Ability of General Practitioners in the Treatment of Acute Rhinosinusitis

Zavalii M. A.

DISCUSSIONS

Scentific article

Acute rhinosinusitis is one of the most prevalent diseases in otorhinolaryngological practice. Such patients initially refer to general practitioners, as it usually is preceded by acute respiratory viral infection (ARVI). According to statistics, bacterial rhinosinusitis develops in 2-13 % of patients after ARVI. During the influenza epi- demic, the incidence of rhinosinusitises cases among the ones who got sick reaches 50-55 %. Disease outcome in many ways depends on the quality of diagnostics and the time after provision of specialized care. It should be taken into consideration that mucosal edema, rheological properties disorders of mucociliary transport system secretion take place in acute rhinosinusitis. Elimination of namely these factors can contribute to normalization of mucosal function of the upper respiratory tract and therefore can manage the inflammatory process. The article presents information on the diagnostic search and the volume of therapeutic procedures in patients with suspected acute rhinosinusitis. In patients with suspected acute rhinosinusitis it is important to collect the following data: typical complaints, disease history. Palpation and percussion in the projection of paranasal sinuses, rhinoscopy (anterior and poste- rior) which can detect hyperemia, swelling of nasal mucosa, the presence of mucopurulent or purulent discharge must be conducted. Radiological techniques should be used: X-ray, paranasal sinuses CT if indicated, ultrasound diagnostics of paranasal sinuses, endoscopic sinusscopy, medical and diagnostic punctures of paranasal sinuses. The latter two points of the diagnostic algorithm can be performed only in the settings of otorhinolaryngology in- patient department or ENT office. Taking into consideration the fact that treatment of sinusitis may be accompanied by orbital or intracranial com- plications, general practitioners, especially family doctors, must have sufficient knowledge and skills for timely rec- ognition of the disease. Thus, the rate of orbital complications in children varies from 0,5 % to 14,7 %, in adults – from 0,5 % to 8,5 %; intracranial complications are observed in 1,6 % of patients with nasal cavity and paranasal sinuses diseases. Complicated course of rhinosinusitis is referred to emergency states in otorhinolaryngology and requires emergency specialized care in the settings of otorhinolaryngology in-patient department. Therefore, the article focuses on the need for general practitioners to know the possible types of the disease course which should target them for timely referral of patients with suspected rhinosinusitis to otolaryngologist. Acute rhinosinusitis are widely spread disease, often associated with ARVI. Pathogenic bacteria, as well as functional and morphologic dysfunctions in mucociliary transfer system (MCTS) are significant factors in pathogenesis of rhinosinusitis. Acute rhinosinusitis are mostly accompanied by the shortness of nasal breath, pain syndrome, general condition disturbance, nasal discharge. The successful recovery of patients with acute rhinosinusitis can be mainly achieved by the timeliness and proper treatment at the otorhinolaryngologic room or hospital. In conventional treatment of acute rhinosinusitis it is reasonable to include mucoactive medications (e. g., BNO 101) in combination with standard antibacterial drugs to normalize surface activity of mucociliary transfer system. MCTS is the first barrier for infectious and dust particles entry into lower respiratory tracts and is crucial for the protective function of nasal cavity and paranasal sinuses. In case of its dysfunction the infection resistance is reduced and mucus congestion occurs, creating favorable conditions for pathologic process development.

acute rhinosinusitis, diagnostics, treatment, complications, general practitioner family practice

«Bulletin of problems biology and medicine» Issue 4 part 1 (113), 2014 year, 31-36 pages, index UDK 616. 211. /216:614. 254. 3