The results obtained suggest that common upper airway pathogens do not play a major role in the pathogenesis of chronic rhinosinusitis. The microbiome of inflamed sinonasal mucosa is extremely diverse and involves exotic species of bacteria that, to date, have not been considered as potential inhabitants of the paranasal sinuses.
Isolated sphenoid sinusitis (ISS) is a group of pathologies characterized by inflammation in one or both sphenoid sinuses. The gold standard for analyzing and diagnosing ISS is computer tomography. Many researchers have discussed the treatment of patients with ISS variants such as fully opacified sinus, mostly with surgery. A retrospective analysis of clinical data of 59 patients (21 male (35%), 38 female (65%)) with ISS, who were treated in the Otorhinolaryngological Department of Pavlov First Saint Petersburg State Medical University between January 2017 and January 2020, was conducted. All patients were in the first stage of the same medical therapy. In cases where there was no recovery, these patients were referred to surgery. For the control group, we analyzed patients without any disorders according to CT-scan examination. After analyzing the obtained clinical and radiological data, we found indicators that were common in patients who did not recover after medical therapy. According to the reverse regression method statistical model, in male patients with a diffuse headache and nasal discharge it was shown that medical therapy was highly effective (more than 78%). The presence of nasal septum deviation and adenoids in male and female patients leads to the highest risk of surgical treatment (83% probability of the logistic model). The detailed analysis of CT-scans and the complaints of patients with ISS can be the key to determining the preferred therapy choice. Not all cases need to have an endoscopic opening of the sphenoid sinus, according to our research.
The article presents our own research data on systemic immunity status in patients with chronic tonsillitis (CT) and microbiological profile of the flora isolated from the tonsils in CT. The study showed that phagocytic index in neutrophils decreased by 81.9% and the phagocytosis in neutrophils reduced by 67.2% in patients with CT. We studied microbial flora of the tonsils and its persistent properties in CT. The steps for that were as follows: we evaluated the antilysocyme (ALA), anti-interferon (AIA), anticomplementary (ACA) activities of the isolated microorganisms as possible ways to stand against the oxygen-independent mechanism of phagocytosis. Most strains of Staphylococcus aureus had ALA, AIA and AСA, while most strains of Streptococcus pyogenes had ALA, less frequently AСA and did not show AIA. We found antibacterial polyresistance in 56.0% of pathogens among the selected strains in the examined patients with CT. A comparative analysis of species antibiotic resistance showed that the largest number of multiresistant strains were S.aureus - 62.0%. The set of revealed persistent properties of chronic tonsillitis pathogens serves as underlying rationale for the search for new methods of therapy using drugs of non-antibacterial origin, affecting the factors of bacteria resistance to inborn and acquired immunity. It is possible, and necessary that attention be paid to phytotherapy in the search for such new methods. Tonsilgon N is one of the complex phytotherapeutic products, which efficacy and safety has been proven in clinical trials, and the main pharmacological properties are confirmed in in vitro and in vivo preclinical studies. It contains marshmallow root, chamomile flowers, horsetail grass, walnut leaves, yarrow grass, oak bark, and dandelion grass. The clinical studies revealed that it has positive effect on the dynamics of both clinical and microbiological, immunological parameters in patients with chronic tonsillitis. All these things allow us to recommend that this complex herbal product be more often included into the comprehensive treatment of chronic tonsillitis.
Benign pituitary gland tumors (or adenomas) constitute the vast majority of all chiasmosellar tumors. There are various approaches in surgical treatment of the sella turcica pathology. Endonasal transsphenoidal approach is the method of preference. Choosing the approach to the skull base, the surgeon should carefully study the results of magnetic resonance imaging and computer-aided tomography. If there are anatomic features preventing the approach to the operated area, first of all the patient undergoes the correction of these structures. The surgical excision of pituitary adenoma through endonasal access is conditionally divided into three stages: nasal, sphenoidal and sellar. The final stage of surgical treatment is the stage-by-stage plastic surgery of the bottom of sella turcica with the layer-by-layer implantation of glue compositions and sealing the intracranial space. 12 patients diagnosed with pituitary adenoma with infra- and suprasellar growth were examined at the Chairs of Otorhinolaryngology and Neurosurgery with the participation of cytological laboratories. All the patients were examined by an otorhinolaryngologist on the 7th, 30th and 90th days after surgery. Endoscopic visualization of the surgical intervention area was performed and cytological examination of the nasal cavity secretion was made at the indicated time intervals. Therefore, it has been found that the reactive inflammatory phenomena associated with irrigation therapy were stopped by the 30th-40th day after the surgery. In 8 patients the treatment was supplemented with local antibacterial therapy, which provided the removal of the reactive inflammatory phenomena in the surgical intervention area. Therefore, all patients after endonasal transsphenoidal removal of pituitary adenoma are recommended the 30-day otorhinolaryngologists’ follow-up with the purpose of control of regeneration processes dynamics.
The problem of allergic rhinosinusopathies is one of the most pressing in modern rhinology. It has drawn the attention of clinicians for several decades. Allergic rhinitis is a common disease, the onset of which often come in early childhood. In later life, this disease significantly reduces the quality of life. The widespread prevalence of allergic rhinitis among children and able-bodied adults, growing incidence rates of the disease represent a significant medical and social problem. Allergic rhinitis should be treated by otorhinolaryngologists and allergists-immunologists. Given the pathogenetic mechanisms of the disease, it is necessary to act upon the local symptoms and total body. Extension of disease remissions, teaching patients the principles of elimination therapy and how to maintain a healthy microclimate at home, relapse prevention are the main directions in the treatment of allergic rhinitis. The primary task of otorhinolaryngologists and allergists-immunologists is to restore unlabored nasal breathing in such patients. Symptomatic therapy includes administration of vasoconstrictor drugs, anticholinergics, cromons, local and systemic antihistamines, leukotriene receptor blockers, topical and systemic glucocorticosteroids (GCS), sorbents, pre- and probiotics. Despite the fact that the symptomatic therapy methods cannot provide a long-lasting effect after cancellation, local symptomatic treatment of allergic rhinitis using topical corticosteroids is generally accepted and widely used in the otorhinolaryngology practice. Flixonase is one of the topical corticosteroids that are often prescribed for allergic rhinitis. The aim of our paper was to evaluate the effectiveness of the treatment regimen of allergic rhinitis using Flixonase as a local GCS. 24 people with perennial allergic rhinitis aged from 19 to 38 years were under our observation. The following therapy was prescribed to the patients: decongestants, rinsing the nasal cavity with saline (saltwater) solutions, corticosteroids (Flixonase), mild sedatives. Flixonase showed its efficacy in our study.
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