According to the international classification of diseases, one of the rarest diseases of the respiratory system is considered to be chronic polypous rhinosinusitis (ICD-10 code - J01). This pathology is characterized by partial or complete respiratory failure through the nose due to the occurrence of polyps.
Description
Against the background of a deterioration in the protective properties of immunity, a prolonged course of rhinosinusitis provokes swelling and proliferation of the mucous membrane of the nasal cavity and paranasal sinuses with the slow formation of polyps. This disease usually develops in parallel with many other ailments and is accompanied by unpleasant purulent discharge. More often, chronic polypous rhinosinusitis is diagnosed in males.
Features of the disease
Polyps are benign tumors. Their occurrence is explained by the appearance of inflammatory foci that affect the soft tissues of the sinuses. This pathological condition prevents the penetration of nutrients, resulting in thinning and loss of mucosal plasticity. The body is trying to return it to its original state. Due to this, new layers of tissue appear in the nasal cavity instead of thinning. As the pathological condition progresses, teardrop-shaped polyps filled with infiltrate appear in the sinuses.
Such tumors always nucleate in bulk. They settle down on the walls of the sinuses, creating groups. As a result, the full penetration of air and liquids is disturbed there. A complete blockage of the nasal cavity makes a person inhale and exhale air through his mouth.
It should be said that chronic polypous rhinosinusitis (according to ICD-10 code J01), despite a similar clinical picture and the causes of development, is a separate disease. In contrast to the named pathology, with sinusitis, abnormal tumors appear in the region of the paranasal sinuses.
Causes of occurrence
The exact prerequisites for the development of chronic polypous rhinosinusitis are not yet known. Among the favorable conditions, experts distinguish the following:
- cystic fibrosis;
- heredity;
- chronic sinusitis with purulent processes;
- fungal infection of the body;
- excessive sensitivity to salicylic acid;
- allergies, including rhinitis;
- not cured on time rhinosinusitis in acute form.
This pathology is infectious and develops as a result of infection of the body:
- chlamydia
- streptococci;
- pseudomonads;
- Candida fungus;
- staphylococcus.
Pathogenesis
Of course, due to so many provoking factors, there are a variety of symptoms and signs that complicate the diagnosis and treatment. Therefore, the clinical picture of the described disease should be known in detail.
Inflammatory foci in the nasal cavity and the polyps themselves are formed due to the influence of such factors:
- hypothermia;
- the presence of fistulas between the maxillary sinus and oral cavity;
- weakened immunity;
- caries;
- hypovitaminosis;
- reflux esophagitis;
- curvature of the nasal septum.
In addition, the hormonal factor in the pathogenesis of chronic polypous rhinosinusitis plays an important role. Violations of the endocrine system invariably lead to a weakening of the immune system and malfunctioning of other organs.
Among the conditions that cause the onset of chronic polyposis of rhinosinusitis are such bad habits as smoking and inhalation of harmful chemicals.
Types of disease
Chronic polypous rhinosinusitis (according to ICD-10 code J01) is divided into categories according to the severity of the course, location and causes of neoplasms.
So, depending on the area of location, the disease is single and bilateral. And by the type of pathogens, the pathology is divided into the following types:
- viral;
- bacterial;
- fungal;
- mixed.
By the nature of the course, rhinosinusitis is divided into moderate, light and heavy.
Clinical picture
Shortness of breath is considered the initial symptom, indicating the presence of neoplasms in the nasal cavity. This symptom is accompanied by a number of other phenomena:
- nasal;
- worsening sense of smell;
- the appearance of migraine;
- discomfort in the nose;
- bad breath from the oral cavity;
- purulent discharge from the nose;
- discomfort behind the orbits.
As the pathology progresses and in the absence of proper treatment, abnormal neoplasms spread to the nasal cavities. At this stage, the patient has a feeling of increased pressure in the nose and the presence of a foreign object there. In the near future, if the patient does not take any action, he will be able to breathe exclusively through his mouth.
Probable complications
The history of the disease in chronic polypous rhinosinusitis continues with the development of disorders in the patient's cardiovascular system, as a result of which tachycardia progresses. And this happens as a result of an insufficient amount of oxygen. Sometimes there are problems with swallowing. And due to general malaise, the patient can become too irritable and conflicting.
In the absence of necessary therapy, various complications can occur, including:
- lack or loss of appetite;
- oxygen starvation of the brain, as a result of which working capacity decreases, memory and concentration of attention deteriorate.
The danger of chronic polypous rhinosinusitis lies in the fact that gradually pus accumulates in the sinuses, which forms favorable conditions for the reproduction of bacteria. As a result, microbes spread to nearby organs, damaging even the ears and eyes. In many cases, due to chronic purulent polypous rhinosinusitis, pathogenic microflora penetrate the brain, which is why the patient develops meningitis.
Other consequences
Subperiostal abscess, sepsis, and rhinogenous sinus thrombosis may also occur as complications. As for the risk to the visual organs, this system is prone to:
- pseudotumors of the eye orbits;
- dacreoadenitis;
- abscess of the century;
- conjunctivitis;
- retrobulbar neuritis;
- panophthalmitis;
- paralysis of the eyeball.
In addition, the disease itself can be complicated by a paratonsillar abscess and otogenic sepsis. As a result, purulent rhinosinusitis can provoke severe pathologies, which in 25% of cases lead to death.
Diagnostics
To make a diagnosis, a specialist first examines the patient's cheeks, nose and forehead by palpation, after which he will give a referral to a general blood test. In addition, additional studies may be prescribed:
- CT
- endoscopy;
- rhinoscopy;
- MRI
- biopsy;
- rhinomanometry;
- microbiological analysis;
- radiography.
The second survey option provides the most accurate results. Endoscopy is considered a minimally invasive procedure that allows you to evaluate the general condition of the mucous membrane of the nasal cavity and adjacent tissues.
Computed tomography is considered the main diagnostic technique and a guideline for surgical intervention.
To assess the microbiological flora of the sinuses, biochemical and biological analysis is used.
In the process of laboratory studies in patients with rhinosinusitis, a change in blood composition is noted, including platelet aggregation, high fibrin levels and sorption properties of red blood cells.
Given that this disease is characterized by signs characteristic of other pathologies, a differentiated diagnosis is carried out. A therapy strategy is developed individually based on hardware and laboratory studies.
Treatment of chronic polypous rhinosinusitis
To get rid of the described disease, two methods are used:
However, according to numerous reviews, the treatment of chronic polyposis of rhinosinusitis without surgical intervention does not allow to achieve full recovery. The use of drugs makes it possible to slow down the progression of pathology and increase the distance between existing tumors. And most often, conservative treatment is used to increase the duration of remission. In all other cases, the patient is sent for surgery, during which the removal of neoplasms in the sinuses is performed.
Modern medicine offers patients with such a diagnosis the use of drugs that contribute to the immediate death of growth cells. In the future, neoplasms are eliminated from the body naturally.
In addition, for the treatment of chronic polyposis of rhinosinusitis, one can resort to systematic rinsing of the sinuses with an ordinary salt solution or special means, such as Quickix or Aquamaris. These drugs make it possible to remove purulent accumulations, thus lowering the risk of development and growth of pathogenic microflora.
Drug treatment
A prerequisite for effective therapy is the elimination of the causes of the disease. In this case, it is necessary to avoid the use of anti-inflammatory non-steroid medicines. In addition, it is very important to prevent the penetration of allergens into the nasal cavity. Drug therapy consists of several stages:
- Local anti-inflammatory drugs. As a rule, corticosteroids are used for the treatment of rhinosinusitis, for example: Rinoklenil, Bekonase and Aldetsin. After using these drugs, neoplasms die off in just a couple of weeks. And due to the fact that the medicines used do not enter the blood vessels, side effects from this treatment technique are extremely rare. Just a few days after the administration of these drugs, the patient feels a significant improvement.
- Antihistamines. In the described pathological condition, second-generation drugs are used, similar to "Cetirizine", "Fexofenadine" or "Loratadine". These drugs bring quite a quick result. It is noteworthy that they in no way affect the central nervous system, so they are not addictive. Antihistamines prevent and eliminate swelling of the nasal cavity and effectively fight smooth muscle spasms.
- Neoplasm membrane stabilizers. One of the most popular drugs in this category is Ketotifen. It inhibits the activity of histamine receptors, thereby eliminating the risk of accumulation of eosinophils in the nasal cavity.
- Immunostimulants. Essential for the overall strengthening of the immune system. Thanks to their use, infectious and viral diseases disappear. In addition, these drugs help eliminate puffiness and contribute to a more rapid tightening of the mucous membrane.
Surgical intervention
Surgery for chronic polypous rhinosinusitis involves the use of local anesthesia and a shaver microdebrider. This device, in addition to a hollow tube, is equipped with a special endoscope with a micro camera, which makes it possible to fully control all manipulations. The machine after getting into the nasal cavity creates negative pressure, after which the working handle with small blades is attached to the tumor.
After surgery, cotton swabs must be inserted into the nose to stop bleeding. In addition, drugs are prescribed to the patient as rehabilitation therapy that will prevent the occurrence of relapses.
Conclusion
For the treatment of rhinosinusitis and its prevention, you can resort to recipes of alternative medicine. To do this, you can use steam inhalation over boiled potatoes, the famous Zvezdochka balm, garlic or menthol. You can use a compress from boiled eggs, heated river sand or sea salt.
In the treatment of pathology, several rules should be taken into account:
- the patient needs to undergo allergy tests to detect the pathogen;
- it is advisable to systematically observe a special drinking regimen;
- vasoconstrictor drugs should not be used for longer than a week.