Reparative processes repeat the stages of embryonic histogenesis. Skull bones that underwent intramembranous osteogenesis during embryonic development replicate the pattern of «non-cartilaginous » osteogenesis during reparation (and therefore do not restore their histoarchitecture after injury), while secondary bones participate in the formation of soft and hard calluses. Incorrect determination of the type of bone osteogenesis leads to further errors in the planning and development of rhinosurgical techniques and procedures performed on the facial skull structures. Objective. To determine the type of osteogenesis of the facial bones and classify them according to their developmental pattern. Material and methods. A histological examination of the mid face of 13 human fetuses, including 7 males and 6 females, was performed between the 13th and 19th weeks of gestation. Light microscopy was used to identify the type of osteogenesis. Frontal, nasal, maxillary, palatine, ethmoid bones, inferior turbinates, vomer and sphenoid bones were examined. Results. Bones developing according to the intramembranous type of osteogenesis were identified: frontal, nasal, maxillary and palatine bones. These bones have weak regenerative and remodeling capacities. Bones undergoing the enchondral type of osteogenesis include the ethmoid bone, inferior turbinates and vomer. The bulk of the sphenoid bone underwent enchondral ossification, and the wings of the sphenoid bone developed without the cartilaginous stage. Conclusion. The study of bone histogenesis, which comprise the airway system of the nose and paranasal sinuses, in human fetuses provides a clear understanding of the type of osteogenesis. The embryonic origin of the tissue determines the specific characteristics of bone in the postembryonic period. The reparative and remodeling capacities of primary and secondary bones differ radically, which must be considered during surgical interventions on the skeletal structures of the skull.
Surgical reconstruction in patients with traumatic injuries of the orbital floor (OF) is performed using various surgical approaches. Comparative data on their effectiveness, based on quantitative (including volumetric) criteria with a simultaneous assessment of changes in the orbit and maxillary sinus (MS), remain insufficiently studied. Objective. To perform a comparative clinical and radiological evaluation of the results of surgical reconstruction of the OF in adult patients with unilateral isolated traumatic injuries depending on the used surgical approach. Patients and methods. A multicenter retrospective cohort study was performed. It included 30 patients divided into three equal groups based on the type of surgical approach: transconjunctival, subciliary and transantral. Results of computed tomography (CT) scans of 60 patients performed before and after surgery were analyzed. An assessment of demographic and clinical data, as well as quantitative CT morphometry with three-dimensional segmentation of the orbits and MSs on the injury side and on the intact side in the pre- and postoperative periods, which amounted to 120 segmentations of the orbits and 120 segmentations of the MS (a total of 240 segmentations), were carried out. Additionally, parameters of the bone defect of the OF, density of the inferior rectus muscle of the eye, inclination angle and physiological curvature of the OF as well as position of the surgical implant were evaluated. Results. Baseline demographic, clinical and morphometric characteristics did not differ statistically significantly between groups (p>0.05). Before surgery, in all groups, orbital volume on the injury side was significantly increased compared to the intact side, and volume of the MS was reduced. After the operation, regardless of the approach, a restoration of the orbital volume to values comparable to the contralateral side without intergroup differences was noted (p>0.05). In the transantral approach group, the most complete restoration of the MS volume on the injury side (+3.64 cm3) was observed compared to the transconjunctival (+1.31 cm3) and subciliary (+0.81 cm3) approaches. Along with this, the transantral approach demonstrated significant advantages in terms of qualitative CT signs of the sinus condition (p<0.001). It was also associated with more accurate anatomical restoration of the OF configuration. Conclusion. All studied surgical approaches provide comparable effectiveness in orbital volume restoration. Transantral approach demonstrates advantages in the form of more complete restoration of the volumetric parameters of the MS, its sanitation and more precise anatomical reproduction of the OF configuration in patients. The use of three-dimensional CT segmentation and volumetric analysis allows to objectify assessment of treatment results and can serve as an additional criterion when choosing the optimal surgical approach.
Study of the function of the nasal cavity and its comparison with the reactions of the autonomic nervous system under stressful conditions can improve the effectiveness of diagnostic and therapeutic measures and detail the processes of pathogenesis in pathology of the nose and paranasal sinuses. Objective. To evaluate the reactivity of the respiratory function of the nasal cavity under the influence of the regulation of the sympathetic nervous system (SNS) and parasympathetic nervous system (PNS) using standard physiological tests and active anterior rhinomanometry. Patients and methods. The study involved 97 healthy subjects divided into 3 groups according to their vegetative status — sympathotonics, normotonics, vagotonics using the Kerdo index and Vein scale. All participants underwent a number of tests using active anterior rhinomanometry (AAR): cold pressor test, Martinet test and Valsalva test. Correlation and regression analysis (Pearson’s coefficient) and multivariate analysis of variance (MANOVA) were used for statistical analysis and evaluation of intra-group relationships and ratios. Results. Cold pressor test showed a strong correlation between the initial values of rhinomanometry and indicators 1 and 3 minutes after the test. Martinet test revealed less pronounced relationships between heart rate (HR), systolic and diastolic blood pressure (BP) and rhinomanometry indicators. A strong correlation between the initial value of AAR and indicator 1 minute after the test was established when evaluating vagosympathetic activity by means of Valsalva test. The results showed different dynamics of AAR depending on the patient’s vegetative status. The revealed correlations between rhinomanometry, BP and HR were combined with the vegetative status of the subjects. Conclusion. AAR can be used in a comprehensive assessment of the ANS function and demonstrates that vagotonia can be the cause of the development of vasomotor rhinitis; dysfunction of the SNS can be the basis for the formation of atrophic changes in the nasal cavity and sinuses.
The urgency of the problem of allergic fungal rhinosinusitis (AFRS) is caused by clinical course severity, resistance to conservative therapy, high recurrence rate after surgery and high intraoperative risk due to frequent destruction of the orbit and skull base. Objective. To present current views on the pathophysiology, diagnosis and treatment of AFRS. Material and methods. A bibliographic search was carried out in RSCI, PubMed, ScienceDirect databases by the following keywords: allergic fungal rhinosinusitis, eosinophilic fungal rhinosinusitis, rhinosinusitis with eosinophilic mucin, fungal rhinosinusitis. Results. It has been revealed that the disease pathogenesis involves a complex interactions of genetic, ecological and immunological factors although the mechanisms of this interaction have not been fully studied. Existing AFRS diagnostic criteria are largely based on the examination of pathological content in the sinuses obtained during the surgery. Endoscopic incision of the affected sinuses is the basic treatment for AFRS. Topical and systemic corticosteroids are drugs with the most convincing evidence base in the absence of generally accepted treatment standards for AFRS. Additional treatment methods such as immunotherapy and antifungal therapy may provide some benefit in cases of resistant AFRS. The development of biological therapy methods is a promising direction for AFRS treatment.
A narrowed pyriform aperture (PA) can negate the success of functional rhinosurgery, and its expansion is justified in certain cases or in patients with previous unsuccessful septoplasty and/or turbinate reduction. Currently, there are no data in the scientific literature on the bilateral measurement of PA width. Objective. To assess the data of bilateral measurement of the pyriform aperture width in a population of different age groups. Patients and methods. In the study, bilateral measurements of the PA width were performed using cone beam computed tomography in 577 patients of the Central European type of the Caucasian race aged 18 and over (1154 bilateral measurements), divided by sex (304 women and 273 men) and into homogeneous groups by age according to the WHO classification (young age — up to 44 years, middle age — 45—59 years, elderly age — 60—74 age, senile age and longevity ≥75 years). Results. The mean values of the PA unilateral width were a stable parameter ranging from 9 to 10 mm on both sides in all study groups with a low 95% confidence interval (from 0.13 mm to 0.4 mm in all measurements). When measuring the aperture width on both sides, comparable results in men and women, which did not have statistically significant differences both when comparing all subjects and separately in each age group, were obtained (p>0.05). It was found that there is no significant change in the PA unilateral width with age (p>0.05). Despite the stability of the PA unilateral width, a significant sample range (8.1 mm in men and 7.04 mm in women) was noted, while in 19% of all bilateral measurements the difference between the left and right halves was 2 mm and more, and in 6.8% — 3 mm and more. Conclusion. The unilateral PA width is an important rhinosurgical parameter both for determining a significant asymmetry in the width of the nasal cavity at the PA level and for planning the necessary amount of surgery to relieve chronic nasal obstruction, and its measurement can contribute to reduction of diagnostic and surgical errors.
Osteitis of the paranasal sinuses (PNSs) is considered as a manifestation of chronic rhinosinusitis (CRS), but its prevalence and clinical manifestations remain poorly studied. Objective. To evaluate the incidence and severity of osteitis of the PNSs in patients with CRS. Patients and methods. A retrospective analysis of 300 computed tomography (CT) scans of the PNSs was performed. The study included 44 patients with a history of PNS surgery and 256 patients without it. Among them, 90 (30.0±2.6%) patients had a form of the disease with nasal polyps, and 210 (70.0±2.6%) — CRS without them. The prevalence of pathological changes in the PNSs was assessed using the Lund-Mackay staging system, and the severity of osteitis was evaluated using the Global Osteitis Scoring Scale (GOSS). The Mann-Whitney U test and Pearson’s χ2 test were used to compare groups. Results. In the total sample, osteitis was detected in 34 patients (11.3±1,.8%). Among patients with nasal polyps, osteitis was found in 27 out of 90 (30.0±4.4%), while among patients without polyps — in 7 out of 210 (3.3±1.2%; p<0.001). Among 44 patients with a history of surgical interventions on PNSs, osteitis was diagnosed in 18 (40.9±7.4%) cases, among 256 non-operated patients — in 16 (6.3±1.5%; p<0.001). In terms of the number of lesions of the PNSs (106 cases), osteitis of the ethmoid cells (59 cases; 55.6±4.8%) and maxillary sinuses (41 cases; 38.7±4.7%) was predominant; it was less common in the sphenoid (4 cases; 3.8±1.9%) and frontal sinuses (2 cases; 1.9±1.3%). In patients with CRS with osteitis, a clinically insignificant degree (GOSS<5) was more often recorded — in 21 (61.8±8.3%) cases; mild (GOSS 5—20) — in 11 (32.4±8.0%); moderate (GOSS 21—35) and severe (GOSS>35) degrees accounted for 1 case each (2.9±2.9%). In the group of patients with osteitis, the median score on the Lund-Mackay staging system was 9.0, and in the group without osteitis — 7.0; the differences were borderline and did not reach the level of statistical significance (U=5408.0; p=0.05). In patients with clinically significant osteitis, the median Lund-Mackay score was statistically significantly higher and amounted to 14.0 points compared to 7.0 points in the group without osteitis (U=2445.5; p=0.010). Conclusion. Osteitis of the walls of the PNSs, as detected by computed tomography, is revealed in approximately one in ten patients with CRS, significantly more often in persons with past history of surgery. In patients with CRS, the presence of nasal polyps is associated with a higher incidence of osteitis, which indicates a possible role of nasal polyps as a risk factor for the involvement of the PNS bone structures. Clinically significant osteitis is associated with greater severity of pathological changes in the PNSs on CT, which requires further study of its role in the course and outcomes of CRS.
The nasal cycle is an important and currently poorly understood phenomenon. Understanding of its true role in the physiology of nasal breathing is still being clarified. Objective. To analyze and systematize data from English and Russian-language literature devoted to historical and current aspects of the nasal cycle study in the physiology of the nose and the body as a whole. Material and methods. A literature analysis concerning the issues of the nasal cycle study using PubMed, ScienceDirect, eLIBRARY.RU online information resources and printed publications of the Russian National Library, Saint Petersburg Research Institute of Ear, Throat, Nose and Speech was carried out for the period from 1895 to 2024. Results. It is shown that during analyzed period scientists made attempts to study the nasal cycle and examine its influence on organs and systems using various diagnostic methods. Morphological examinations of the nasal mucosa allowed to reveal the anatomical basis for the formation of this phenomenon, and a number of observations demonstrated the key influence of the autonomic nervous system on the regulation of the cavernous vessels tone and on the connection between the nasal cycle and physiological phenomena in the body as a whole. The study of dynamic changes in the nasal patency remains a relevant issue in otorhinolaryngology. To this date, long-term rhinoflowmetry and computational fluid dynamics are promising methods for studying the nasal cycle. Conclusion. Current knowledge on the nasal cycle suggests its multifaceted role in nasal physiology, which requires further research using modern technologies.
Genetically engineered biological therapy is a new promising treatment option for T2-induced chronic rhinosinusitis with nasal polyps (CRSwNP). Currently, there are 4 monoclonal antibodies indicated for this disease (dupilumab, mepolizumab, omalizumab, tezepelumab), and their list will gradually expand. Criteria for prescribing these drugs and criteria for assessing their effectiveness have been developed. Nevertheless, there are no clear guidelines for choosing a monoclonal antibody in a specific clinical case. The objective of this review is to analyze factors that can significantly influence the choice of monoclonal antibody in the uncontrolled course of T2-induced CRSwNP. It has been shown that dupilumab genetically engineered biological drug (GEBD) is an agent of choice for the treatment of primary, uncomplicated, T2-induced CRSwNP with an uncontrolled course. In case of high blood eosinophil counts, careful diagnosis is necessary for the early detection of possible eosinophil-associated diseases; if there are indications for GEBT, mepolizumab may be the starting monoclonal antibody in such patients. Patients with concomitant allergic diseases are candidates for the prescription of omalizumab monoclonal antibody.
Nasal septum perforations, especially of anterior localization, are associated with severe symptoms and reduced quality of life. Despite the availability of a wide range of surgical methods for their plasty, a single standardized approach to the treatment of such patients is currently lacking. This review presents modern methods for closing perforations, comparative analysis of which considering the anatomical characteristics of the defect, condition of the mucous membrane and previous interventions was performed. Special attention was given to the anatomy of the blood supply of the nasal cavity, which determines the viability of the flap and effectiveness of surgical intervention. The necessity to develop personalized surgical tactics aimed at increasing the effectiveness of treatment is emphasized.
Middle turbinate (MT) is a key structure in the nasal cavity, anatomical changes of which can impede access to the middle meatus and contribute to the development of synechias in the postoperative period. However, criteria allowing to determine the need for surgical intervention on the MT during endoscopic sinus surgery are absent in the literature. Objective. Comparative morphometric assessment of different variants of the MT structure using computed tomography data and anatomically based planning of surgical correction of the turbinate as a stage of endoscopic rhinosurgery. Material and methods. CT scans of 40 patients who underwent endoscopic interventions on the paranasal sinuses were analyzed. Among them, 20 (50%) had anatomically abnormal MT (paradoxical flexure, double, accessory and hypertrophied MT) and 20 (50%) had typical MT. Using a computer thermogram viewing program (RadiAnt DICOM Viewer (64-bit)), measurements of the MT were performed in two segments (points): in the area of the anterior attachment of the uncinate process to the lateral wall of the nasal cavity and in the projection of its free edge. The obtained indicators were compared with intraoperative data on the method of influence on the MT. Results. Horizontal dimension of the MT at the first point was significantly larger in patients with atypical anatomy and averaged 6.98±1.58 mm compared to 4.51±1.69 mm in the group with typical anatomy (p<0.001), horizontal dimension at the second point was significantly higher in the group with atypical anatomy — 7.21±1.16 mm versus 5.71±1.23 mm in the group with typical anatomy (p<0.001). Vertical dimension at the first and second points did not demonstrate significant differences between the groups (p=0.133 and p=0.860, respectively). Comparison of data from patients who underwent surgical correction of the MT and patients who underwent limited medialization of the turbinate showed significant differences in the horizontal and vertical dimensions of the MT at the first measurement point. The vertical dimension of the MT at the first point was significantly greater in the surgical correction group — 27.7±4.0 mm versus 24.5±4.1 mm (p=0.042). The horizontal dimension at the same point was also significantly higher in the surgical group — 7.25±1.55 mm versus 5.24±1.96 mm (p=0.006). The horizontal dimension of the MT at the second point had a tendency to differ between the groups (p=0.055) amounting to 7.19±1.07 and 6.21±1.43 mm, respectively, with a mean difference of 0.98 mm. The vertical dimension at the second point did not show statistically significant differences between the groups (p=0.473). Conclusions. The horizontal dimensions of the MT in both anatomical segments are significant morphometric indicators of anatomically abnormal anatomy as well as predictors of the need for surgical intervention on this structure. In patients with atypical anatomy of the MT, significantly larger horizontal dimensions compared to the group with typical anatomy were found, which allows to differentiate them objectively.
Olfactory analyzer receives information about a variety of odorants contained in the surrounding air. Like a number of other neural structures, the olfactory analyzer is capable of undergoing adaptive processes depending on the intensity of sensory stimulation. Numerous experiments on animals demonstrate that the neural structures responsible for olfaction change qualitatively and quantitatively in reduced sensory activation. The objective of this review was to summarize the available literature data on changes in the structure of the olfactory epithelium, olfactory bulb and anterior olfactory nucleus in a decrease or absence of odorant intake as a result of obstruction of one half of the nasal cavity in animals. During the review, we revealed that such neural structures do undergo changes at several levels: macro- and microscopic, biochemical and molecular genetic. In addition, the changes are not only negative and atrophic but also adaptive. It has been shown that the relevant volume of inhaled air is necessary for adequate maturation, functioning and regeneration of the neural structures of the olfactory analyzer.
Allergic rhinitis (AR) is the main risk factor for the development of bronchial asthma (BA), increasing the likelihood of its development by 2—7 times and influencing the course of the disease throughout life. The presence of concomitant AR is associated with a more severe and uncontrolled course of asthma. Intranasal glucocorticosteroids (InGCSs) are the most effective drugs for the treatment of AR and are used as first-line therapy for patients with persistent AR. According to ARIA guidelines, preference is given to intranasal agents, which provide a more pronounced clinical effect and rapid onset of action compared to systemic drugs. Fixed combinations of InGCSs and intranasal antihistamines (InAHs) are considered as a promising treatment option in patients with moderate to severe symptoms. Despite the presence of data on the impact of InGCSs on the course of BA in patients with a combination of AR and BA, studies assessing the effect of fixed combinations of InGCSs and InAHs on the control of BA in children could not be found in the available literature. Objective. To evaluate the effect of olopatadine hydrochloride/mometasone furoate (OLO/MF) combination spray and mometasone furoate (MF) nasal spray as monotherapy on the control of AR and concomitant BA symptoms in children of different ages. Patients and methods. An open prospective comparative clinical study included 81 children aged 7—17 years (median age 12 [10; 14] years) with uncontrolled moderate to severe persistent AR and concomitant partially controlled or uncontrolled mild or moderate BA. Patients were divided into two groups using a simple randomization method. For 57 [56; 60] days, all subjects underwent AR therapy: the 1st group included 60 patients who received a fixed combination of OLO/MF; the 2nd group included 21 patients who received MF in age-related dosages. Background BA therapy remained unchanged throughout the study, three visits were carried out at interval of 28 [28; 30] days. At the first and final visits, laboratory and instrumental studies (spirometry with bronchodilator test, determination of nitric oxide in exhaled air, FeNO) were performed, and at each visit, AR and BA control was assessed using validated questionnaires (VAS, ACQ-5, cACT/ACT, PAQLQ(s)). Results. The use of both the fixed-dose combination of OLO/MF and MF as monotherapy resulted in improved control of AR and BA, but the intensity of the clinical effect varied. In the OLO/MF group, a more significant decrease in the severity of AR symptoms according to the VAS (from 60 to 20 mm) was noted compared to the MF group (from 60 to 35 mm). BA control according to the cACT/ACT and ACQ-5 data improved statistically significantly in both groups, thus in primary school-age children, a significant improvement in the ACQ-5 and cACT scores was noted only in the OLO/MF group. Quality of life indicators according to the PAQLQ(s) questionnaire increased significantly in both groups. However, no significant changes were found in the physical activity domain in the MF group. Improvement in respiratory function and reduction in bronchial obstruction were more pronounced in patients who received OLO/MF. Levels of FeNO did not change statistically significantly, reflecting its auxiliary nature as an inflammatory marker. Dynamics of laboratory parameters of eosinophilic inflammation was more pronounced in the OLO/MF group, especially in adolescents. Conclusion. AR plays a key role in the development and maintenance of uncontrolled BA course in children, which necessitates a comprehensive assessment and treatment of the symptoms of both diseases. The obtained data indicate that rapid and effective achievement of AR control using the fixed combination of OLO/MF contributes to improvement of the control of concomitant BA and quality of life in children of different age groups without the need for escalation of background anti-asthmatic therapy.
The article presents a rare case of multiple mucoceles of both frontal, left maxillary and left ethmoid sinuses after previous extranasal surgical approach to the left frontal sinus for acute rhinosinusitis complicated by reactive edema of the left eyelids. Surgery using combined external (to the lateral part of the left frontal sinus) and endonasal approach to the affected sinuses was performed. Observation for 6 months showed a good functional effect of the operation with restoration of drainage and ventilation of all sinuses.
In the domestic literature, despite the development of surgical treatment for obstructive sleep apnea syndrome (OSAS), no significant scientific studies devoted to the analysis of the effectiveness of various surgical techniques in the comprehensive treatment of patients with this pathology have been identified. Objective. To evaluate the effectiveness of surgical techniques in the comprehensive treatment of patients with OSAS based on a literature review. Material and methods. Surgical treatment methods for OSAS proposed in Powell-Riley protocol were selected. During the comparative analysis of the effectiveness of the methods, operations of stage I of the Powell-Riley protocol were divided according to the levels of upper airway (UA) obstruction: nasal surgery, retropalatal surgery (uvolopalatopharyngoplasty and its modifications) and retrolingual surgery (which included osteotomy of the mandible with advancement of the genioglossus muscle and advancement of the hyoid bone with myotomy). Among the operations of stage II of the Powell-Riley protocol, the use of orthognathic surgery with maxillomandibular advancement (OSMMA) was analyzed. The ffectiveness of each surgical technique was assessed separately in patients with moderate and severe OSAS based on a meta-analysis of published data from 2000 to 2014. Results. Success rate of isolated surgical techniques used in stage I of the Powell-Riley protocol was less than 50%. The effectiveness of orthognathic surgery with maxillomandibular advancement as stage II of the Powell-Riley protocol amounted to 88%. Conclusion. The low effectiveness of isolated stage I Powell-Riley procedures is associated with multilevel UA obstruction, which necessitates the use of multilevel surgery for the treatment of patients with moderate and severe OSAS. OSMMA showed high effectiveness as a method of stage II of the Powell-Riley protocol in the surgical treatment of patients with moderate and severe OSAS, suggesting its more frequent use in the comprehensive treatment of OSAS.
Objective. To determine the prevalence of nasal bone fractures (NBFs) using cone beam computed tomography (CBCT). Material and methods. The continuous study is devoted to prevalence, localization and sex-specific differences in NBFs based on a retrospective analysis of 1000 cone beam CT scans of patients who complained of the nose and paranasal sinuses disorder. Results. Radiographic signs of NBFs have been found in more than 43% of the examined patients, and significantly more frequently in men than in women. The differences between the isolated NBFs on the left were 32% higher than on the right, and variation amounted to 15% for the frontal processes of the maxilla. Significant differences in the frequency of external nose fractures depending on the sex have been found. This indicator amounted to 62% for nasal bones among men, and among women — 38%. Men also led among the fractures of the frontal processes of the maxilla: 78.5% of cases versus 21.5% in women. Conclusion. The wide prevalence of NBFs (43% of cases at admission with complaints of the nose and paranasal sinuses disorder according to CBCT) should be considered in the examination of patients with pathology of the nose and paranasal sinuses.
Some of the most common complications of endoscopic rhinosinusosurgery are lateralization of the middle nasal concha and formation of synechiae in the middle nasal passage. Surgical correction of the middle nasal concha is aimed at preventing such complications. However, data on the effectiveness of interventional approaches on the middle nasal concha are highly contradictory. Objective. Based on the literature, to present anatomical variants of the middle nasal concha, to describe the methods of its surgical correction, their advantages and disadvantages. Material and methods. The literature search was conducted in the PubMed, UpToDate databases using the following keywords: middle nasal concha, surgery of the middle nasal concha, endoscopic rhinosinusosurgery, complicated rhinosinusosurgery, lateralization of the middle nasal concha, synechiae of the middle nasal passage. Based on the findings, 76 articles were included in the literature review for analysis. Results. Several types of anatomical structure of the middle nasal concha have been described. Classification of various surgical correction techniques of the middle nasal conchae with evaluation of their effectiveness and number of complications has been presented. Conclusion. Correction of the middle nasal concha in endoscopic interventions on the paranasal sinuses is an important stage of the surgery, allows to improve intraoperative access to the structures of the middle nasal passage, facilitates the wound surface care in the early postoperative period and reduces the frequency of relapses of the paranasal sinuses diseases in long-term follow-up with a relatively low risk of complications. Determination of indications and choice of correction method is based on the anatomical structure of the middle nasal concha and experience of the surgeon.
Primary ciliary dyskinesia (PCD) is a little-studied polygenic pathology from the group of ciliopathies, characterized mainly by the failure of the entire respiratory tract and requiring a multidisciplinary approach. Often the first symptoms of the disease are related to pathological changes in the nasal cavity and paranasal sinuses (PNSs). The most common manifestation of the upper respiratory tract (URT) pathology in PCD is chronic rhinosinusitis (CRS) with polyps and without them. There is a direct relationship between the condition of the PNSs and lungs due to the downstream contamination with the pathogenic microflora, that has an influence on the course and prognosis of the disease in general. The low degree of awareness of otorhinolaryngologists about this genetic nosology leads to a lack of appropriate suspicion and adequate diagnostic search. Objective. To analyze and generalize results of studies on the pathology of the nasal cavity and PNSs in children and adults suffering from PCD. Material and methods. The review includes publications from PubMed database and eLIBRARY.RU scientific electronic library for the period from 2007 to 2024, which provide relevant information on clinical picture, diagnosis and treatment of sinonasal pathology in patients with PCD. Results and conclusion. The review of available literature on sinonasal pathology in patients suffering from PCD has shown that the available information is insufficient and of low confidence, based on short-term and often single-arm studies with small samples. According to the majority of scientists, CRS is the main manifestation of URT failure in patients with PCD, thus PNSs are becoming a reservoir of bacterial flora. The results of bacteriological study of the nasal cavity and PNSs discharge have demonstrated dependence on the biomaterial sampling method and direct relationship with the microbiological status of the lower respiratory tract (LRT). Characteristic radiographic signs of changes in the PNSs in PCD are described. A combination of endoscopic surgery of the PNSs with adjuvant therapy has shown good results in the treatment of severe forms of CRS in patients with PCD. According to a number of scientific studies, early diagnosis and treatment of CRSs in patients with PCD correlate with lower prevalence of Pseudomonas aeruginosa, reducing the probability of the PNSs colonization, that further prevents pulmonary dysfunction and bronchiectasis formation, predetermining a relatively favorable outcome.
The problem of nasal hemorrhages (NHs) is still relevant mainly due to the difficulties in diagnosis and treatment of relapsing NHs. Although causes and triggers of NHs occurence are described in many studies, factors predisposing to the risk of relapsing hemorrhages have not been studied enough. Objective. To study the risk factors for NHs relapses according to publications. Material and methods. A bibliographic search in the RSCI, PudMed, ScienceDirect databases according to «nasal hemorrhage», «relapse risk factors» keywords as well as analysis of risk factors of NHs relapses according to the literature were performed. Results and conclusion. Major cohort studies distinguish the following risk factors for NHs recurrences: recent hospitalization for NHs in the last 30 days, absence of identification of the bleeder at primary examination, use of posterior tamponades at primary care delivery, age of the patient (70 years and older) and administration of oral anticoagulants, location of the bleeding source in the posterior nasal cavity, presence of comorbid pathology (arterial hypertension, heart failure, diabetes mellitus, obstructive sleep apnea syndrome).
The high prevalence of respiratory diseases, in particular acute viral rhinosinusitis (AVRS), the frequency of antibacterial therapy prescription for its treatment and the associated global issue of antibiotic resistance necessitate the search for new treatment approaches for this condition. The implementation of therapeutic strategies based on herbal medicinal products, comprehensive action of which is aimed both at inflammatory mechanisms and at symptom control, is one of the promising areas in treatment of AVRS. The multicomponent nature of standardized plant extracts provides synergistic therapeutic effects that act simultaneously on multiple pathophysiological mechanisms. Objective. To systematize and analyze current evidence on the potential and role of phytotherapy in the treatment of AVRS from the perspective of evidence-based medicine. Material and methods. Materials from publications in the MedLine, Embase, and PubMed databases were used in the review. Selection of sources was carried out using the following keywords: acute viral rhinosinusitis, treatment, phytotherapy, herbal medicinal product. Results. Systematic reviews show that herbal remedies have combined mucolytic, secretolytic, antiviral, antimicrobial, and anti-inflammatory actions, contributing to the reduction of rhinosinusitis symptoms with high tolerance. Among all herbal medicinal products, the most convincing evidence base for the treatment of AVRS has been obtained for the BNO 1016 plant extract, known as Sinupret extract. The evidential basis contains numerous data demonstrating significant clinical benefits of treatment regimens for AVRS that include Sinupret extract. Conclusion. Accumulated clinical evidence confirms the therapeutic potential of standardized herbal medicines in AVRS, positioning phytotherapy as a real alternative to conventional symptomatic treatment methods. It has been shown that therapeutic outcomes comparable to or superior to traditional treatment approaches can be achieved in application of herbal medicines while maintaining favorable safety profiles.
The article describes a clinical observation of a patient with bone replacement material migrated from the frontal sinus to the nasofrontal duct after supraorbital Keyhole craniotomy. Long-lasting presence of the bone replacement material in the nasofrontal duct and partially in the cavity of the left frontal sinus has led to the development of secondary polypous ethmoiditis, exudative left-sided frontal sinusitis and maxillary sinusitis.
