Diagnosis and treatment algorithm for inflammation of the rhinosinusotubal area

Abstract

Introduction: Inflammation of rhinosinusotubal area is a clinical situation, characterized by inflammation in the paranasal sinuses, nasal cavity, nasopharynxand Eustachian tube, in which dripping of infected discharge from the nasal cavity towards the Eustachian tube leads to the inflammation and obstruction of the latter. This complex of symptoms significantly impairs the quality of life.That’s why it is so important to improve diagnostic methods and develop a treatment algorithm for such simultaneous pathology of the paranasal sinuses and Eustachian tube. Material and methods: A total of 27 patient (19 women, 8 men), aged from 34 to 55 years, were enrolled in our study. Main complaints were prolonged autophony andhearing loss (10 days and longer), which did not improve after the standard treatment. All patients underwent the following examination: ENT examination, rigid endoscopy of the nasal cavity and nasopharynx by endoscopes 0 and 30 grade, cone-beam 3D Sirona middle and upper faces areas to examine the condition of paranasal sinuses and audiological assessment (pure tone audiometry, tympanometry). Results: After a thorough examination of patientswe found that all of them had different forms of sinusitis. Acute bilateral sinusitis was diagnosed in 56% of patients, 34% - had acute unilateral sinusitis and the last 10% -hemisinusitis. According to the results of pure tone audiometry 78% of patients had insignificant hearing loss, 10% had 1-2 grade conductive hearing loss, 12% had mixed hearing loss 2-3 gradewith prevalence of conductive component. According to the study results we developed a diagnostic and treatment algorithm for the inflammation of rhinosinusotubal complex. In addition to standard diagnostic methods it is necessary to use: plain X-ray or cone-beam computed tomography of the paranasal sinuses, audiological examination (pure tone audiometry, tympanometry), endoscopy of the nasopharynx. The treatment should include drainage of involved sinusesand restorationof the Eustachian tubefunction. This can be achieved by maxillary sinus puncture with instillations of antibacterial solutions and Eustachian tube catheterization. Pathogenetic treatment with mucoactive drugs, including herbal remedies, elimination therapy and hyposensitizing drugsfor mucociliary clearance improvement is also of a great importance. Conclusion: We recommend the use of plain X-ray or computed tomography of the paranasal sinuses for all patients with inflammation of rhinosunusotubal area to exclude possible “covert” sinusitis.