RHINOSINUSOPATHY (rhinosinusopathia; Greek rhis, rhinos hoc + lat. sinus a bosom + Greek pathos suffering, a disease) — the allergic disease of a nasal cavity and his adnexal bosoms which is shown subjective and objective symptoms of acute rhinitis and sinusitis, but differing from them in lack of pathomorphologic signs of an inflammation.
Adlersberg and Forshner (D. Adlersberg, L. Forschner) suggested to call an allergic disease of a nasal cavity a rhinopathy. As a rule, allergic process in a nasal cavity is often combined with defeat of subordinate clauses (okolonosovy, T.) bosoms of a nose (allergic rinosinusit). Considering that the disease proceeds without inflammatory component, i.e. is not inflammatory in full sense, B. S. Preobrazhensky in 1956 called it an allergic rhinosinusopathy.
The river can be combined with other allergic processes and diseases.
In R.'s development the essential role belongs to penetration into an organism in preferential inhalation way of various allergens (see). At the same time plays an essential role hereditary or acquired in the course of repeated contact with allergen (see. Allergy ) tendency to allergic reactions. At patients, sensibilized through respiratory tracts to any allergen, response arises in a mucous membrane of a nose, and further, at the subsequent contact with allergen, the mucous membrane of adnexal bosoms of a nose, a throat, a trachea and bronchial tubes also can be involved in process. In development of allergic reaction disturbance of a functional condition of c is of great importance. N of page, obviously, with formation of the center of the congestive excitement which arose on type conditioned reflex (see).
Morphologically the chronic rhinedema and adnexal bosoms with eosinophilic infiltration under the main membrane, a thickening and a hyperplasia of an epithelium in the form of polyps comes to light; mucous glands are stretched, edematous, muciferous.
B. S. Preobrazhensky allocates three forms of acute R.: transsudativny, at a cut in paranasal sinuses there is a serous transudate; edematous pristenochnuyu when hypostasis of a mucous membrane is observed and transudate is not found; and the third form representing a combination of two first.
A frequent symptom of acute R. is the headache sometimes of diffuse character, but is more often preferential in a zone of an innervation of a trifacial. In nek-ry cases hypostasis of soft tissues of the person on the party corresponding to an arrangement of the affected bosom is noted, to-ry keeps not for long and disappears upon termination of an attack of the acute River.
On the roentgenogram, as a rule, define an uneven zavualirovannost of a bosom that is a valuable diagnostic character. At suspicion on availability of transudate in it recommend to make a X-ray analysis in vertical position of the patient when it is possible to define a horizontal fluid level. Rentgenol. the picture P. is very dynamic and can change literally within several hours that needs to be considered in diagnosis of this disease.
The diagnostic puncture is a little informative, however transudate (if it is received) needs to be directed on tsitol. research. At the same time pay attention to existence in a smear of eosinophils. In favor of R. also often recurrent and long respiratory diseases, tendency to repeated rhinitises and bronchitis testify. During the progressing or a long current of R. irreversible changes of a mucous membrane — a hypertrophy of nasal sinks, a persistent pristenochny hyperplasia of a mucous membrane of adnexal bosoms of a nose and polyps can develop — being manifestations chronic
R. B. S. Preobrazhensky distinguishes the following forms of chronic R.: pristenochno-hyperplastic, pristenochno-hyperplastic in combination with transsudativny, pristenochno-hyperplastic in combination with polyps, diffusion and polypostural.
At hron. Rubles patients complain of constant headaches of uncertain localization and the spontaneous expiration of serous liquid from a nose at a ducking. At rentgenol. a research find a pristenochny thickening or cystiform formations of a mucous membrane. During a diagnostic puncture Highmore's (maxillary, T.) bosoms, it is frequent because the end of a needle gets into a reinforced mucous membrane, the symptom of «vacuum» is noted. Sometimes by means of the syringe it is possible to suck away a small amount of liquid (unlike true cysts of adnexal bosoms of a nose, at to-rykh liquid follows a stream or frequent drops). During suction of liquid at hron. The ruble is marked out pain, at cysts of adnexal bosoms of a nose it appears only after the expiration of liquid.
Chronic R. often is complicated by infectious process, and in these cases a little in what differs from a current usual hron. rhinitises (see) and sinusitis of an inflammatory origin (see. Antritis , Sphenoiditis , Frontal sinusitis , Etmoidit ).
Differential diagnosis carry out taking into account the anamnesis, character of a course of a disease (repeatability of aggravations to a certain season, communication with effect of certain allergens, frequent aggravations). Also simultaneous damage of several adnexal bosoms of a nose is characteristic.
Treatment it is directed first of all to desensitization of an organism (see. Desensitization ), whenever possible specific or nonspecific, drugs of calcium, sulfur, antihistamines (isopromethazine, Pipolphenum, Suprastinum, Diazolinum, tavegil). In nek-ry cases the histamine in small doses is effective, use also drugs of bromine and caffeine. In cases of unsuccessfulness of reflex and antihistaminic therapy resort to treatment by corticosteroids, but after careful inspection of the patient and an exception of diseases, at to-rykh purpose of hormonal means contraindicated. Small edematous polyps usually disappear as a result of use of corticosteroids.
Use of physiotherapeutic procedures is reasonable: uv radiation, an electrophoresis of a histamine, calcium on area of cervical nodes of a sympathetic trunk, a galvanic collar on Shcherbaka, fonoforez a hydrocortisone (see. Ultrasonic therapy , Ultraviolet radiation , Electrophoresis ). Apply also novocainic blockade (ShM.) — 2 ml of 1% of solution of novocaine in the lower nasal sink of 1 times in 3 — 4 days (the course of treatment consists of 8 — 10 blockade), acupuncture (see), use climatotherapy (see). Treatment also includes obligatory sanitation of an oral cavity and throat.
Operational treatment it has to be carried out carefully and be combined with the hyposensibilizing therapy, to-ruyu, according to M. R. Bogomilsky, it is necessary to continue within 2 — 3 months and after operation. Operative measures, hl. obr. intranasal, galvanocautery (see), turbinotomy (see), removal of polyps (see. Nose ) shall be most sparing.
Prevention includes restriction of topical administration of vasoconstrictors, a close check behind its duration. It is also reasonable to limit topical administration of antibiotics and sulfanamide drugs, to-rye even more often are the reason of various allergic phenomena.
Bibliography: Voyachek V. I. Fundamentals of otorhinolaryngology, D., 1953; D and y-N I to JT. B. Modern opportunities of conservative treatment of sinuites, Zhurn. ushn., nose. and throats, Bol., No. 4, page 57, 1979, bibliogr.; Bvdoshchenko E. A. To an etiology and treatment of acute rhinitises and rinosinuit, in the same place, No. 4, page 7, 1980; Likhachev A. G. and Gold-m and I. I N. Chronic allergic rinosinuita, M., 1967, bibliogr.; P from and p about in I. I., Pogosov V. G. and Shevrygin B. V. Treatment of rhinitis and a rinosinuit at adults and children, M., 1968; Preobrazhensky B. S. Vasculomotor and allergic antritis as nosological form, Vestn. otori-nolar., No. 5, page 38, 1956, bibliogr.; Preobrazhensky B. S., etc. Allergic diseases of upper respiratory tracts, M., 1969, bibliogr.; At N d r and V. F c. Value of upper respiratory tracts in a pathogeny of allergic diseases, Zhurn. ushn., nose. and throats, Bol., No. 4, page 3, 1960, bibliogr.; Bhargava K. Century, Abhyan-k and of U. S. a. Shah of T. M. of Treatment of allergic and vasomotor rhinitis by the local application of silver nitrate, J. La-ryng., v. 94, p. 1025, 1980, bibliogr.; Principato J. J. Chronic vasomotor rhinitis, cryogenic and other surgical modes of treatment, Laryngoscope (St Louis), v. 89, p. 619, 1979.
H. I. Kostrov, V. P. Fomina-Kosolapov.