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Djuraev Jamolbek Abdukhahharovich, Tashkent Medical Academy Khasanov Ulugbek Saidakramovich, Tashkent Medical Academy Vokhidov Ulugbek Nuridinovich, Tashkent State Dental Institute E-mail: dr_ulugbek@list.ru
THE PREVALENCE OF CHRONIC INFLAMMATORY DISEASES OF THE NOSE AND PARANASAL SINUSES IN PATIENTS WITH MYOCARDITIS
Abstract: The aim of this research was to study the prevalence of chronic inflammatory diseases of the nose and paranasal sinuses in patients with myocarditis. The material of this research was 186 patients with myocarditis. In 80 patients of them have chronic inflammatory diseases of the nose and paranasal sinuses. These patients had a thorough anamnesis and carried out comprehensive clinical laboratory, endoscopic, radiographic and microbiological studies. The study showed that patients with myocarditis have chronic inflammatory diseases of the nose and paranasal sinuses, which in the future can aggravate the course of the inflammatory process in the myocardium.
Keywords: chronic rhinosinusitis, myocarditis, inflammatory process, paranasal sinuses.
The increasing number of patients with inflammatory diseases of the paranasal sinuses causes significant expenditures in the public health system associated with modern technologies of treatment, as well as using a large number of expensive drugs [1]. The reasons for the increase in morbidity include anatomical and physiological features of the structure of the nose and paranasal sinuses, the complexity of the pathogenesis of the onset of chronic inflammatory diseases, as well as the increasing environmental burden on the upper respiratory tract [3]. In this regard, it is relevant to determine the appropriate methods for preoperative preparation of patients, surgical treatment and rational medication for chronic inflammatory diseases of the nose and paranasal sinuses [4].
Among the urgent problems of modern practical otorhi-nolaryngology, the issues of increasing the efficiency of diagnosis and treatment of inflammatory diseases of the nose and paranasal sinuses occupy one of the leading positions [3].
In recent years, there has been a significant increase in the number of diseases of the nose and paranasal sinuses both in absolute figures and in percentage of the total number of ENT diseases [1, 5]. According to observations of some authors, over the past decade the number of cases of sinusitis per 1000 people has increased from 4.6 to 12.2. During this time, the number of patients with diseases of the nose and paranasal sinuses increased by 1.5-2% annually and reached 52.7% [3, 5].
Rhinosinusitis is an inflammation of the nasal mucosa and paranasal sinuses, which is almost always caused by stasis of secretion and by the breakdown of the aeration of the paranasal sinuses. The starting point in the development of rhinosinusitis is usually a viral infection [4].
Annually 40 million people fall ill with infectious diseases, of which 90% are influenza and acute respiratory infections. Over the past 10-20 years, the incidence of myocarditis and pericarditis has increased significantly [8]. The proportion of noncoronogenic myocardial diseases accounted for 7 - 9% of all diseases of the cardiovascular system [2]. The existence of a direct connection between influenza and acute respiratory disease has been proved to develop with the subsequent chronic therapeutic pathology and serious medical complications [2]. It is considered possible to develop primary heart damage in acute infectious diseases [8], myocarditis and dilated cardiomyopathy in patients who underwent viral infection [8]. Of particular relevance is the study of the role of inflammatory diseases of the ENT organs in the onset of cardiac pathology, which are very often the cause of dystrophy of the heart muscle [2], myocarditis and rheumatism [8].
The number of rhinosinusogenic orbital and intracranial complications, often leading to disability or death of the patient, has not at least decreased at least [6, 7].
Violations of the function of the cardiovascular system can occur in about 80% of patients with various acute infectious diseases [2, 8]. Most of them represent a natural functional reaction of the body, complete independently, without additional special treatment. But some children develop rhythm disturbances, heart failure, often with a long protracted course, and sometimes with a risk of death.
Now it is known that any of the known pathogens can cause damage to the myocardium, including myocarditis [2]. Often, viruses that directly interact with cardiomyocytes, which lead to apoptosis of cells, become an etiological factor [8].
Section 11. Medicine
According to the authors, rhinosinusitis significantly reduces the quality of life of people. In studying the general health status, patients with rhinosinusitis had significantly lower rates of pain sensitivity and social activity, sleep disturbed, emotional state worsened (compared to patients with coronary insufficiency and chronic obstructive pulmonary diseases [9,10].
The solution of the problem of timely detection of diseases of the ENT organs in patients with myocarditis and the development of effective methods of treatment is associated with an in-depth study of the pathogenetic mechanisms of their development and the search for highly informative diagnostic criteria [8]. Changing economic conditions and the introduction of new medical technologies into practice have necessitated a medical and economic justification for the recommended diagnostic methods and treatment and recovery measures [5].
The aim of this research was to study the prevalence of chronic inflammatory diseases of the nose and paranasal sinuses in patients with myocarditis.
The material of this research was 186 patients with myocarditis who were on inpatient treatment at the Republican Specialized Cardiology Center from 2015 to 2017. The age of the patients was from 18 to 70 years. The patients were divided into 2 groups. The first group consisted of 80 patients with chronic inflammatory diseases of the nose and paranasal sinuses. The second group consisted of 106 patients without pathology of the nose and paranasal sinuses. All patients had a thorough anamnesis and carried out comprehensive clinical laboratory, endoscopic, radiographic and microbiological studies. The control group consisted of 50 healthy volunteers from the staff of the 2nd clinic of the Tashkent Medical Academy. Statistical processing of data was conducted using Microsoft Office 2016.
A microbiological study to study the contamination of the nasal cavity in patients with chronic inflammatory diseases of the nose and paranasal sinuses showed that a positive culture (56% of cases), Streptococcus epidemi-didis (47% of cases), Staphylococcus aureus (36% of cases) is most often sown from the nasal cavity. Also 22% of cases were determined by Streptococcus viridans, Escherichia coli, Pseudomonas Aeruginosa, Proteus vulgaris,
Results of the study and their discussion. The study of the anamnesis showed that chronic inflammatory diseases of the nose and paranasal sinuses in patients with myocarditis were more frequent at the age of 31-50 years. There was no gender difference.
Patients with chronic inflammatory diseases of the nose and paranasal sinuses often complained of obstruction of nasal breathing (91.25%), nasal discharge (78.75%), impaired smell (22.5%), subfebrile body temperature increase (71.25%), general weakness (52.5%). Also, patients often noted headaches (52.5%), more in the maxillary region.
In the study of anamnesis in 35% of patients with chronic inflammatory diseases of the nose and paranasal sinuses, associated pathologies were found, such as thyroid pathology (8.75%), migraine (6.25%), vegetovascular disease (5%), hypertension (12.5%), allergic rhinitis (8.75%), gastritis (10%) and cholecystitis (17.5%).
On computer tomograms in all patients, various combinations of paranasal sinuses involved in the pathological process were revealed. In 20 patients (25%) isolated maxillary sinus lesions were detected, in 12 - defeat of the maxillary and ethmoid sinuses, in 12 - damage to the ethmoid and frontal sinuses, 16 patients with maxillary, etmoidal and sinus lesions. As shown in Table 1, in patients with myocarditis the inflammatory lesion of the maxillary sinus was more often noted. In 15 patients, the curvature of the nasal septum was revealed, in 4 - hypertrophy of the lattice bulla, in 11 - hypertrophy of the inferior nasal concha.
The results of endoscopic examination showed that all patients had hyperemia and swelling of the nasal mucosa, 38 had a pathological discharge in the nose, 15 had a deviation of the nasal septum, 3 had hypertrophy of the process uncinatus, 10 had hypertrophy of the inferior nasal concha, 4 patients -hypertrophy of the ethmoid bulla.
Haemophilus influenza, Klebsiella pneumonia and other bacteria. Also, mycological examination in 5% of cases revealed fungi of the genus Candida, in 4% of cases, fungi of the genus Aspergilus.
Thus, it can be concluded that, on average, patients with myocarditis have chronic inflammatory diseases of the nose and paranasal sinuses, which in the future can aggravate the course of the inflammatory process in the myocardium.
Table 1. - Involvement of the paranasal sinuses in the inflammatory process (computer tomography data)
Paranasal sinuses Number of patients (n) Total
Unilateral Bilateral
Maxillary sinus 20 18 38
Ethmoidal sinus 12 16 28
Frontal sinus 5 7 13
Sphenoid sinus 11 5 16
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