Polypous Rhinosinusitis Research Articles

Chronic polypous rhinosinusitis and lung function in the profile of multi-organ pathology in children with cystic fibrosis in the Russian Federation

Chronic rhinosinusitis (CRS), including chronic rhinosinusitis with nasal polyps (CRSwNP), is one of the manifestations of cystic fibrosis (CF). The paranasal sinuses (PNS) are considered as a reservoir of pathogenic microflora and a source of descending infection of the entire respiratory tract. Nevertheless, paranasal sinuses pathology is usually assessed in isolation from both the lower respiratory tract and the entire spectrum of multiple organ damage in CF.Aim. To determine the prevalence of CRSwNP and its correlation with other characteristics of CF in children in Russia.Methods. The study included data of 2216 children from 0 to 18 years old from 81 regions of the Russian Federation from the Registry of patients with cystic fibrosis in the Russian Federation for 2018. Children with an established diagnosis of CRSwNP (n = 599) were compared to those without this condition (n = 1 617). The prevalence was assessed in the subgroups by age, sex, respiratory function, nutritional status, microbiological status, complications, the need for various therapies, and the average duration of inpatient treatment during the year. The statistical analysis included parametric and nonparametric tests.Results. According to the Registry, the average prevalence of CRSwNP among children with CF was 27.03% and tended to increase with age. Children with CRSwNP had statistically significant higher incidence of homozygous F508del mutation, more common intermittent and chronic infection with P. aeruginosa, S. aureus (MSSA and MRSA), cystic fibrosis-associated diabetes mellitus with daily use of insulin, liver damage (as with or without cirrhosis), osteoporosis, a more frequent need for systemic antibacterial and inhalation (except for bronchodilators) therapy, as well as a relatively high need for hospital stay. Unexpectedly, the respiratory function indicators (FEV1, %, FVC, %) and body mass index turned out to be higher in the group of patients with nasal polyposis. A likely explanation is that the study included only children, and the lung function was not analyzed in the children and adolescents.Conclusion. The results suggest that CRSwNP is a predictor of adverse course of CF and requires attention from CF specialists and otorhinolaryngologists, as well as interdisciplinary collaborations.

Структурная перестройка слизистой оболочки полости носа и околоносовых пазух у больных с полипозным риносинуситом по данным цитологического и гистологического исследования

Aim: to study the morphological patterns of polypous tissue according to cytology and histology. Pateints and methods: 78 patients with a confirmed diagnosis of polypoid rhinosinusitis (PRS) were selected for the study, including 50 men and 28 women aged 25 to 74 years. The material for cytology was scraped from the surface of nasal cavity and paranasal sinus (PNS) polyps, as well as touch smears from the cut surface of removed polyps, and the material for histology was pieces of removed polypous tissue. Results: in the course of the study, the following comparative analysis of the obtained results was made: a) with polyps with a fibrous component in touch smears, there are expressed signs of chronic inflammation along with signs of respiratory epithelial cells proliferation; b) edematous and myxoid polyps are commonly combined with an allergic condition; c) analysis of cytomorphological signs of the respiratory epithelium of the nasal cavity and PNS in PRS indicates a structural alteration of the mucous membrane in this disease. The epithelial proliferation is associated with the activation of stroma components — fibroblasts and leukocytes. At the light-optical level, the characteristics of compensatory and adaptive changes that contribute to the morphofunctional cell unity preservation of the mucous membrane that counteract the pathological process are revealed. Conclusions: according to the method of sampling material for cytology, the most informative are touch smears from the cut surface of the removed polyp, which help to identify more morphological patterns of the polypous tissue. The analysis of cytomorphological features of the respiratory epithelium of the nasal cavity and PNS in PRS indicates the remodeling of the mucous membrane in this disease. The epithelial proliferation is associated with the activation of stroma components — fibroblasts and leukocytes. At the light-optical level, the characteristics of compensatory and adaptive changes that contribute to the morphofunctional cell unity preservation of the mucous membrane that counteract the pathological process are revealed. The obtained results will help to understand the mechanisms of structural and functional alteration in the nasal mucosa and PNS in PRS. KEYWORDS: polypoid rhinosinusitis, cytology, histology, paranasal sinuses, smears, fibroblasts, eosinophils, leukocytes, respiratory epithelium. FOR CITATION: Zakharova N.M., Shabalova I.P., Egorov V.I. et al. Structural reconstruction of the nasal mucosa and paranasal sinuses in patients with polypous rhinosinusitis according to cytological and histological studies. Russian Medical Inquiry. 2021;5(7): 479–485 (in Russ.). DOI: 10.32364/2587-6821-2021-5-7-479-485.

Клинико-лучевые особенности смешанных полипозной и полипозно-гнойной форм хронических риносинуситов в сочетании с зубочелюстной патологией

The choice of diagnostic tactics and methods of conservative and surgical treatment of mixed polypous and polypous-purulent types of chronic rhinosinusitis in patients with concomitant dentoalveolar pathology, comorbid somatic pathology depends on the availability of clinic’s technical supply and the patient's mood to make the optimal choice. The literature does not provide a unified algorithm for the examination and management of patients with chronic mixed polypous and polypous-purulent types of sinusitis occurring against the background of dentoalveolar pathology. Aim. Justification of differentiated approach to the diagnosis of chronic mixed polypous and polypous-purulent rhinosinusitis in patients with dentoalveolar pathology. Materials and methods. In 200 patients with these types of rhinosinusitis, pathological changes in the paranasal sinuses, nasal cavity and dentoalveolar apparatus were revealed. Results. In activation of the focus of odontogenic infection, pathological changes in the nasal cavity and paranasal sinuses were more severe at the side of odontogenic infection focus; in inactive odontogenic process and in presence of rhinogenic provoking factors, the severity of pathological changes in the nasal cavity and paranasal sinuses were similar at both sides. With each relapse of activation of the focus of odontogenic infection, the duration and severity of sinusitis increased. Conclusion. The basic diagnostic method for examining patients with mixed polypous and polypous-purulent types of chronic sinusitis in combination with dentoalveolar pathology is cone-beam computed tomography, which let to assess the severity of odontogenic infection focus against the background of pathological changes in the nasal cavity and paranasal sinuses to select the optimal therapeutic tactics.

Characteristic of iatrogenic odontogenic sinusitis

The aim of the study was to study the structure of odontogenic sinusitis and identify iatrogenic etiological factors. A retrospective analysis of the case histories of patients operated from 2015 to 2019 with a diagnosis of «Sinusitis» in the Clinical City Emergency Hospital in Tashkent, Republic of Uzbekistan in the department of emergency maxillofacial surgery was carried out. The total number of patients was 333 people: 105 (31.5%) men and 228 (68.5%), the average age of patients was 39.4 years. When analyzing the reasons for the development of sinusitis, in 73% of the total number of operated patients, there was an associated lesion of the teeth. When detailing the sources of odontogenic infection, it was determined that periapical foci of inflammation (granulomatous, granulating periodontitis, cystogranulomas) accounted for 26%, foreign bodies (teeth, roots of teeth, filling materials removed into the maxillary sinus during endodontic treatment) 31%, fistulous passages after removal teeth and attempts to eliminate perforation by surgery 43%. Other etiological factors were found: chronic polypous rhinosinusitis 14%, benign tumors 8%, allergic fungal sinusitis 5%. Clinical analysis showed that the development of most cases of odontogenic sinusitis is associated with the mistakes of dentists and is of iatrogenic origin. To prevent the development of odontogenic iatrogenic sinusitis, prior to dental interventions on the teeth of the upper jaw, it is necessary to carry out a topical diagnosis of their ratio with the maxillary sinus.

Modern approaches to the treatment of chronic polypous rhinosinusitis

Introduction: Today, chronic polypous rhinosinusitis (CPR) occupies a special place among otolaryngological diseas­es, the incidence rate of which increases every year. To date, the main causes of chronic polypous rhinosinusitis are Staphylococcus aureus and anatomical abnormalities.
 Diagnostics: Knowledge of a universal algorithm for the diagnosis of this disease, consisting of the collection of an­amnesis, endoscopic examination of the nasal cavity, computed tomography of the paranasal sinuses, anterior active rhinomanometry and bacteriological determination of the microbial spectrum, allows diagnosing chronic polyposis rhinosinusitis in time, and, as a consequence, to prescribe a treatment.
 Treatment: This review describes conservative therapies, including antibiotics and glucocorticosteroids. Today, the main task of doctors is to find the most effective method of administration of glucocorticosteroids to achieve the max­imum effect. One of these methods is the introduction of the drug with the help of nebulizer, as in this case, the drug will remain in the perirhinal cavity for a long time and have the maximum effect due to the directed action only in the area of the pathological process.
 Features of chronic polypous rhinosinusitis in childhood: It should be noted that children under 12 years of age due to the formation of the paranasal sinuses at different stages of ontogenesis will be characterized by different forms of chronic polyposis rhinosinusitis. That is why they should be known and taken into account when making a diagnosis and prescribing a treatment.
 Conclusion: Today, the frequency of chronic rhinosinusitis increases exponentially, which makes the question of the modern approach to its treatment the most relevant. It is possible that additional research in this area will solve the issue of searching for both the optimal path of therapy and treatment of CPR in children.

MORPHOLOGICAL CHARACTERISTICS OF THE MUCOUS MEMBRANE OF THE NOSE AND PARANASAL SINUSES IN CASE OF CHRONIC RHINOSINUSITIS

Chronic polypous rhinosinusitis is not a fully understood clinical condition and is challenging to treat. Its features are polypous inflammation of the nasal mucosa and paranasal sinuses. The purpose of this study was to identify histopathological options in patients withchronic rhinosinusitis.

Polypous rhinosinusitis in combination with bronchial asthma: clinical features and cellular characteristics of local and systemic inflammation

Background. The combination of chronic rhinosinusitis with nasal polyps (CRSwNP) and bronchial asthma (BA) is currently considered as a separate phenotype characterized by similar features of inflammatory changes leading to an increase in the clinical course of both CRSwNP and BA. The aim of the study was to investigate the clinical features and characteristics of the local and systemic inflammatory process in patients having a combination of CRSwNP and BA. Materials and methods. The study included 96 volunteers, who were divided into 4 groups: group 1 consisted of healthy volunteers (Normal); group 2 consisted of volunteers with CRSwNP in combination with allergic BA (CRSwNP + aBA); group 3 - volunteers with PRS in combination with non-allergic BA (CRSwNP + nBA); and group 4 - CRSwNP without BA. Clinical, laboratory, instrumental and allergology examination methods were applied for all participants of the study. BA control status was determined using the asthma control questionnaire (ACQ-7), and CRSwNP control status was determined using the nasal and paranasal sinus clinical outcome control questionnaire (SNOT-22). At the same time, the quality of life of the patients was also evaluated using AQLQ (Asthma Quality of Life Questionnaire). Results. The results confirmed the interaction of BA and CRSwNP, where the combination of these diseases led to a more severe and uncontrolled clinical course of BA and CRSwNP based on the assessment using SNOT-22, ACQ-7 and AQLQ questionnaires. These results correlated with an increase in the absolute number of eosinophils in peripheral blood and pronounced eosinophilic cell infiltration of nasal polyp stroma. Data processing demonstrated that the combination of CRSwNP and nBA showed signs of more pronounced eosinophilic inflammation, which is an unfavorable prognostic factor. Conclusions. The comparison of the cellular characteristics of the local and systemic inflammatory process in patients with CRSwNP in combination with BA allowed us to conclude that polyp development follows a local inflammatory process. Further study of the pathogenesis of CRSwNP and BA will help to understand the mechanisms that connect these diseases and consider possible target molecules for biological therapy.

Опыт работы Центра диагностики и лечения полипозного риносинусита

Polypous rhinosinusitis (PRS) ranks as one of the most important chronic inflammatory ENT diseases that significantly impair the quality of life. Today, it is known that chronic rhinosinusitis with nasal polyps (CRSwNP) is a multifactorial heterogeneous disease characterized by chronic inflammation of the mucosa of the nasal cavity and paranasal sinuses, leading to the growth of polyps. The interrelation of CRSwNP, atopy and bronchial asthma (BA), their pathogenetic mechanisms, as well as the effect on the severity of the course and the frequency of each other’s relapses, are the subject of study. Data on the role of allergy in CRSwNP are controversial, while the relationship between PRS and BA is not in doubt. Patients suffering from CRSwNP and BA and / or allergic rhinitis (AR) require dynamic monitoring and regular correction of treatment not only by an otorhinolaryngologist, but also by an allergist-immunologist. To this end, since 2016, in Vladimirsky Moscow Regional Research Clinical Institute the Moscow Regional Center for Diagnosis and Treatment of Polypous Rhinosinusitis and Allergic Rhinitis was established, which monitored and treated patients with ARS and comorbid diseases from various medical institutions of the Moscow region. By using a multidisciplinary approach during our work from 2016 to 2020, we managed to achieve a stable remission in most patients, significantly improve their quality of life and reduce the number of surgical interventions.

New approach to treatment of polypous rhinosinusitis

Polypous rhinosinusitis (PRS) is a hardly treatable disease due to the unknown etiology and recurrent course. Standard treatment regimens are aimed at removing polyps and reducing the activity of inflammation, while little attention is paid to pathogenesis factors such as oxidative stress and mucociliary insufficiency. To improve the combined treatment of PRS. The study involved 98 patients (50 people - the study group, 48 people - control group). The structure of the comorbid pathology of patients in the control group was selected so as to correspond to the pathology in the study group. Patients of both groups received combined treatment, including surgical treatment in accordance with the FESS principles, followed by the prescription of 200 mcg mometasone furoate in each half of the nose for 6 months. The treatment of patients of the study group also included the drug N-acetylcysteine - 3 ml (300 mg) in each maxillary sinus intrasurgicaly, then 600 mg orally in the morning after meals for 6 months. Survey methods included a questionnaire survey using the SNOT-22 questionnaire, the prevalence of the polypous process was assessed by endoscopy (Claus Bachert scale) and CT (Lund-Mackay scale), and mucociliary function was also evaluated by performing a saccharin test. The results were compared with each other before surgery and after 6, 12 and 24 months after surgery. Patients who have been taking N-acetylcysteine for a long time have a more pronounced and long-term improvement in their general condition (according to SNOT-22, an average by 1.7 times, p<0.05) compared with patients in the control group. Also, the frequency of relapses decreases and the effectiveness of surgical treatment increases (according to the Lund-Mackey scale - 5.02 in the experimental group and 10.75 in the control; according to S. Bachert - 1 point and 3 points, respectively). Long-term use of N-acetylcysteine in PRS increases the effectiveness of surgical treatment, reduces the frequency of relapses, and also improves the general condition of patients.

Особенности локального воспаления слизистой оболочки носа у детей с бронхиальной астмой

Bronchial asthma (BA) is often associated with chronic inflammatory processes in the nasal mucosa; these processes give rise to allergic rhinitis (AR), chronic rhinosinusitis, adenoiditis and polypous rhinosinusitis. Due to their multiple symptoms, these diseases of the upper respiratory tract, especially allergic rhinitis, are often difficult to verify in patients with asthma. The aim of the study was to assess the features of local inflammation of the nasal mucosa in patients with BA and AR. Patients and methods. 93 children with BA were examined. General clinical, allergological, functional examination, measurement of endonasal temperature and determination of IgE and IL4 content in nasal secretions were performed. Results. Children with BA have lower values of endonasal temperature than healthy ones. There was a tendency to decrease endonasal temperature as the symptoms of AR increased. In the acute stage of AR, the temperature values were lower than in the remission stage, р = 0,02. The addition of infectious inflammation of the nasal mucosa in children with AD was accompanied by an increase in endonasal temperature, р = 0,04. The increase of the content of nasal IgE in acute AR – 115,6 (49,9; 181,2) ME/mg, compared to the remission period to 24,9 (6,2; 43,7) ME/mg. Exacerbation of AR was associated with increased IL4 to 109,7 (54,2; 165,2) PG/mg, in the period of remission – 34,4 (12,0; 56,8) PG/mg. The increase of these biomarkers of allergic inflammation have a correlative relationship, R = 0,44, p = 0,002. The relationship of IL4 content with endonasal temperature, R = 0,44 р = 0,02 was established. Conclusion. Patients with BA and AR showed a decrease in endonasal temperature compared to healthy ones. Exacerbation of AR in children with BA characterized by an increase in the content of nasal IgE and IL4 and a decrease in endonasal temperature, which allows us to consider these indicators as biomarkers of activation of allergic inflammation.

Expression of pro- and anti-apoptotic molecules in the mucous membrane of the nasal cavity with polypous rhinosinusitis

To study the expression of proapoptotic (p53, p21) and antiapoptotic (MDM2) factors, as well as the distribution of proliferating PCNA-immunoreactive cells in the nasal mucosa in various types of polyposis rhinosinusitis (PRS). We studied the immunolocalization of proapoptotic (p53, p21) and antiapoptotic (MDM2) factors, as well as the distribution of proliferating PCNA immunoreactive cells in the mucous membrane of the nasal cavity for various types of polypous rhinosinusitis. Comparing with the control group, increased expression of all factors is detected. The main portion of marked cells is located in the loose connective tissue of the lamina propria of mucous membrane, a relatively small number of cells are detected in the epithelial layer. The edematous, eosinophilic (allergic) type of PRS is characterized by the expression of p53 and PCNA and by the reduction of MDM2 immunoreactive cells, while the expression of p53 and p21 is reduced in fibroinflammatory (neutrophilic) type. PRS is accompanied by epithelial metaplasia, by formation of inflammatory cell infiltrates, fibrosis and edema. The results are discussed in connection with the data on the regulatory role of apoptosis in the pathomorphism of chronic productive inflammation.

Features of the course of polypous rhinosinusitis combined with allergic rhinitis

Both allergic rhinitis (AR) and polypous rhinosinusitis (PRS) are a serious problem in context of their impact on quality of life, the risk of complications, overlay of bronchial asthma (BA) and medical control of these diseases. In most cases, T2 type eosinophilic inflammation lies beneath their pathogenesis, but the mutual influence of simultaneously existing chronic processes on each other appears under-investigated. Objective of the study: Compare the clinical and immunological characteristics of patients with polypous rhinosinusitis and concomitant allergic rhinitis and without respiratory allergy. All patients with PRS were divided into 2 phenotypic groups: Group 1 – PRS without bronchial asthma and respiratory allergy (54 people), Group 2 - PRS + allergic rhinitis, but without bronchial asthma (46 people). IL-1β-, IL-4-, IL-5-, IL-6-, IL-13-, IFN-γ-, TGF-β1-, TGF-β2-, TGF β-3 cytokines in nasal polyp tissue were determined using the Bio-Plex multiplex analysis system. Results: In patients with PRS combined with AR, the eosinophilic type of inflammation in the polyp tissue was determined in 100% of cases, it was accompanied by an increased level of IL-6, TGF-β1, TGF-β2, TGF-β3 and a reduced level of IL-5, IL-13 compared to PRS without comorbid pathology. Conclusions. Given the same clinical course of polypous rhinosinusitis, the identification of the difference in the cytokine profile in the nasal polyp tissue gives evidence of a different mechanism of the inflammatory response for different phenotypes of PRS. The polypous rhinosinusitis combined with allergic rhinitis is characterized by 100% eosinophilic type of inflammation, high levels of TGF-β family protein cytokines, pro-inflammatory cytokine IL-6 and a lower level of T2-cytokines IL-5 and IL-13 compared with the PRS group without comorbid pathology. The simultaneous treatment of PRS and allergic rhinitis using the joint efforts of otorhinolaryngologists and allergists will allow to achieve medical monitoring of both diseases and prevent their progression and development of complications.

To the issue of differential diagnosis of listeriosis

A clinical example shows the erroneous diagnosis of listeriosis in a 15-year-old child hospitalized in the infectious department. The child was admitted with severe symptoms of intoxication, febrile fever, difficulty in nasal breathing, hyperemia of the mucous membranes of the oropharynx, tonsillitis, cervical lymphadenitis, facial tissue pasteness with swelling of the eyelid and conjunctivitis of the left eye, hepatosplenomegaly. A laboratory examination revealed pronounced leukocytosis up to 24 thousand, lymphocytosis, atypical mononuclear cells up to 9%, IgM and IgG to EBV capsid protein, IgM to CMV, IgM and IgG to listeria. But with a repeated double study of IgM and IgG to Listeria were not detected. The initial positive result was possibly due to the presence of cross-reacting antibodies in EBV mononucleosis. The final diagnosis was made: Infectious mononucleosis of mixed (EBV, CMV) etiology. Chronic polypous rhinosinusitis, exacerbation. Reactive edema of the eyelids against the background of inflammation of the sinuses.Given the variety of clinical forms of listeriosis and their similarity with the manifestations of other infections, for the full diagnosis of listeriosis infection, it is advisable to evaluate the epidemiological and medical history data, as well as use an extended spectrum of laboratory confirmation of the diagnosis.

Анализ схем лечения полипозного риносинусита в Российской Федерации

Chronic polypous rhinosinusitis does not subject to complete medicinal control; it is difficult to predict the prospects of the pathology development in each individual patient. Therefore, the search of new regimens of treatment of these patients is still in progress. An international consensus published in 2016, considers, inter alia, various groups of drugs for conservative treatment of polypous rhinosinusitis from the viewpoint of evidence-based medicine. We conducted a retrospective analysis of outpatient records and personal data of 1059 patients with polypous rhinosinusitis who underwent outpatient and inpatient treatment at the period from February 2016 to March 2018 in Moscow, Moscow Region and 26 regions of Russia. According to the results, in outpatient treatment, the basic therapy with intranasal glucocorticosteroids was performed in 92.4%, irrigation therapy – in 82.2% of cases, antihistamines were recommended in 79.4%. In case of hospitalization for surgical treatment, 16.6% of patients in Russian regions and 24% in Moscow Region had received no preliminary therapy for 6 months before hospitalization. In general, analyzing the management and treatment regimens of the patients with polypous rhinosinusitis, we found almost no deviations from the present-day domestic and foreign clinical guidelines. However, we observed prescription of some intranasal glucocorticosteroids, the leaflets of which contain no indications for polypous rhinosinusitis treatment.

Оценка роли факторов гуморального иммунитета в рецидивировании хронического полипозного риносинусита

The effect of humoral immunity factors on the progress of chronic polypous rhinosinusitis remains unclear, there is no evidence of their role in the recurrence of the disease. The objective of the study was to assess the prognostic significance of humoral immunity factors (immunoglobulins) in the blood serum of patients with chronic recurrent polypous rhinosinusitis. The humoral immunity factors (immunoglobulins) were identified in 82 patients with chronic polypous rhinosinusitis (ChPRS). The share of the patients with the level of immunoglobulins M, E, sIgA above the normal range was statistically significantly higher in the patients with the recurrence of the chronic polypous process than in those without the recurrence (p &lt; 0.001). It has been established that the risk of recurrence in the patients with IgE level above the normal range is 3.5 times higher than that in the patients with normal IgE level (RR 3.50 (1.83–6.70)), and with sIgA level exceeding the normal range it is 2.93 times higher than that in the patients with normal sIgA level (RR 2.93 (1.31–6.57)). The most significant humoral immunity factors characterizing the risk of recurrence in the patients with chronic polypous rhinosinusitis are the level of immunoglobulins E, sIgA in blood serum above the normal range in the patients who may be included in the building of a model of predicting the recurrence of chronic polypous rhinosinusitis.

Морфологическая характеристика разных типов полипозного риносинусита

The publication presents the results of morphological study of patients with chronic polypous rhinosinusitis (ChPR). ChPR is characterized with a chronic productive type of inflammation of the nasal mucosa and paranasal sinuses, with the formation and growth of polyps. In this study, we examined 70 people (50 patients in the study group and 20 patients in the control group). In this work, the authors found the polypous changes in the tissue, three types of the nasal cavity polyps. 1. Edematous polyps – histological signs: an edematous polyp stroma containing a small number of fibroblasts and connective tissue fibers, due to which the intercellular space has a spongy, loose appearance. In the depth of the polypous tissue there are areas containing single glands, cysts. 2. Allergic (eosinophilic) polyps – histological signs: the presence of infiltrates with a significant number of eosinophils, alongside with monocytes and mast cells. 3. Fibrous (fibrous-vascular, fibrocystic, fibrous-glandular) polyps – histological signs: the stroma has dense compact structure, it is made of a great number of fibroblasts and surrounding connective tissue fibers. The stroma has a large number of various caliber vessel profiles.

Эффективность эндоскопической риносинусохирургии при антрохоанальных полипах в детском возрасте

Antrochoanal polyps (ACP) are benign tumors, mainly originating from the maxillary sinus. The incidence in children is high – up to 35% of all chronic polypous rhinosinusitis. Endoscopic examination of the nasal cavity and computed tomography of the paranasal sinuses (PS CT) are generally used for ACP diagnostics. The medical treatment of ACP is deemed ineffective. Multiple options have been proposed for surgical treatment of ACP, including those used in children. In recent years, the role of FESS in the surgical treatment of ACP has increased. This paper provides an analysis of the efficacy of surgical treatment of 50 children with ACP at the period of 2012-2018 at Children’s Municipal Multidisciplinary Clinical Center for High Medical Technologies named after K. A. Rauhfus. All patients were operated on using endoscopic endonasal access. 40 children (80%) underwent combined access surgery. The efficacy analysis was carried out according to sino-nasal outcome test SNOT-20 (GAV), Lund-Kennedy endoscopic evaluation scores, Lund-Mackay computed tomography results evaluation scale. Our results showed the statistically significant association of improvement of all symptoms according to SNOT-20 (GAV) scale (p &lt; 0,05) after FESS. Moreover, the analysis of nasal endoscopy results showed the pronounced positive changes in the parameters of the „discharge“ and „mucosal edema“ in the postoperative period according to Lund-Kennedy scale (p &lt; 0,05). A statistically significant association of improvement of PS CT signs according to Lund-Mackay scale after FESS is also observed. The most significant changes were observed in the maxillary sinuses, anterior and posterior ethmoid cells, as well as in the osteomeatal complex on both sides, on average by –1 point (p &lt; 0,05). Therefore, FESS has proven its efficacy at ACP in children.

СПОСОБ ПРОГНОЗИРОВАНИЯ РАЗВИТИЯ БРОНХИАЛЬНОЙ АСТМЫ У БОЛЬНЫХ ПОЛИПОЗНЫМ РИНОСИНУСИТОМ.

The method for prediction of asthma in patients with polypous rhinosinusitis was developed. It consists of determination of the average mass molecules (AMM, optical density units), measurement of exhaled and inhaled air temperature (T exh, ºC), and (T inh, ºC), and determination of the temperature difference (ΔT, ºC) between the inhaled and exhaled air temperatures and with the help of the discriminant equation: D = +5.028 × T exh - 0.405×ΔT - 8.910 × AMM, where the discriminant function (D) boundary value is 152.16. At D greater than or equal to the discriminant function boundary value, the absence of asthma in patients with polypous rhinosinusitis is predicted; at D less than the discriminant function boundary value, the development of asthma is predicted.

КОМПЬЮТЕРНЫЙ СПОСОБ РЕГИСТРАЦИИ ТЕМПЕРАТУРЫ ВДЫХАЕМОГО И ВЫДЫХАЕМОГО НОСОМ ВОЗДУХА

A computer method for recording the temperature of inhaled and exhaled air is developed. Using this method, the airway conditioning function was studied in 10 healthy individuals and 16 patients with polypous rhinosinusitis, in order to predict the development of bronchial asthma in the latter. The proposed computer method for recording the temperature of the air inhaled and exhaled through the nose allows to obtain visual and accurate indicators. This method can be used in the conditions of pulmonological and otorhinolaryngological departments, for example, to predict the development of bronchial asthma in patients with polypous rhinosinusitis.

MASKS OF POLYPOUS RHINOSINUSITIS

Polypous rhinosinusitis is a chronic disease of the nasal mucosa and paranasal sinuses, which is characterized by recurrent growth of nasal polyps. This disease is found in 1-5% of the population. According to the data of 2017, patients with nasal polypous rhinosinusitis account for 13% of all patients treated in our clinic. Polypous rhinosinusitis can be either an independent disease or a manifestation of other diseases. Aim - to present a case from practice, which is interesting due to the fact that two independent diseases were hiding under the mask of polypous rhinosinusitis. Results. Strict administration of the diagnostic algorithm, modern principles of functional surgery of the paranasal sinuses led to the recovery of the patient.