The severity of lacrimation was assessed before and after the operation using a point scale from 0 to 4: a score of 0 indicated an absence of lacrimation complaints, 1 denoted mild lacrimation, 2 signified moderate lacrimation, 3 indicated lacrimation occurring solely outdoors, and 4 represented severe lacrimation both indoors and outdoors. All patients underwent examinations 1, 3, 7 days, 1 month, 3 months, and 6 months post-surgery. A successful outcome, defined as a score of 0 points, was achieved in 95.8% of cases. Results. In the majority of patients operated because of traumatic dacryocystitis, a rhinological examination revealed displacement and deformation of the nasal bones, hypertrophic rhinitis and other nasal diseases. Moreover, intraoperative examination revealed a poor-quality anastomosis due to scar tissue, the presence of movable bone fragments in the area of rhinostomy and displacement of the lacrimal sac. Other reasons for relapse included insufficient drainage and incorrectly formed bone hole in the wall of the nose. Conclusions. Drainage of the formed anastomosis is a prerequisite for successful surgery of chronic dacryocystitis. Factors that increase the likelihood of relapses are significant changes in the topography of the tear ducts, as well as scar tissue changes in the rhinostomy area and the nasal mucosa. The correct choice of surgical treatment method (in our case, EDCR) in patients with recurrent chronic dacryocystitis, it allows to increase the effectiveness of surgical treatment of these patients.

Comparison of complete nasal packing with and without integrated airways.

To compare the effects of nasal packing using a Nasopore nasal packing with and without an airway tube on postoperative pain, SpO2, nasal obstruction, and difficulty in breathing complaints. This comparative study was conducted at Dow University of Health Sciences (DUHS), DMC Civil Hospital Karachi between September 18, 2021, to May 19, 2022. A total of 70 patients who underwent septoplasty for septal deviation and chronic hypertrophic rhinitis were equally divided into two groups. Group-A patients received nasal packing using a Nasopore nasal packing with an airway tube, and Group-B patients received nasal packing using a Nasopore nasal packing without an airway tube. Post-operation Nasal pain sensations were measured using the Wong-Baker Faces Pain Rating Scale at 2 and 12 hours. SpO2 was measured at 30 minutes pre-operatively with an O2 saturation monitor and 12 hours post-operatively during sleep. The postoperative pain at two hours and 12 hours was compared between the two groups, and a significant difference was observed. In Group-A, the average SpO2 decreased > 4% from baseline in 5.7% patients, and 37% in Group-B. A significant difference was observed in the severity of nasal obstruction and difficulty breathing, P-value < 0.05. It is concluded that septoplasty followed by applying nasal packing with integrated airway reduces postoperative pain and improves oxygen saturation compared to nasal packing without integrated airways.

The use of acoustic rhinometry as a postoperative evaluation method in children with chronic hypertrophic rhinitis

acoustic rhinometry has opened new perspectives in the objective estimation of nasal physiology. With the help of this method, it is easy to determine the geometry of the nasal fossae, using minimal resources. The method offers an objective control of the surgery of the cartilages and bones of the nasal pyramid. That method represents an objective method of measuring nasal permeability, which in recent years is increasingly used in pediatric patients. In this study, we aim to evaluate nasal patency in children with chronic hypertrophic rhinitis. Study of nasal permeability using acoustic rhinometry in children with chronic hypertrophic rhinitis in order to evaluate the effectiveness of diode laser surgical treatment for hypertrophy of the inferior nasal turbinate. The study was conducted on 50 children with chronic hypertrophic rhinitis. The comparison group was represented by the control group, which includes 50 children without nose and paranasal sinus pathology. These children were selected from the number of patients hospitalized in the clinic with other forms of pathology. In patients from the study groups, nasal patency was evaluated at certain postoperative time intervals, in order to determine the efficiency of the applied surgical technique. There is a dynamic increase in nasal cavity volumes and ASTmin postoperatively in patients from the study group. Compared to the control group, the differences are insignificant, which indicates that the surgical treatment had an effect. Acoustic rhinometry is an objective method of evaluating the geometry of the nasal cavities, with a special role in the postoperative monitoring of patients with chronic hypertrophic rhinitis

INFLUENCE OF PLASTIC SURGERY OF THE INFERIOR TURBINATE ON THE PATENCY OF THE EUSTACHIAN TUBE

Introduction: Chronic hypertrophic rhinitis is one of the most common diseases in rhinology. Various surgical techniques are used to reduce hypertrophic changes in the inferior turbinates. The aim of our study is to determine the impact of plastic surgery of the lower nasal turbinates, performed by cryoablation or radiocoblation, on the patency of the Eustachian tube and to determine how long the waiting period should be for activities that particularly require patent ear tubes, such as traveling by plane. Material: A total of 70 patients treated at the Department of Otolaryngology of the Military Institute of Aviation Medicine were qualified for the study. Due to the technique of conchoplasty of the lower nasal turbinates, the patients were divided into two groups. Group I consisted of 35 patients, including 15 women and 20 men, aged 24 to 62 (mean 42.67 years), operated on by cryoablation. Group II also comprised 35 patients, including 12 women and 23 men, aged 29 to 69 (mean 44.21 years), operated on by radiocoblation. Methods: Plastic surgeries of the lower nasal turbinates, also known as conchoplasties, were performed under local anesthesia with a cryosurgery machine with the use of a nasal applicator and an apparatus for submucosal coblation with the use of radio waves. The patency of the Eustachian tube was assessed by tympanometry before the operation and 1, 2 and 3 weeks after the operation. Results: No statistically significant (p &lt; 0.001) disturbances of the patency of the Eustachian tubes were observed after conchoplastic surgeries, using both the cryoablation and radiocoablation methods. Conclusions: Conchoplasties of the lower nasal turbinates performed by cryo- and radiocoblation do not impair the patency of the Eustachian tubes. After operations on the lower nasal turbinates, the waiting period for activities that particularly require patent tubes should be two weeks.

Pleiomorphism of the cytokine profile in nasal polyp tissue depending on the phenotype of chronic rhinosinusitis with nasal polyps

To compare inflammation response in patients with different phenotypes of CRSwNP according to level secretion of the key cytokines in nasal polyp tissue. 292 patients with CRSwNP were divided into four phenotypes: group 1 - CRSwNP without respiratory allergy (RA) and without BA; group 2a - CRSwNP+ AR with aBA; group 2b - CRSwNP+AR without aBA; group 3 - CRSwNP+nBA. Control group (n=36) included patients with hypertrophic rhinitis without atopy or BA. Using multiplex assay we defined the level of IL-1β, IL-4, IL-5, IL-6, IL-13, IFN-γ, TGF-β1, TGF-β2, TGF-β3 in nasal polyp tissue. The evaluation of cytokines levels in nasal polyps in different CRSwNP phenotypes showed a pleiotropy of different cytokine secretion depending on different comorbid pathology. In control group we estimated the lowest levels of all detected cytokines in comparison with other CRS groups. High levels of local proteins IL-5 and IL-13 and low levels of all isoform of TGF-β characterized CRSwNP without RA and BA. The combination of CRSwNP with AR showed high levels of proinflammatory cytokines IL-6 and IL-1β, and high levels of TGF-β1 and TGF-β2. The combination of CRSwNP with aBA estimated low levels of proinflammatory cytokines IL-1β, IFN-γ; in case of CRS+nBA we determined the highest levels of TGF-β1, TGF-β2 and TGF-β3 in nasal polyp tissue. Each CRSwNP phenotype is characterized by different mechanism of local inflammation. This underlies the necessity to diagnose BA and respiratory allergy among these patients. The evaluation of local cytokine profile in different CRSwNP phenotypes can help to determine the target anticytokine therapy for patients who has low efficacy of basic corticosteroid therapy.

Влияние назальной обструкции на газово-электролитный баланс организма

According to statistics, the most common complaint to an ENT doctor is difficulty in nasal breathing. The leading cause of such complaints is the curvature of the nasal septum, vasomotor and hypertrophic rhinitis. These conditions cause changes in the quality of life in the human body, and most importantly, the development of chronic diseases. The purpose of the study: to identify general patterns in patients with nasal obstruction, to develop recommendations for managing patients in the postoperative period. Patients and methods. In the period from 2018 to 2020, we examined 96 people aged 20 to 40 years: 72 of them were men, 24 were women with varying severity of nasal obstruction syndrome. The control group consisted of 16 people who did not complain of difficulty in nasal breathing. The patients were divided into two groups: those who received conservative treatment, and the group that was planned to undergo a surgical intervention aimed at eliminating nasal obstruction. Further, in patients of both groups, indicators of the acid-base state of venous blood were evaluated. Results. Indicators of the acid-base state of venous blood in patients of the group treated with a course of nasal decongestants and intranasal glucocorticosteroids remained practically unchanged after the treatment. Recovery of indicators of the acid-base state of venous blood in patients who underwent surgery is fully determined by the third month after the surgical treatment. Conclusions: The prevalence of diseases, including the hypoxic component, determines the need to study and understand the mechanisms of hypoxia, as well as the issues of eliminating oxygen deficiency, the process of adaptation to it.

Management of hypertrophic rhinitis by application of Kadali kshara

Nasal obstruction is a predominant symptom in hypertrophied inferior turbinate. It can be understood as Nasanaha (~nasal obstruction) in Ayurveda. Even though there are many conditions of the nose causing nasal blockage; inferior turbinate hypertrophy which is a cardinal feature in hypertrophic rhinitis is one of the most common causes of anatomical nasal obstruction, the others being internal nasal valve stenosis and septal deviation. The turbinate hypertrophy in this condition can be managed medically using nasal decongestants and corticosteroids and it can be also managed surgically. Continuous use of nasal decongestants can cause rebound congestion. Surgical management also has limitations such as synechiae formation and postoperative bleeding. Kshara pratisarana (~external application of alkali), which is one among the types of parasurgical procedures explained in Ayurveda, can be used effectively in this condition. Moreover, nasal obstruction is one of the most common symptoms presented to an otorhinolaryngologist and it badly affects the quality of life of the patient. The present case report is a case of a 24-year-old female who was unable to sleep properly due to severe nasal obstruction and chronic rhinitis along with hypertrophy of both inferior turbinates. This also affected her studies badly. She also complains of thick nasal discharge along with obstruction. The patient had the complaints for two years but the symptoms became more severe during the past six months. On anterior rhinoscopic examination using Thudicum's nasal speculum, the presence of bilateral inferior turbinate hypertrophy was observed. The patient was treated with Pratisarana of Kadali kshara (~alkali of Musa paradisiaca Linn.) along with Sigrusimhyadi taila nasya. The treatment was effective in the present case with no recurrence during a follow-up period of 30 days. This case report revealed that nasal obstruction, which is a common problem seen nowadays can be managed effectively using Ayurvedic intervention.

TRPA1/M8 agonists upregulate ciliary beating through the pannexin-1 channel in the human nasal mucosa

BackgroundNasal breathing is important for maintaining physiological respiration. However, airflow in the nasal cavity has an inherent cooling effect and may suppress ciliary beating, an essential frontline defense in the airway. Nasal airflow is thought to be perceived by thermoreceptors for cool temperatures. We herein investigated the effect of the activation of thermosensitive transient receptor potentials (TRPs) for cool/cold temperatures on ciliary beating to search for a compensatory mechanism.MethodsInferior turbinates were collected from patients with chronic hypertrophic rhinitis. Ex vivo ciliary beat frequency (CBF) and ATP release were measured using a high-speed digital video camera and by luciferin-luciferase assay, respectively. Intracellular Ca2+ ([Ca2+]i) imaging of isolated ciliated cells was performed using Fluo-8. The nasal mucosae were also subjected to fluorescence immunohistochemistry and real-time RT-PCR for TRPA1/TRPM8.ResultsCBF was significantly increased by adding either cinnamaldehyde (TRPA1 agonist) or l-menthol (TRPM8 agonist). This increase was inhibited by pannexin-1 blockers, carbenoxolone and probenecid. Cinnamaldehyde and l-menthol also increased the ATP release from the nasal mucosa and [Ca2+]i of isolated ciliated cells. Immunohistochemistry detected TRPA1 and TRPM8 on the epithelial surface including the cilia and in the submucosal nasal glands. Existence of these receptors were confirmed at the transcriptional level by real-time RT-PCR.ConclusionsThese results indicate the stimulatory effect of the activation of TRPA1/TRPM8 on ciliary beating in the nasal mucosa, which would be advantageous to maintain airway mucosal defense against the fall of temperature under normal nasal breathing. This stimulatory effect is likely to be mediated by pannexin-1.

The Roles of Vascular Endothelial Growth Factor, Angiostatin, and Endostatin in Nasal Polyp Development

Background and Objectives: Microvascular remodeling and angiogenesis are elements of tissue remodeling characteristic of chronic inflammatory diseases, including nasal polyps (NPs). Angiogenesis reflects the balance between the actions of pro- and anti-angiogenic factors. Many pro-angiogenic factors are known, including vascular endothelial growth factor (VEGF). A number of anti-angiogenic factors (e.g., angiostatin and endostatin) also has been identified. Our objective was to assess the roles of VEGF, angiostatin, and endostatin in NP development.Methods: The expression levels of VEGF, angiostatin, and endostatin were measured in NPs harvested during endoscopic endonasal surgery and compared with those in inferior turbinate mucosa (control) samples acquired from patients with hypertrophic rhinitis without allergy. Western blotting and immunohistochemical staining were used to analyze all samples.Results: The levels of VEGF and angiostatin were significantly higher in the NP subjects than in the controls. Neither the VEGF/angiostatin ratio nor the endostatin level differed significantly between the two groups. However, the VEGF/endostatin ratio was significantly higher in the NP than in the control group. Both the NP and control tissues were diffusely immunoreactive for VEGF, angiostatin, and endostatin.Conclusion: NP-associated hypoxia can elevate angiostatin level; moreover, an imbalance in the VEGF/endostatin ratio can contribute to NP formation.

Transforming growth factors TGF- β1, TGF- β2 and TGF- β3 in the tissue of nasal polyps in different phenotypes of chronic rhinosinusitis with nasal polyps

Chronic rhinosinusitis with nasal polyps (CRSP) is a heterogenous disease. We have earlier detected differences in severity of clinical manifestations, cellular infiltration degree shown in nasal polyps, of eosinophil-to-neutrophil ratio, efficacy of intranasal glucocorticosteroid baseline therapy, and various inflammatory patterns for several cytokines on the mRNA expression level in different phenotypes with isolated CRSP cases, CRSP associated with respiratory allergy (RA), or non-allergic bronchial asthma.The purpose of this work was to study the cytokines of TGF-â family in the tissues of nasal polyps in patients with different CRSP phenotypes. The research involved 292 patients suffering from CRSP divided into 3 phenotypic groups. Group I consisted of patients with isolated CRSP free of associated BA and/or sensitization to atopic allergens. Group II included patients with CRSP combined with respiratory allergy and was further divided into two subgroups. I.e., Group 2a comprised patients with CRSP, allergic BA (aBA), and allergic rhinitis (AR), while the patients with CRSP, AR, and non-allergic BA were placed to the group 2b. The patients suffering from CRSP complicated with non-allergic BA were allocated to the group III. The patients with hypertrophic rhinitis served as control. The levels of TGF-â1, TGF-â2, and TGF-â3 proteins (pg/mg) were measured by means of multiplex immunoassay approach in supernates of tissue homogenates from nasal polyps removed by surgery, and in posterior parts of inferior nasal conchae. The total protein level was determined in tissue supernatant, with cytokine contents recalculated for the mg/ml protein concentration for standardization of measurements.In the control group, trace concentrations of all three growth factors were detected. Significant difference in protein contents was found for the studied cytokines, depending on CRSP phenotype. The levels of TGF-â1 and TGF-â2 were statistically lower in isolated CRSP than in other groups of comorbid CRSP patients. TGF-â1 and TGF-â2 concentrations were significantly lower in CRSP + allergic BA group IIa than in CRSP + nonallergic BA and CRSP + RA groups. The amount of TGF-â3 cytokine was maximal in CRSP + non-allergic BA group III compared to the patients with isolated CRSP of group I and CRSP + non-allergic BA group 2a.Conclusions.The high level of all three TGF-â isoforms in patients with CRSP compared to the control group suggested a high potential of mucous membranes of paranasal sinuses for active tissue remodeling followed by nasal polype formation.Different mechanisms were presumed for development of local pathological process in different clinical phenotypes of CRSP, depending on the comorbid pathology, especially, BA or respiratory disorders.Minimal TGF-â1 and TGF-â2 levels were detected in isolated CRSP.The highest concentrations of TGF-â1, TGF-â2, and TGF-â3 were discovered in the patients with CRSP accompanied by non-allergic BA as compared to the groups with isolated CRSP and CRSP+allergic BA.5. Determination of TGF-â1, TGF-â2, and TGF-â3 levels can serve as an additional criterion for differentiating between the mechanisms of mucous membrane damage in local pathological process in tissues of comorbid patients with different CRSP phenotypes.

Expression of T-Type Voltage-Gated Calcium Channel in the Cilia of Human Nasal Epithelial Cells

Introduction: The mucociliary transport function of the airway epithelium is largely dependent on ciliary beating. The control signal of ciliary beating is thought to be intracellular Ca2+. We herein investigated the expression of T-type voltage-gated calcium channel (VGCC), a generator of intracellular Ca2+ oscillation, in the human nasal mucosa. Methods: The inferior turbinate was collected from patients with chronic hypertrophic rhinitis. The expression of T-type VGCC α1 subunits was examined by immunohistochemistry, transmission immunoelectron microscopy, Western blot, and real-time reverse transcription-polymerase chain reaction (RT-PCR). Participation of T-type VGCC in the ciliary beat regulation was examined by pharmacological inhibition tests using specific blockers of T-type VGCC in ex vivo measurements of the ciliary beat frequency (CBF) and ATP release and in intracellular Ca2+ imaging of isolated ciliated cells. Results: Immunohistochemical staining showed the expressions of T-type VGCC α1 subunits, Cav3.1 and Cav3.3, on the surface of the epithelial cells. At the ultrastructural level, immunoreactivity for Cav3.1 was localized on the surface of the cilia, and that for Cav3.3 was localized in the cilia and at the base of the cilia. The existence of Cav3.1 and Cav3.3 was confirmed at the protein level by Western blot and at the transcriptional level by real-time RT-PCR. Specific blockers of T-type VGCC, mibefradil and NNC 55-0396, significantly inhibited CBF. These blockers also inhibited a CBF increase induced by 8-bromo-cAMP/8-bromo-cGMP and significantly lowered the intracellular Ca2+ level of isolated ciliated cells in a time-dependent manner. On the other hand, the ATP release from the nasal mucosa was not changed by mibefradil or NNC 55-0396. Conclusion: These results indicate that T-type VGCC α1 subunits, Cav3.1 and Cav3.3, exist at the cilia of the nasal epithelial cells and participate in the regulation of ciliary beating and that these channels act downstream of cAMP/cGMP.

Current approach to surgical treatment of hypertrophic rhinitis

<h3></h3> В лечении хронического гипертрофического ринита в последнее время значительное место занимают хирургические радиоволновые и коблационные методики. В статье рассмотрены методы хирургического лечения гипертрофического ринита с применением электрохирургической системы ESG-01-«ЭлеПС». <h3>ЦЕЛЬ ИССЛЕДОВАНИЯ</h3> Изучить результаты клинического применения электрохирургической системы ESG-01-«ЭлеПС» при хроническом гипертрофическом рините. <h3>МАТЕРИАЛ И МЕТОДЫ</h3> В исследование включены 32 пациента в возрасте от 25 до 42 лет с гипертрофическим ринитом, которым выполняли радиочастотную коагуляцию и коблацию нижних носовых раковин при помощи аппарата ESG-01-«ЭлеПС». В послеоперационном периоде оценивали реактивные явления в зоне операции по данным эндоскопии носа, проходимость носовой полости носа с помощью передней активной риноманометрии. <h3>РЕЗУЛЬТАТЫ</h3> Через месяц после вмешательства констатировано завершение процессов регенерации слизистой оболочки полости носа и восстановление дыхательной функции до значений физиологической нормы. <h3>ЗАКЛЮЧЕНИЕ</h3> Проведенное исследование продемонстрировало хороший клинический и функциональный эффект применения электрохирургической системы ESG-01-«ЭлеПС», что свидетельствует о целесообразности использования аппарата при хирургическом лечении гипертрофического ринита.

Identification of the phase composition of solid microparticles in the nasal mucosa of patients with chronic hypertrophic rhinitis using Raman microspectroscopy

Solid particles, predominantly in micron and submicron sizes, have repeatedly been observed as a threat to a human health unique compared to the other textures of the same materials. In this work, the hypothesis the solid metal-based particles play a role in the pathogenesis of chronic hypertrophic rhinitis was investigated in patients who had not responded positively to medication. In the group of 40 randomly selected patients indicated for surgical mucotomy, the presence of solid micro- and submicron particles present in their nasal mucosa was assessed. For comparison, a set of 13 reference samples from patients without diagnosed chronic hypertrophic rhinitis was evaluated. The analysis was performed using Raman microspectroscopy. The advantage of this method is the direct identification of compounds. The main detected compounds in the mucosa samples of patients with chronic hypertrophic rhinitis were TiO2, carbon-based compounds, CaCO3, Ca(Fe, Mg, Mn)(CO3)2 MgCO3, Fe2O3, BaSO4, FeCO3 and compounds of Al and Si, all of which may pose a health risk to a living organism. In the reference samples, only TiO2 and amorphous carbon were found. In the control group mucosa, a significantly lower presence of most of the assessed compounds was found despite the longer time they had to accumulate them due to their higher mean age. Identification and characterisation of such chemicals compounds in a living organism could contribute to the overall picture of the health of the individual and lead to a better understanding of the possible causes not only in the chronic hypertrophic rhinitis, but also in other mucosal and idiopathic diseases.

Clinical and treatment aspects in chronic hypertrophic rhinitis in children

Background: Chronic hypertrophic rhinitis is a common problem in childhood and adolescence and has a negative impact on both physical, social and psychological well-being. Chronic hypertrophic rhinitis in the prevalence of children is 20-55%, and in the last 5 years this index is increasing. Material and methods: The study included 65 patients, aged 5 to 18 years, being hospitalized in the ENT department of the Emilian Cotaga Clinic of the Institute of Mother and Child, Chisinau, diagnosed with rhinitis complicated chronic hypertrophic over the years January 2018 – December 2020. The study was conducted by retrospective analysis of complicated data from clinical observation sheets and documents accompanying the data. Treatment methods studied: laser coagulation, electrocoagulation, radiofrequency, mucotomy. In most cases, lasercoagulation was chosen. Results: Nasal permeability in children with chronic hypertrophic rhinitis is altered in most cases. The most frequently affected age groups were 10-14 years with a rate of 61.53%, the majority being from urban living environment in 63.08%. The most representative clinical signs and symptoms according to this study are difficult nasal breathing in 96.93% and mouth breathing – 89.24%. From the indicated surgical methods, laser coagulation of the nasal cornets was performed in 47.7% of cases. It proved to be more effective and less invasive compared to electrocoagulation performed in 44.6% of cases and partial mucotomy in 4.62%. Conclusions: From the data obtained in the study, we opted for laser coagulation of the lower nasal horns, which has a faster healing period, shorter postoperative complications, greater acceptability from the doctor and patient.

Volumetric osteoconchoplasty method

Introduction.Pathology of the inferior turbinates (IT) was found in 76.1% of patients with difficulty in nasal breathing. If nasal breathing cannot be restored with conservative measures, surgical intervention becomes the method of choice.Materials and methods.Under local infiltration anesthesia, the IT is fractured and retracted medially (medialization). In the anterior section of the HHP, a vertical incision 0.5 cm long to the bone is made, through which the mucosa is peeled off from the bone base of the concha with a raspator-suction and a small tunnel from 2 to 3 cm long is created. shell surfaces and a small area of the mucosa of the lateral surface of the IT and the lateral wall of the nasal cavity. After insertion into the created tunnel of the required size of the "spreader-implant" plate, treated with a thin layer of LTK glue, the shell is slightly pressed with a self-inflating latex-foam rubber swab introduced into the IT for 10–15 minutes. At the end of the operation, after removing the tampon, the edges of the incision are processed with LTK glue.Results.The results of the study demonstrate the effectiveness of the developed method for the rapid restoration of nasal breathing after rhinosurgical interventions. We use this technique in the overwhelming majority of cases of fibrous and bone forms of IT hypertrophy. In cases of the cavernous form, we perform a submucous conchotomy with a shaver, which makes it possible to very accurately remove exactly that part of the concha that violates the patency of the nasal cavity. In all cases, we consider it compulsory to carry out the IT lateroposition according to our method, which significantly improves the result of the operation. The surface of the shell remains completely covered with mucosa and as a result of matching the edges of the incision, the wound surface is absent. At the same time, after the operation, the shell remains full anatomically and functionally, i.e. consists of the bone skeleton and the corresponding volume of soft tissues.Conclusion.The question of how to predict in the long-term postoperative period the normal size of the modeled IT, apparently, is currently not answered even by highly qualified rhinosurgeons. In this regard, there remains a need to search for new technologies for treating patients with chronic hypertrophic rhinitis.

Морфологические особенности мукоперихондрия у пациентов с посттравматической деформацией перегородки носа

Over the past decades, surgical techniques have been improved, aimed at restoring the position of the nasal septum in case of its deformities. The attitude to the technique of the operation itself has changed, which consists in a sparing approach to the osteochondral skeleton of the nasal septum (NS). It should be noted that to date, the histological features of the mucous membrane (MM) of NS have not been studied with pronounced curvatures of PN, in this regard, the purpose of our work was to conduct a histological study of the MM of NS and to identify the morphological features of the structure of mucoperichondria in the area of septal deformity. Research methods. Our study included 24 patients with nasal septum deviation (NSD) and concomitant vasomotor or hypertrophic rhinitis. All patients noted impaired nasal breathing. 12 men and women were examined, the average age of the patients was 36 ± 10 years. Patients with grade III of NSD according to the classification of Protasevich were examined and operated on. We analyzed the material taken from 5 loci of the MM of NS. A total of 120 histological sections were examined. When describing histological findings from loci A-E, we were guided by the frequency of occurrence of criteria indicating the severity of irreversible post-traumatic changes in MM of NS. After analyzing the material obtained and carrying out a comparative analysis of the frequency of occurrence of histological findings in each locus, we concluded that the proximity of the locus to the most deformed part of the nasal septum is characterized by the maximum severity of dystrophic and sclerotic changes in the MM of NS, similar to the histological picture of a hypertrophic scar.

Medicinal products in the treatment and prevention of occupational diseases of the upper respiratory tract

Occupational diseases of the upper respiratory tract (URT) represent a significant section of occupational pathology of the respiratory system, since the mucous membrane of the nasal cavity and paranasal sinuses is the outpost that first comes into contact with inhaled agents (pollutants), including professional aerosols. The pathogenesis of occupational diseases of URT is based on long-term contact of pollutants with cells of the scintillating epithelium and violation of the function of the mucociliary system of URT. Occupational diseases of URT include: chronic catarrhal, subatrophic, atrophic, hypertrophic rhinitis, rhinopharyngolaryngitis; all forms of laryngitis, laryngotracheobronchitis, allergic diseases. Treatment and prevention of these diseases should be comprehensive with the use of personal respiratory protection equipment, mandatory preventive examinations and various local effects (inhalation, instillation, lavage, herbal medicine, etc.).

Ведение пациентов в периоперационном периоде при операциях в полости носа и на околоносовых пазухах

Nowadays due to the growth of the antibiotic resistance of the bacteria, the issue of the perioperative prophylaxis in surgery of the nasal cavity and paranasal sinuses has become especially relevant. Although the use of antibiotics more than 24 hours after surgery for prophylactic purposes does not increase the effectiveness of perioperative prevention of infectious complications, systemic antibiotics are often continued in the otorhinolaryngology departments for 5-7 days after surgery. Objective: Evaluation of the possibility of using of alternative antimicrobial agents in the framework of perioperative prevention of infectious complications during operations of the nasal cavity and paranasal sinuses. 178 patients undergoing surgical treatment for deviated nasal septum, chronic hypertrophic rhinitis, chronic rhinosinusitis without polyps, were divided into 2 groups. In the first group, 2 weeks before the operation and within 7 days of the postoperative period, applications were applied to the nasal cavity with a gel with Otofag bacteriophages, 2 doses 3 times a day for 60 minutes. In the second group, systemic antibiotic therapy (ceftriaxone 1.0 intramuscularly once) was prescribed 40-60 minutes before the operation. Results: There wasn’t a significant difference in the regression of reactive phenomena of the nasal mucosa and intoxication syndrome, except for the intensity of crust formation in the nasal cavity, the severity of which was 1.9 ± 0.1 points in the first and 4.19 ± 0.54 points in the second group on the 7’th day after surgery. Conclusion: The use of the gel with Otofag bacteriophages can be recommended in the perioperative period during planned operations on the nasal septum, inferior turbinates, and paranasal sinuses, which will allow avoiding the use of standard antibacterial drugs in these patients.

Turbinate Submucosal Reduction Operation Reduced Migraine Admission among Patients with Chronic Hypertrophic Rhinitis.

Rhinitis increases migraine risk. Chronic hypertrophic rhinitis can be treated with turbinate submucosal reduction operation. The relationship between migraine and chronic hypertrophic rhinitis after turbinate submucosal reduction operation is still unclear. The goal of this study was to evaluate the correlation between turbinate submucosal reduction operation and subsequent migraine admission in Asian chronic hypertrophic rhinitis patients. We identified patients suffering from chronic hypertrophic rhinitis and receiving turbinate submucosal reduction operation. The control group was selected from patients with chronic hypertrophic rhinitis without operation. The event was migraine admission. The risk factors of migraine admission were established using multivariate Cox proportional hazard regression. The risk of migraine admission after turbinate submucosal reduction operation is represented by a hazard ratio (HR) of 0.858 (95% confidence interval (CI): 0.633–0.962). The higher risk of migraine included depression with HR 4.348 (95% CI: 2.826–6.69), anxiety with HR 3.75 (95% CI: 2.267–6.203), fibromyalgia with HR of 7.326 (95% CI: 3.427–15.661), and asthma with HR 1.969 (95% CI: 1.11–3.491). Our study revealed that turbinate submucosal reduction operation led to a 14.2% reduction in migraine admission. Clinicians should understand the benefit of turbinate submucosal reduction operation and provide suitable treatments for comorbid conditions. Further prospective studies are required to confirm our findings.

Allergic rhinitis complicated by hypertrophy of the mucous membrane of nasal turbinates in patients of Northern Vietnam

Introduction: Constant contact with allergens contributes to the formation of allergic rhinitis and swelling of the mucous membrane of the nasal cavity. Moreover, constant inflammation stimulates hypertrophy of the mucous membrane of the nasal turbinates and paranasal sinuses. This study aimed to assess the clinical features of hypertrophic rhinitis (HR) in combination with allergic rhinitis (AR) in patients from Northern Vietnam to improve the effectiveness of treatment and quality of life of patients with this pathology of the nasal cavity.&#x0D; Methods: The study was conducted from June to September 2018 by the Department of Otorhinolaryngology, Thai Nguyen Central General Hospital, Vietnam. A total of 158 patients with symptoms of chronic rhinitis, aged 5–70 years, were examined. All patients with allergic rhinitis were subjected to standard, specific allergological tests, such as the determination of specific IgE in the blood, and statistics were assessed according to the otorhinolaryngology examination and CT scan. All patients were also examined by otolaryngologists.&#x0D; Results: According to the results of our study, among 64 patients with a diagnosis of AR, a total of 45 (70.31%) patients were diagnosed as AR in combination with a hypertrophy of the mucous membrane of the nasal turbinate, with an average duration of morbidity of 5.8 ±1.6 years. Moreover, 17 (37.78%) patients were diagnosed with severe hypertrophy of the mucous membrane of the nasal inferior turbinate (the nasal inferior turbinate is 50% or more of nasal cavity and with nasal polyps). The sensitization to house dust mites and fungi was high.&#x0D; Conclusion: The peculiar findings of AR in combination with HR detected in patients of Northern Vietnam was associated with the onset of the disease at the age of 20-40 years, the predominance in men, the predominance of the disease in smokers, and the predominance in residents of cities and industrial areas (71.1%). Indeed, there was an observed combination of AR with severe and moderate degree of HR. The sensitization of patients with AR in combination with HR in Northern Vietnam are similar to those in Asia, with predominant allergy to house dust mites.