Chronic polyposis rhinosinusitis: symptoms and treatment. What are nasal polyps: classification and development, and why are growths dangerous? Polyp of the maxillary sinus mcb 10

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

Nasal polyps are benign formations that significantly impair the patient's full breathing. The disease has no gender differences, it occurs equally in people of different ages.

Children usually suffer early and adolescence. But cases of pathological proliferation of the mucosa in older patients are not excluded. almost identical to clinical manifestations in adult patients.

The human nose is a complex anatomical structure.

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

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

The lateral surfaces of the nose are made up of cartilage. Inside the cavity of the nasal passages are lined with mucous epithelial tissue, and outside they are covered with skin, muscles and sebaceous glands.

Usually, nasal polyps affect children of early and adolescence, but cases of pathological proliferation of the mucosa in older patients are not excluded.

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

Outwardly, polyps resemble peas, similar in appearance to a vine or mushroom. AT clinical practice polyps are regarded as a common complication chronic rhinitis different nature. However, clinicians classify any neoplasms as precancerous conditions or pathologies with increased oncogenic risks.

The risk group includes patients with a burdened oncological history, as well as those who have polyposis of various localization in heredity.

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

Choanal and antrochoanal polyp

The main classification of polyps determines the localization of the pathological growth of the mucosa.

By location, nasal polyposis is classified into the following groups:

• Choanal. Polyposis is known as fibroma of the nasopharyngeal tract. Mature polyps have a dense structure, 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 over the mucous area.
  Against the background of a polyp, air exchange worsens due to the overlap of part of the nasopharynx and nasal cavity. Children are more likely to suffer from choanal polyposis than adults.
• Anthrochoanal polyposis. Localization is determined by the location in the sinuses. The complexity of the diagnosis depends on the need for research in more "deep" ways: ultrasound, X-ray, endoscopic research methods. The main cause of pathology is chronic sinusitis, congenital anatomical imperfections of the nasal sinuses, septum, chronic diseases organs 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, rhinopharyngitis, cystic fibrosis;
2. Neurological and mental disorders;
3. hereditary predisposition.

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

During normal nasal breathing, the incoming air is warmed and humidified. External nasal passages provide preliminary air purification from small particles and dust.

With difficulty in nasal breathing, some changes occur in natural processes air supply :

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

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

Polyp malignancy is possible with:

• chronic rhinitis without long-term medical 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 against the background of the following effects:

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

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

What to do with nasal polyps?

There is only one way to get rid of polyps in the nose - a surgical operation, after which patients experience instant relief, the elimination of all previous accompanying symptoms.

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

Features of treatment in children

For kids early age sparing treatment tactics are chosen only if:

• The degree of overlap of the nasal passages does not impede nasal breathing;
• There are no signs of distortion of facial features, violations of the speech apparatus.

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

Drug treatment involves the appointment of the following drugs:

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

Note! An important factor is the course of physiotherapy to prevent the risks of growth growth. Physiotherapy is especially important with a burdened history of the child, as well as when it is impossible to carry out surgical resection of pathological growths.

Surgical tactics are acceptable in the following treatments:

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

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

In adolescence

In children 10-14 years old, the risks of polyps increase due to the peculiarities of the hormonal background. It is known that puberty is characterized by a powerful release of hormones, depending on the sex of the child.

Treatment is usually surgical:

• avoid the risk of recurrence of polyposis,
• normalize 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 the surgical operation, it can be prescribed drug therapy along with the use of methods traditional medicine. How to cure nasal polyps.

The latter methods do not guarantee getting rid of polyposis, however, they can significantly alleviate the symptomatic picture of the disease, especially during a woman's pregnancy.

Self-therapy or application folk methods treatment can adversely affect the condition of the child and provoke various complications.

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

• clarify the nature of the occurrence 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 against loved ones.

Watch a helpful 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 equally affect the quality respiratory function patient. 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 mucous tissue with a dense structure without a different content.

Only differential diagnosis can reliably determine pathological neoplasms.

Both polyps and cysts require radical methods treatment in case of frank overlapping of the nasal passages and violation of full nasal breathing.

Nasal polyps are pathological foci of growth based on hypertrophy of the mucous tissues of the membranes 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 the tactics of treatment. Self-therapy often means aggravation of the pathological process and the appointment of a more radical correction.

You can make an appointment with a doctor directly on our resource.

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

Against the background of a decrease in immunity, a long course of rhinosinusitis leads to edema 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 polypous rhinosinusitis manifests itself: symptoms

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

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

Attention

This condition is formed for a long period, so the increase in severe symptoms and the nature of complaints are different at the beginning of the disease and during the entire period of progression.

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

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

Causes of the disease

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

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

The inflammatory process is caused influence of eosinophils on the structure of the mucous membrane ( eosinophilic inflammation). When examining the tissue of the polyp, an increased content of interleukin-5, albumin and other proteins was found, which contribute to the activation of the transport of eosinophils and / or their apoptosis (extension of the functioning period).

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

Allergic IgE-dependent reaction. This theory does not have reliable confirmation, since pathology accompanies pollinosis 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.

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

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 maintaining eosinophilic inflammatory process.

In confirmation of the theory, the effect of enterotoxin on the growth and development of polyps, as a superantigen, was found. The role of bacteria in the etiology of the disease confirms the formation of "neutrophilic" neoplasms or polyposis purulent rhinosinusitis.

The theory of the influence of fungi. It is assumed that the mycelium of pathogenic fungi that has entered with 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, toxic components and decay products accumulate. As a result, inflammation is stimulated in genetically predisposed individuals.

Pathogenic effect of viral respiratory infections. The experience of clinical observations of pathogenesis suggests the relationship of a viral infectious agent with 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 relationship 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 link can be traced.

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

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

Anomalies can be located on various levels- cellular, subcellular, organismal, etc. Some of the violations may never appear, as there is no corresponding factor of influence.

At 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.

Obviously, in addition to a wide variety of factors that cause the disease, there is a variety of symptoms. All this significantly complicates the correct diagnosis, prescribing effective treatment and suggests a risk of complications.

Why is this disease dangerous?

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

• osteomyelitis of the cranial 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 fatal dangerous diseases like meningitis, purulent meningoencephalitis and brain abscess.

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

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;
• eyelid abscess and others.

In addition, the pathology itself can occur with such complications as paratonsillar 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 a complete conclusion about the condition and function of the nose, so they use:

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

CT is the most informative method and is recommended for all newly applied patients. With multispiral CT using multiplanar reconstruction, the image can assess the safety of the pneumatization of the paranasal sinuses.

By the degree of their filling with dense mucin or pus, one can judge the degree of the disease. The method also allows to detect anatomical disorders in the intranasal structures.

It is worth noting

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

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

At laboratory research there is a change in blood rheology in patients with polypous rhinosinusitis, namely platelet aggregation, elevated level fibrin fibers, characteristics of osmotic and sorption abilities of erythrocytes.

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

Based on the analysis of data from laboratory and hardware studies, 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 for unilateral rhinosinusitis, can be treated with medications.

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

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

Its effectiveness has been proven in clinical research. With a pronounced violation of nasal breathing with polypous rhinosinusitis, allergic rhinitis, sinusitis and other pathologies of the nose, Nasonex spray is prescribed, active substance 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 drug has a lot of side effects.

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

Among the methods of treatment, irrigation therapy can also be called. Nasal irrigation is recognized as safe and simple methods impact. Usually, isotonic or hypertonic saline solution, as well as sea water. The scientific literature has documented the effectiveness of the irrigation technique.

Special systems have been created and are used, which, under various pressures, wash the nose or only irrigate the mucous membrane.

Developing and researching new alternative methods therapy:

• 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, prevents the accumulation of eosinophils.

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

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

Operation

The current trend in the use of minimally invasive methods of treatment also takes place in the treatment of polypous rhinosinusitis. For this use:

• laser coagulation, the operation is performed using a YAG-holmium and Er 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 blades rotating inside it and an attached microsuction.
Under the control of the endoscope, the tube is inserted into the nasal cavity and the polyp, with the help of a pump it is sucked to the end of the tube. The blades crush the neoplasm and its parts are sucked into the reservoir. After the operation, tampons are inserted into the patient's body, 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, minimally invasive, speed. The operation is performed on an outpatient basis local anesthesia. Postoperative period significantly less than after radical polypectomy.

The method of laser coagulation 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, stimulates tissue regeneration. Thanks to the coagulating ability laser beam The operation is bloodless.

Since polyposis rhinosinusitis most often occurs in men, some patients of military age are interested in: “Do they take to the army with such a pathology?” A conscript who has been diagnosed with rhinosinusitis with a persistent pathology of nasal breathing or with purulent sinusitis is entitled to a delay in order to undergo an additional examination or operation.