International Journal of Medical Sciences And Clinical Research
25
https://theusajournals.com/index.php/ijmscr
VOLUME
Vol.05 Issue02 2025
PAGE NO.
25-28
10.37547/ijmscr/Volume05Issue02-05
Prevalence of diseases of the nose and paranasal sinuses
in community-acquired pneumonia
Shahlo Xamidullayevna Bakiyeva
Republic of Uzbekistan, Tashkent Medical Academy, Department of Otorhinolaryngology, Uzbekistan
Received:
09 December 2024;
Accepted:
11 January 2025;
Published:
13 February 2025
Abstract:
In most cases, patients with community-acquired pneumonia have inflammatory diseases of the nose
and paranasal sinuses, as well as in patients who have had a history of inflammatory diseases of the upper
respiratory tract several weeks and months ago. When examining such patients with rhinosinusitis, the functions
of the nose and paranasal sinuses are impaired, which in turn leads to the activation of opportunistic microflora,
which increases the adhesion of pathogenic microorganisms to the mucous membrane of the upper respiratory
tract and creates favorable conditions for microbial colonization. It is known that viruses have a bronchotropic
effect, manifested by damage to the epithelium and a violation of the trophism of the bronchi due to damage to
the nerve conductors. Under the influence of the general toxic effect of the virus, phagocytosis is inhibited,
immunological protection is impaired, as a result, favorable conditions are created for the entry of pathogenic
bacterial flora located in the upper respiratory tract into the bronchi and alveoli of the lungs, which to a large
extent contributes to the development of diseases of the lower respiratory tract.
Keywords:
Diseases of the nose and paranasal sinuses, community-acquired pneumonia, pathogenic microflora.
Introduction:
From year to year, infectious diseases of
the upper respiratory tract and upper respiratory tract
occupy the 1st place in the structure of general
morbidity not only in our country, but also in the world
[1]. According to WHO, respiratory pathology is one of
the top five causes of death in the world's population
[2]. The incidence of pneumonia in Europe and North
America is 5
–
10 cases per 1,000 population. Mortality
from severe pneumonia reaches 10% and continues to
grow [7]. The most common complication of influenza
is pneumonia. It can develop at any period of the
disease in case of accession of the bacterial flora
(pneumococci, staphylococci, etc.). Most often,
pneumonia occurs in children, in the elderly and in
chronic diseases of the respiratory system. The second
place in frequency is occupied by lesions of the ENT
organs, with the occurrence of rhinitis, pharyngitis,
laryngitis, tracheobronchitis, as well as lesions of the
tonsils and paranasal sinuses [3]. Usually, acute
rhinosinusitis develops against the background of SARS.
It is believed that in almost any acute respiratory viral
infection, the paranasal sinuses are involved in the
process to one degree or another [11,12]. Acute
rhinosinusitis in 95% of cases is caused by viruses, the
development of a bacterial process (usually 10-12 days
after the onset of SARS) [8,9]. Under the influence of
the virus on the ciliated epithelium of the nasal cavity
and paranasal sinuses, epithelial cells lose cilia, the
epithelium becomes loose, and mucosal edema
develops. As a result of these processes, as well as the
active release of pro-inflammatory mediators, an
inflammatory reaction develops. The consequence of
this is a violation of the aeration of the sinuses,
inactivation of mucociliary clearance and the
accumulation of serous exudate in the lumen of the
sinuses. A decrease in the rate of mucociliary transport
makes it possible to prolong the time of contact of
pathogenic bacteria with the mucous membrane and
promotes bacterial infection [10,13,14]. Rhinosinusitis
in children leads to serious complications. Sinusitis in
children under 3 years of age in 94.7% of cases occurs
with complications, in almost half of cases acute
rhinosinusitis is accompanied by pneumonia [4].
According to WHO (2019), pneumonia causes 15% of
deaths in children under 5 years of age worldwide.
Worldwide, about 17 million people a year fall ill with
pneumonia, of which about 265,000 cases end in death
[5]. The nasal cavity and paranasal sinuses are a highly
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International Journal of Medical Sciences And Clinical Research (ISSN: 2771-2265)
organized structure, with a subtle and complex
regulatory mechanism, with many specific functions.
Such a morphofunctional system provides the creation
of the first barrier to the penetration of infection. The
subtle functional connection of the nasal cavity and
paranasal sinuses with other organs and systems,
primarily with the bronchopulmonary system, is
obvious [6]. The close anatomical and physiological
relationships of the upper and lower respiratory tract
are the reason that the increase in the number of
rhinosinusitis keeps pace with the increase in the
number of pulmonary diseases, in particular
community-acquired pneumonia, and this trend has
not yet been broken, despite the joint efforts of the
leading experts of all peace. Therefore, it is necessary
to study the state of the ENT organs in patients with
pneumonia, since this is of great importance for
treatment and prevention.
METHODS
A total of 102 patients with community-acquired
pneumonia who were hospitalized in the pulmonology
department of the clinic of the Tashkent Medical
Academy were examined. The age of patients ranged
from 18 to 60 years (average 39.1 ± 1.14 years), the
mean age of men was 34.1 ± 2.7 years, women 40.1 ±
2.9 years, respectively (Table 1).
Distribution by gender: men - 41 people (40.2%),
women - 61 people (59.8%), men - 41 people (40.2%).
Complaints and the history of the development of the
disease were clarified in detail in all patients, and the
general condition of the patients was examined. When
collecting an anamnesis, the timing of the onset of the
disease was specified, the timing of the occurrence of
relapses, their relationship with infectious diseases of
the upper respiratory system, and the presence of
concomitant diseases of other organs were taken into
account.
Table 1. Distribution of patients with CAP by sex (male/female) and age (n=102)
DISCUSSION AND RESULTS
Assessment of the clinical course of chronic
rhinosinusitis in patients used a visual analogue scale
(VAS), which divides the course of the disease into mild,
moderate and severe. On a conditionally 10-point
scale, the patient must independently assess how much
he is concerned about the symptoms of CRS, while from
0 to 4 - mild, from 5 to 10 - moderate / severe. As a
result of nasal endoscopy, 31 patients (30.4%) were
found to have deviated nasal septum (DNS); 23 (22.5%)
patients had vasomotor rhinitis; in 10.8% of cases (11
patients) - hypertrophy of the inferior nasal concha; 2
patients revealed (1.9% of cases) hypertrophy of
concha bullosa and uncinate process; also polyposis of
the nasal mucosa was observed in 1 (0.9%) patient
(table 2).
Table 2. Results of nasal endoscopy
Of the total number of patients (102 patients), 62
patients underwent 3D radiography (CBCT) of the
paranasal sinuses.
X-ray changes in the paranasal sinuses showed
19
13
7
2
18
15
13
15
0
5
10
15
20
18-30 yaers
31-40 yaers
41-50 yaers
51-60 yaers
31
23
11
2
2
1
0
5
10
15
20
25
30
35
DNS
vasomotor rhinitis hypertrophy of the
inferior nasal
concha
concha bullosa
hypertrophy of
uncinate process
polyposis of the
nasal mucosa
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International Journal of Medical Sciences And Clinical Research (ISSN: 2771-2265)
the presence of an increase in the thickness of the
mucous membrane by more than 5 mm. Explicit
radiographic changes were detected in 32 (51.6%)
patients. In 2 patients, a subtotal and total decrease in
pneumatization of all paranasal sinuses was observed,
i.e. a clear picture of pansinusitis, 3 patients had right-
sided and left-sided hemisinusitis, 4 patients had right-
sided sinusitis, 7 patients had left-sided sinusitis, 2
patients had bilateral sinusitis, 10 patients showed
signs of etmoiditis and ethmoidosphenoiditis,
respectively, 4 patients had sphenoiditis.
Figure 1. Patient D., 31 years old. 3D
radiography of the paranasal sinuses.
Identification of subtotal and total areas of
blackouts in the left maxillary sinus and
ethmoid cells
Figure 2. Patient G., 27 years old. 3D
radiography of the paranasal sinuses
subtotal and total areas of eclipse of the
anterior and middle groups of cribriform
cells.
CONCLUSION
Thus, based on the data obtained, it can be concluded
that patients suffering from community-acquired
pneumonia often have inflammatory diseases of the
nose and paranasal sinuses. In 60.8% of patients with
community-acquired pneumonia (CAP) inflammatory
diseases of the nasal cavity and paranasal sinuses were
identified. 3D radiography (CBCT) of patients with
chronic rhinosinusitis (CRS) revealed darkening of the
paranasal sinuses in 51.6% of cases. In particular, in the
cells of the ethmoid bone - 45.0%, in the maxillary sinus
- 25.3%, in the sphenoid sinus - 22.0%.
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