Fungal rhinosinusitis - why do I like it?

Abstract

PURPOSE: To perform a prospective comparative in vitro study of the nasal mucociliary epithelium activity in patients with fungus ball of the maxillary sinus for adjustment of the diagnostic protocol, conservative treatment and to establish the variety of infectious agents involved in this clinical entity. METHODS: Clinical prospective study. Study group I: 30 patients – surgical treatment and conservative treatment with dry extract BNO 1016 14 days preoperatively, nasal saline irrigations, topical vasoconstrictors. Study group II: 30 patients – surgical treatment and conservative treatment with nasal saline irrigations, topical vasoconstrictors. Methods: patients were interviewed using the SNOT 22 test. Microbiological and histopathological methods were used. Instrumental methods (nasal endoscopy, CT, in vitro estimation of vibrational activity of pituitary cells) were performed. RESULTS: Fungus ball is a localized, non-invasive, slightly aggressive, extramucosal fungal rhinosinusitis. The importance of restoring the nasal mucosa function and the local immunity after a fungal process is primary in improving the quality of life of our patients. The mucociliary system is an important component of the innate system of the respiratory tract protection against the action of pollutants, allergens and pathogenic microorganisms. Mucociliary clearance is a natural process of airway cleaning. Failure of the nasal mucociliary clearance and local immune-biochemical indices is one of the basic links in the pathogenesis of many rhinosinusal diseases. Statistic test applied: Anova. In our study, the frequency of ciliary movements after the post-surgical conservative treatment was statistically significantly higher in patients of group I compared to patients in group II (4.9±0.06 Hz and 8.5±0.1 Hz, respectively, p<0.001), and subjects in the control group (4.9±0.06 Hz and 11.9±0.3 Hz, respectively, p<0.001). CONCLUSIONS: (1). The frequency of ciliary movements was statistically higher in patients in group I compared to those in group II. (2). This can be caused by the use of dry extract BNO 1016 that has an anti-inflammatory and regenerative effect, facilitating the dissolution of mucous secretions and restoring the integrity of the nasal mucosa and mucociliary epithelium. (3). Processes occurring in the mucociliary epithelium, including non-specific and specific immunity, require a more detailed description, because they allow to understand the physiopathological mechanisms of fungal rhinosinusitis and are potential therapeutic targets.