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19THE INCIDENCE OF RHINOSINUSITIS AMONG ENT DISEASES IN
SCHOOL-AGE CHILDREN
U. I. Nurov G. U. Nurova D. R. Rashidov
Bukhara State Medical Institute
ABSTRACT
A scientific study was conducted in children who applied to the ENT department. The diagnosis was made based on anamnestic data, clinical-instrumental and laboratory analysis results.
The results of the analysis showed the following, acute sinusitis accounts for 5.7% of all diseases of the upper respiratory tract (fluctuations depending on the time of year from 2.5% to 8.2%) among children applying to the emergency department of the hospital and 21.2% (fluctuations depending on the time of year) from the time of year (from 13.5% to 30.7%) among patients of the specialized ENT department.
Key words: rhinosinusitis, childhood, paranasal sinuses.
Relevance. According to American researchers, 4.6% of all visits to a general practitioner are for cases of rhinosinusitis [5]. Acute bacterial rhinosinusitis is the 5th most common antibiotic prescription in children. Each child suffers acute respiratory viral infections (ARVI) up to 6-8 times a year, which are often complicated by rhinosinusitis [1,2]. Every year, the number of patients with inflammation of the paranasal sinuses increases by 1.5-2%. Acute rhinosinusitis accounts for 9 to 20% of all childhood ENT diseases [3]. The prevalence of diseases of the nose and paranasal sinuses in children is 28-30% of all diseases of the upper respiratory tract, and about 50% of children, becoming adults, continue to suffer from these diseases [4].
Rhinosinusitis is a collective term that characterizes a group of acute or chronic inflammatory diseases of the nasal cavity and paranasal sinuses. According to computed tomography, up to 90% of children with ARVI in the first days of the disease have signs of sinusitis. Bacterial rhinosinusitis after ARVI develops in 10% of children [6;9]. Chronic diseases of the paranasal sinuses account for 16 to 34% of all ENT diseases in children. Due to incorrect treatment tactics, sinusitis is often complicated by severe orbital complications in 10-20% of cases [2;7]. Bacteriological studies of sinus exudate show that in recent years both the quantitative and qualitative composition of the microflora has changed significantly, the role of Pseudomonas aeruginosa (30.7%) and staphylococcus (16.6%) has noticeably increased [8]. Sinusitis caused by Pseudomonas aeruginosa and Proteus is severe, protracted and often becomes chronic.
In children, the lower nasal passage becomes the main airflow conductor after 7 years due to the low and thick nasal septum, as well as the absence of cavernous tissue
in the area of the free edges of the turbinates in children of the first years of life. The perpendicular plate of the ethmoid bone finally develops only by the age of 10. Cavernous tissue in older children is highly labile and is regulated by the trigeminal nerve, which gives blockade, rhinorrhea, including when changing teeth. In addition, a number of anomalies and malformations can also cause difficulty in nasal breathing [8].
With difficulty in nasal breathing, the supply of oxygen to the entire body is limited, which disrupts the normal aeration of the paranasal sinuses and the middle ear cavity. This leads to a decrease in pH in the sinuses, increasing the production of mucus, which cannot be excreted due to edema in the area of the mouths of the sinuses and the Eustachian tube, respectively, there is a difficulty in the outflow of secretions, which provides favorable conditions for the reproduction of pathogenic microflora [7]. Obstruction of the outlet openings of the paranasal sinuses and difficulty in the outflow of inflammatory secretions from them can also lead to the development of sinusogenic complications. Depending on the predominant localization of the process, orbital and intracranial complications can form. From the cells of the ethmoidal labyrinth, the process tends to spread into the cavity of the orbit with the formation of orbital phlegmon (the medial wall of the orbit in a child is cartilaginous). In the case when edema blocks the release of secretions from the maxillary sinus, the development of infection leads to osteomyelitis of the maxilla with the involvement of tooth germs [8]. The key points in the development of sinusitis are the violation of ventilation, drainage and congestion that form in the nasal cavity. When a bacterial infection is added to this process, which usually appears on the 5th day, the patient develops purulent inflammation.
Thus, the most important factors in the development of rhinosinusitis are inflammation and swelling of the mucous membrane of the nasal cavity and sinuses, impaired aeration and drainage, viral and bacterial infection. The nature of the course of ARS in children depends on the etiology of the disease, as well as on the age of the patient.
Research materials and methods. To assess the prevalence of acute sinusitis in the structure of ENT pathology in children at the Bukhara hospital stage of medical care. To assess the prevalence of AS in the structure of ENT pathology in children, an analysis was made of outpatient cards and case histories of children who applied to the emergency department and were hospitalized in the ENT department. The diagnosis was made based on anamnestic data, clinical-instrumental and laboratory analysis results.
Research results. Children of primary school age (7-12 years old) - 31.25%, senior school children age (12-18 years) - 26.79%. The study included patients from 7 to 18 years of age with a clinically and radiologically confirmed diagnosis of mild to moderate AS, with no signs of a chronic process in the mucous membrane of the PNS and a disease duration of not more than 4 weeks, who did not receive treatment with
systemic antibacterial and antiviral drugs. Patients younger than 1 year and older than 18 years, with a symptom duration of more than 4 weeks, with signs of a chronic process in the mucous membrane of the PNS, treated with systemic antibacterial and antiviral drugs, were not included in the study.
According to our data, among children who received assistance at the level of the admission department of a hospital, the number of patients with АS was 5.7%: fluctuations ranged from 2.5% to 8.2% depending on the season. The ratio of patients diagnosed with АS to the total number of patients hospitalized in a specialized ENT department for emergency indications was 21.2%: fluctuations ranged from 13.5% to 30.7% depending on the season. From 2021 to 2022, 500 children applied to the ENT room of the admission department of the hospital, of which 5.7% were diagnosed with АS.
120 children with acute ENT pathology were hospitalized in a specialized ENT department, 21.2% of which were diagnosed with АS. Among all patients diagnosed with АS (n=54), boys predominated 53.4% (n=29). Most often, patients had signs of sinusitis - in 93.7% of cases, a little less often - ethmoiditis - in 32.8%. In third place in terms of frequency of occurrence is frontal sinusitis - 21.7%. It is extremely rare that the sphenoid sinus is affected (0.7%), which is primarily due to the difficulty in diagnosing sphenoiditis. Complicated course of АS was noted in 8.3% (n=5) of cases.
Thus, acute sinusitis accounts for 5.7% of all diseases of the upper respiratory tract (fluctuations depending on the time of year from 2.5% to 8.2%) among children applying to the emergency department of the hospital and 21.2% (fluctuations depending on the time of year), from the time of year (from 13.5% to 30.7%) among patients of the specialized ENT department.
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