Chronic polypous rhinosinusitis: symptoms and treatment. Chronic polypous rhinosinusitis: symptoms and treatment Polyp of the maxillary sinus ICD 10

The symptomatic picture and intensity of manifestations of nasal polyps depends on the degree of blockage of the nasal passages. If the polyp is just beginning to form, patients experience minor discomfort, reminiscent of a mild cold. The only effective treatment is surgery.

Nasal polyps are benign formations that significantly impair the patient’s proper breathing. The disease has no gender differences and occurs equally in people of different ages.

Children and teenagers are usually affected. But cases of pathological growth of the mucous membrane in older patients cannot be excluded. almost identical to the clinical manifestations in adult patients.

The human nose is a complex anatomical structure.

The visible part of the face is the outer nose, where:

• frontal process;
• lateral cartilage;
• the large pterygoid cartilages that form the outer wings of the nose.

The lateral surfaces of the nose consist of cartilaginous tissue. The inside of the nasal passages is lined with mucous epithelial tissue, and the outside is covered with skin, muscles and sebaceous glands.

Typically, nasal polyps affect children of early and teenage age, but cases of pathological growth of the mucous membrane in older patients cannot be excluded.

Polyps form from the inside. The pathological neoplasm is based on transformations of the internal tissues of the nasal passages, mainly the mucous membrane.

Externally, polyps resemble peas, similar in appearance to a grapevine or mushroom. In clinical practice, polyps are regarded as a common complication of chronic rhinitis of various natures. However, clinicians classify any neoplasms as precancerous conditions or pathologies with increased oncogenic risks.

The risk group includes patients with a significant history of cancer, as well as those who have a hereditary history of polyposis of various locations.

The ICD-10 disease code is J33.0 - nasal polyp.

Choanal and antrochoanal polyp

The main classification of polyps determines the localization of pathological growth of the mucous membrane.

Based on location, nasal polyposis is classified into the following groups::

• Choanal. Polyposis is known as fibroma of the nasopharyngeal tract. Ripe polyps have a dense structure and a red tint. Fibrous neoplasms are localized in the opening of the nasal cavities and the upper nasopharyngeal region. The polyp has a stalk, and is also prone to the tendency of the neoplasm to generalize throughout the mucosal area.
  Against the background of the polyp, air exchange worsens due to the blocking of part of the nasopharynx and nasal cavity. Children are more likely to suffer from choanal polyposis than adults.
• Antrochoanal polyposis. Localization is determined by location in the nasal sinuses. The complexity of diagnosis depends on the need for research using more “deep” methods: ultrasound, x-rays, endoscopic research methods. The main cause of the pathology is chronic sinusitis, congenital anatomical imperfections of the nasal sinuses, septum, chronic diseases of the upper respiratory system.

The lack of adequate therapy for nasal polyposis often leads to malignancy of the growth tissue.

The causes of both types of pathology include:

1. Inadequate drug therapy for rhinitis, sinusitis, nasopharyngitis, cystic fibrosis;
2. Neurological and mental disorders;
3. Hereditary predisposition.

How dangerous is a polyp and can it develop into cancer?

During normal nasal breathing, the incoming air is warmed and moistened. The external nasal passages provide preliminary purification of the air from small particles and dust.

When nasal breathing becomes difficult, some changes occur in the natural processes of air supply:

1. The inhaled air directly enters the lungs;
2. The brain does not receive adequate oxygen supply;
3. The risks of infection increase, including pneumonia and dysplastic changes in the lung tissue.

The risk of oncological transformation of polyp tissue is largely determined by hereditary predisposition or a burdened history of cancer.

Malignancy of polyps is possible with:

• chronic rhinitis without long-term drug treatment,
• serious infectious diseases with melting of the nasal mucosa,
• chronic exacerbation of sinusitis.

The main dangers of a bleeding polyp

Bleeding from the nose with polyposis rarely has serious consequences, but such symptoms should not be ignored.

Bleeding of polyps occurs due to the following effects::

1. Mechanical cleaning of the nose (when immersing turundas and cotton swabs, the structure of the polyp is injured);
2. Intense nose blowing;
3. Entry of foreign bodies.

Chronic bleeding, even minor but regular, can lead to iron deficiency anemia. The pathology is more typical for women of reproductive age and children aged 1 to 4 years. It is then that the level of hemoglobin in the blood is reduced due to the development of the body’s immune forces and many other biochemical processes.

What to do about nasal polyps?

There is only one way to get rid of nasal polyps - surgery, after which patients experience instant relief and the elimination of all previous accompanying symptoms.

However, for some patients, radical treatment of nasal polyposis is unacceptable, especially if the degree of respiratory impairment is minor.

Features of treatment in children

For young children, gentle treatment tactics are chosen only if:

• The degree of blockage of the nasal passages does not impede nasal breathing;
• There are no signs of distortion of facial features or speech disorders.

Weakened immunity plays an important role in the formation of nasal polyposis of any etiological type and location.

Drug treatment involves prescribing the following drugs:

• Antihistamines with an allergic nature of rhinitis and polyposis:
• Hormonal agents to stop the growth of a polyp;
• Vitamin complexes to increase local and systemic immunity;
• Anti-inflammatory drugs and antibiotics for infectious diseases of various origins.

Note! An important factor is a course of physiotherapy to prevent the risk of growth of growths. Physiotherapy is especially important if the child has a complicated medical history, as well as if it is impossible to carry out surgical resection of pathological growths.

Surgical tactics are acceptable for the following treatment methods:

• To a lesser extent, polypotomy using a Lange loop (cutting a polyp with a loop and its subsequent cauterization with electrodes);
• Cryotherapy (freezing and necrosis of the polyp with its subsequent removal).

Treatment of nasal polyposis in children should occur under the careful supervision of specialists.

During adolescence

In children aged 10-14 years, the risk of polyps increases due to hormonal characteristics. It is known that puberty is characterized by a powerful release of hormones depending on the gender of the child.

Treatment is usually surgical to:

• avoid the risk of recurrence of polyposis,
• normalize the breathing and quality of life of a growing child.

Treatment in adults

Treatment for nasal growths in adults usually involves surgery. If there are contraindications to surgery, drug therapy may be prescribed along with the use of traditional medicine methods. How to cure nasal polyps.

The latest methods do not guarantee relief from polyposis, but can significantly alleviate the symptomatic picture of the disease, especially during a woman’s pregnancy.

Self-therapy or the use of traditional methods of treatment can negatively affect the child’s condition and provoke various complications.

Any treatment is prescribed only after a high-quality and thorough diagnosis, this allows:

• to clarify the nature of nasal polyposis,
• identify the risks of oncological transformation,
• assess the likelihood of a radical solution to the problem.

Psychologists believe that the basis of most health problems is psychosomatics. In the case of nasal polyposis, these are unspoken or hidden grievances towards loved ones.

Watch a useful video about the causes of nasal polyps and their treatment:

Polyps and cysts of the nasal cavity

Polyposis and cystic components have an identical nature of occurrence, and have the same effect on the quality of the patient’s respiratory function. Cysts and polyps are formed as a result of pathological degeneration of the tissues of the mucous membranes of the nasal passages.

The main differences are:

• Cysts- cavity formations with exudative fluid inside (including purulent ones) with a tendency to grow and block the nasal passages;
• Polyps- formations from hypertrophied mucosal tissue with a dense structure without varying content.

Only differential diagnosis can reliably identify pathological neoplasms.

Both polyps and cysts require radical treatment methods in case of obvious blockage of the nasal passages and disruption of full nasal breathing.

Nasal polyps are pathological foci of growth based on hypertrophy of the mucous tissues of the nasal passages. The tendency to malignancy is possible only under the influence of certain predisposing factors. Only a doctor can assess the degree of pathology, as well as determine treatment tactics. Self-therapy often means worsening the pathological process and prescribing a more radical correction.

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Polypous rhinosinusitis, according to the international classification of diseases, refers to diseases of the respiratory system (ICD code 10 J 01).

Against the background of decreased immunity, a long course of rhinosinusitis leads to swelling and proliferation of the mucous membrane of the paranasal sinuses and nasal cavity with the gradual formation of thickenings and the formation of polyps.

How does polypous rhinosinusitis manifest: symptoms

Benign formations of the nasal mucosa (polyps) prevent the normal discharge of mucus from the sinuses, which leads to characteristic symptoms of the pathology:

• headaches, aching in nature;
• pain in the lower part of the eye sockets;
• discomfort and nasal congestion;
• weakening or complete loss of sense of smell;
• feeling of a foreign body in the nasal cavity;
• scanty mucous or purulent thick discharge.

Attention

This condition develops over a long period of time, so the increase in severe symptoms and the nature of complaints are different at the beginning of the disease and throughout the entire period of progression.

The clinical picture is expressed in a combination of manifestations of intoxication of the body (increased body temperature, general malaise, febrile phenomena) and symptoms characteristic of the stage and localization of the pathology.

In addition to polypous rhinosinusitis with clinical manifestations, asymptomatic forms of the disease are also noted.

Causes of the disease

To date, there is no consensus on the causes of pathology of the nasal mucosa and paranasal sinuses. Scientists agree on one opinion - the presence of genetic predisposition and polyetiology of the disease.

The study of the mechanism of formation and histological picture of nasal polyps has led to the creation of several theories of pathogenesis:

The inflammatory process is caused the influence of eosinophils on the structure of the mucous membrane ( eosinophilic inflammation). A study of polyp tissue revealed an increased content of interleukin-5, albumin and other proteins that contribute to the activation of eosinophil transport and/or their apoptosis (extension of functioning).

These processes cause the accumulation of eosinophils and the resulting inflammatory process.

Allergic IgE-dependent reaction. This theory does not have reliable confirmation, since the pathology accompanies hay fever only in 10% of cases, which corresponds to the prevalence of an allergic reaction in the population as a whole. It has been proven that polyps do not change during the flowering period, which suggests that IgE-dependent allergy does not cause the disease, but is a concomitant pathology that aggravates the course of rhinosinusitis.

Impaired biotransformation of arachidonic acid. Salicylates in cellular biosynthesis trigger an alternative course of arachidonic acid metabolism, which results in the formation of leukotrienes (LTE-4; LTC-4; LTD-4), which are very active mediators of inflammation.

Bacterial cause. The role of bacteria in the development of polyp formation has not been fully studied. It is assumed that bacteria are a kind of superantigens capable of supporting the eosinophilic inflammatory process.

In support of the theory, the influence of enterotoxin on the growth and development of polyps as a superantigen was discovered. The role of bacteria in the etiology of the disease confirms the formation of “neutrophilic” neoplasms or polypous purulent rhinosinusitis.

The theory of fungal influence. It is assumed that the mycelium of pathogenic fungi that enters the inhaled air is attacked by T-lymphocytes. They activate eosinophils and cause them to migrate into the mucous contents of the paranasal sinuses.

There, eosinophils secrete toxic proteins from their cytoplasm, which destroy fungi, but at the same time there is an accumulation of toxic components and breakdown products. As a result, inflammation is stimulated in genetically predisposed individuals.

Pathogenic effects of viral respiratory infections. The experience of clinical observations of pathogenesis suggests a relationship between the viral infectious agent and the progression of rhinosinusitis and the growth of polyps.

Genetic factor. Scientists do not dispute the genetically determined nature of the pathology. Indirect confirmation may be the connection between polyploid rhinosinusitis and cystic fibrosis or Kartagener's syndrome.

This assumption is due to changes in the karyotype of patients. The gene responsible for the development of rhinosinusitis has not yet been isolated, but the connection can be traced.

Violation of the anatomical structure of the nose and, as a consequence, a violation of aerodynamics. As a result of anomalies of various etiologies, irritation of the mucous membrane with air flow with various particles occurs, as well as morphological restructuring of the membrane, hypertrophy and blocking of the ostiomeatal complex.

Multifactor theory. According to the assumption, there is a relationship between rhinosinusitis and congenital or acquired pathologies in the body.

Anomalies can be localized at various levels - cellular, subcellular, organismal, etc. Some of the violations may never appear, since there is no corresponding influencing factor.

For diffuse disease the cause may be In this case, the occurrence of cystic polypous rhinosinusitis is secondary and the pathology is localized in the affected sinus.

It is obvious that in addition to the wide variety of exposure factors that cause the disease, there is also a variety of symptoms. All this significantly complicates correct diagnosis and the prescription of effective treatment and implies a risk of complications.

How dangerous is this disease?

Typically, polypous rhinosinusitis does not have serious consequences, but its purulent forms can cause pathologies such as:

• osteomyelitis of the skull bones;
• meningitis and other intracranial purulent lesions;
• inflammatory and purulent pathologies of the visual apparatus.

Intracranial purulent pathologies caused by progressive purulent rhinosinusitis are accompanied in 15% of cases by such deadly diseases as meningitis, purulent meningoencephalitis and brain abscess.

Also, complications of the disease can be sepsis, subperiosteal abscess, rhinogenic thrombosis of the cavernous sinus, etc.

Complications caused by rhinosinusogenic pathology in the structures of the visual analyzer include many diseases and conditions:

• pseudotumor of the orbit of the eye;
• conjunctivitis;
• panophthalmitis;
• dacreoadenitis;
• retrobulbar neuritis;
• paralysis of the eyeball;
• abscess of the eyelid and others.

In addition, the pathology itself can occur with complications such as peritonsillar abscess and otogenic sepsis.

Diagnostics

To clarify the preliminary diagnosis, an external examination, collection and analysis of anamnestic data, and a study of the medical history are carried out. Often ultrasound and diaphanoscopy do not allow making a complete conclusion about the condition and function of the nose, therefore they use:

• rhinoscopy and endoscopy;
• computed tomography (CT);
• rhinomanometry;
• study of mucolytic transport;
• microbiological analysis and biopsy, etc.

CT is the most informative method and is recommended for all new patients. With multislice CT using multiplanar reconstruction, the image can assess the preservation of pneumatization of the paranasal sinuses.

The extent of the disease can be judged by the degree to which they are filled with dense mucin or pus. The method also allows you to detect anatomical disorders in intranasal structures.

It is worth noting

Computed tomography is the main diagnostic method and guide for surgical intervention.

To assess the microbiological composition of the intranasal cavities and sinuses, biological and biochemical research methods are used.

Laboratory studies indicate changes in blood rheology in patients with polypous rhinosinusitis, namely platelet aggregation, increased levels of fibrin fibers, characteristics of the osmotic and sorption abilities of erythrocytes.

These changes indicate the formation of microthrombi and impaired blood circulation in the capillaries. There is also an increase in the level of leukocytes in the blood, which indicates inflammatory processes.

Based on the analysis of laboratory and instrumental research data, the doctor develops an individual treatment strategy.

Treatment

In the treatment of polypous rhinosinusitis, both conservative and surgical methods are used. All types of pathology, except unilateral rhinosinusitis, can be treated with medications.

According to modern methods of treating polysinusitis, the first-line drugs are intranasal hormonal drugs. Preference is given to drugs that have high topical activity and low bioavailability, that is, the safest for long-term, sometimes lifelong use.

Among the licensed drugs, it best meets all requirements Mometasone furoate. It is prescribed in a therapeutically recommended dose in courses of 3-6 months or longer.

Its effectiveness has been proven in clinical studies. If nasal breathing is severely impaired due to polypous rhinosinusitis, allergic rhinitis, sinusitis and other nasal pathologies, Nasonex spray is prescribed, the active ingredient of which is momesonate furoate. An alternative to the drug are nasal sprays Beclomethasone and Budesonide.

When using systemic glucocorticoids, Prednisolone is used in short courses, since the medicine has a lot of side effects.

The medicine is used to prevent relapses, as well as in the presence of contraindications to surgery. Deposited glucocorticoids are not used in therapy due to their high bioavailability.

Among the treatment methods, irrigation therapy can also be called. Nasal irrigation is recognized as a safe and simple method of exposure. Usually, an isotonic or hypertonic solution of table salt, as well as sea water. The scientific literature contains documentary evidence of the effectiveness of the irrigation technique.

Special systems have been created and used that rinse the nose under various pressures or only irrigate the mucous membrane.

New alternative therapies are being developed and studied:

• treatment with low doses of macrolides;
• antimycotic therapy, local and systemic;
• desensitization with aspirin, etc.

Ketotifen is used to stabilize mast cell membranes. The drug has antihistamine and antianaphylactic properties and prevents the accumulation of eosinophils.

In order to increase local immunity, Polyoxidonium is used. Folk remedies used for local effects on pathology are thuja oil, which has antioxidant, reparative and immunomodulatory effects.

If conservative methods do not bring the expected result, surgical treatment is used.

Operation

The modern trend of using minimally invasive treatment methods also occurs in the treatment of polypous rhinosinusitis. For this use:

• laser coagulation, the operation is performed using a YAG-holmium and E-fiber laser;
• ultrasonic disintegration;
• submucosal vasotomy;
• electroacoustics;
• micro- and endoscopic methods;
• removal of polyps using polyp loops, etc.

Most often it is carried out using a shaver-microdebrider apparatus. The device is a thin nasal tube with rotating blades inside it and an attached microsuction.
Under the control of an endoscope, the tube is inserted into the nasal cavity and the polyp, and is suctioned to the end of the tube using a pump. The blades crush the tumor and its parts are sucked into the reservoir. After the operation, tampons are inserted into the patient, and then standard anti-relapse therapy is carried out.

The advantage of the method is its accuracy - the device operates only in the area of ​​the polyp, it is minimally invasive, and it is fast. The operation is performed on an outpatient basis under local anesthesia. The postoperative period is significantly shorter than after radical polypectomy.

The laser coagulation method also has good performance. As a result of testing the effectiveness of modern medical equipment for surgery, it was noted that laser exposure not only evaporates the polyp, but also relieves the inflammatory process and stimulates tissue regeneration. Thanks to the coagulating ability of the laser beam, the operation is bloodless.

Since polypous rhinosinusitis most often occurs in men, some patients of military age are interested in: “Are people with this pathology accepted into the army?” A conscript diagnosed with rhinosinusitis with persistent pathology of nasal breathing or with purulent sinusitis is given a deferment to undergo additional examination or surgery.