The American Journal of Medical Sciences and Pharmaceutical Research
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TYPE
Original Research
PAGE NO.
37-40
10.37547/tajmspr/Volume07Issue02-05
OPEN ACCESS
SUBMITED
09 December 2024
ACCEPTED
11 January 2025
PUBLISHED
13 February 2025
VOLUME
Vol.07 Issue02 2025
CITATION
Shahlo Xamidullayevna Bakiyeva. (2025). Results of complex treatment of
chronic rhinosinusitis in patients with community acquisited pneumonia.
The American Journal of Medical Sciences and Pharmaceutical Research,
7(02), 37
–
https://doi.org/10.37547/tajmspr/Volume07Issue02-05
COPYRIGHT
© 2025 Original content from this work may be used under the terms
of the creative commons attributes 4.0 License.
Results of complex
treatment of chronic
rhinosinusitis in patients
with community
acquisited pneumonia
Shahlo Xamidullayevna Bakiyeva
Republic of Uzbekistan, Tashkent Medical Academy, Department of
Otorhinolaryngology, Uzbekistan
Abstract:
As world statistics show, 60% of patients with
chronic rhinosinusitis develop bronchopulmonary
pathology. According to foreign authors, the number of
patients with chronic rhinosinusitis increases annually
by 1.5-2%, and today more than 2/3 of inpatients are
affected by this pathology. Due to the anatomical,
physiological and complementary characteristics of the
upper and lower respiratory tracts, there is a tendency
towards a protracted course of rhinosinusitis, which in
turn leads to the spread of the infectious process to the
lower respiratory tract. It should be noted that existing
foci of infection in the upper respiratory tract spread to
the lower respiratory tract through microaspiration
after an acute respiratory illness, which is the cause of
the development of chronic bronchitis, bronchial
asthma, and in particular pneumonia. It should be noted
that despite the efforts of a number of specialists in the
treatment of penmonia, in recent years there has been
a significant increase in the incidence rate, as well as,
unfortunately, an increase in mortality among people of
various age groups.
Keywords:
Chronic rhinosinusitis, upper and lower
respiratory tract, community-acquired pneumonia.
Introduction:
The results of medical statistics
convincingly indicate an increase in the number of
diseases of the nose, paranasal sinuses (PS) [1,2] and
bronchopulmonary pathology [3]. The close anatomical
and physiological connections between the upper and
lower respiratory tracts are the reason that the increase
in the incidence of rhinosinusitis has kept pace with the
increase in the incidence of pulmonary diseases [4] and,
in particular, community-acquired pneumonia (CAP).
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The American Journal of Medical Sciences and Pharmaceutical Research
The incidence of pneumonia in Europe and North
America is 5
–
10 cases per 1 thousand population. The
mortality rate from severe pneumonia reaches 10%
and continues to rise [3;5]. Pneumonia most often
occurs in children, the elderly and chronic diseases of
the respiratory system. It is believed that in almost any
acute respiratory viral infection, the paranasal sinuses
are involved in the process to one degree or another
[10]. Acute rhinosinusitis in 95% of cases is caused by
viruses; 5-7 days after the onset of ARVI, a bacterial
process develops [6,7]. Under the influence of the virus
on the ciliated epithelium of the nasal cavity and
paranasal sinuses, the epithelial cells lose their cilia,
the epithelium becomes loose, and swelling of the
mucous membrane 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 impaired aeration
of the sinuses, inactivation of mucociliary clearance
and accumulation of serous exudate in the lumen of
the sinuses. Reducing the speed of mucociliary
transport allows prolonging the time of contact of
pathogenic bacteria with the mucous membrane and
promotes bacterial infection [8,11].
The nasal cavity and paranasal sinuses are a highly
organized structure, with a subtle and complex
regulatory mechanism, which has many specific
functions. Such a morphofunctional system ensures the
creation of the first barrier to the penetration of
infection. A subtle functional connection between the
nasal cavity and paranasal sinuses with other organs and
systems, primarily with the bronchopulmonary system,
is obvious.
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)
RESULT AND DISCUSSION
Of the total number of patients (102 patients), 62
patients underwent 3D radiography (MSCT) of the
paranasal sinuses. X-ray changes in the paranasal
sinuses showed an increase in the thickness of the
mucous membrane of more than 6 mm. Obvious
radiological 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, in 3 patients - right-
sided and left-sided hemisinusitis, in 4 - right-sided
maxillary ethmoiditis, in 7 patients - left-sided maxillary
ethmoiditis, in 2 patients - bilateral maxillary
ethmoiditis, in 10 patients signs of ethmoiditis and
ethmoidosphenoiditis were revealed, respectively, in 4
patients - sphenoiditis.
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
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The American Journal of Medical Sciences and Pharmaceutical Research
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.
As a result of the study, three groups of patients were
formed: Group 1 - 32 patients diagnosed with clinically
moderate/severe form of MS. The second group
consisted of 30 patients diagnosed with “clinically mild
MS.” The third group included 40 patients without
identified clinical signs of MS.
The first and second groups of patients received
complex treatment: antibacterial therapy included
drugs belonging to the group of cephalosporins (3-4
generations) and fluoroquinolones (2-3 generations),
intranasal local glucocorticosteroids, acetylcysteine-
containing drug 200 mg, 1 tablet 2 times a day for 10
days, antihistamines (Erius 5 mg, 1 tablet 1 time a day
for 10 days), the nasal cavity was also sanitized with a
sterile isotonic solution of sea water. Since patients in
group 3 did not have chronic inflammatory diseases of
the nasal cavity and paranasal sinuses, patients in this
group received only VBP treatment prescribed by a
pulmonologist.
On the 30th day of the study, the clinical effectiveness
of the complex treatment of CRS was 90.7%; three
(9.3%) patients underwent endoscopic surgery on the
sinuses due to the ineffectiveness of the treatment;
during the operation it was revealed that the natural
openings in the area of the osteomeotal complex were
closed . Eight (25%) patients underwent elective
septoplasty, and 9 (28.1%) patients underwent
vasotomy (Table 1).
Table 1
Performed surgical and partially completed surgical measures in patients of group 1
Type of intervention
Number of operations performed (n)
Puncture of the maxillary sinus
7 (21,8%)
Functional endoscopic sinus surgery
3 (9,3%)
Septoplasty
8 (25%)
Vasotomy
9 (28,1%)
CONCLUSION
Complex use in the treatment of CRS in patients with
CAP based on data from a microbiological study to
determine the type of microorganisms and their
sensitivity to antibiotics, cephalosporin drugs of the III-
IV generation and fluoroquinalarines of the II-III
generation (cefoperazone, levofloxacin), as well as
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The American Journal of Medical Sciences and Pharmaceutical Research
intranasal glucocorticosteroids (mometasone furoate),
antihistamines
(desloratadine),
secretolytics
(acetylcysteine) against the background of sanitation
of the nasal cavity and paranasal sinuses is the most
effective method to significantly improve treatment
results.
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