THE INTEGRATED APPROACH TO THE TREATMENT OF PATIENTS WITH ATROPHIC RHINITIS WHO HAVE COVID-19 1Rasulova N.A., 2Abdullaev Kh.N., 3Kuddusova K.K.
1,2,3Tashkent Pediatric Medical Institute https://doi org/10.5281/zenodo. 12785429
Abstract. In 5.2% of patients who had COVID-19, we found an atrophic process in the nasal cavity. Dopplerography of the nasal cavity revealed reliable indicators of blood flow in a. Nasalis posterior dextra et sinistra. The average Doppler indices of LSC in the vessels of the inferior turbinates of healthy people (control group) are equal in aa. Nasali sposterior dextra 0.7 ± 0.1 cm/sec, in aa. Nasalis posterior sinistra 0.8 ± 0.2 cm/sec. In atrophic rhinitis with Covid, before treatment, bloodflow in the vessels of the nasal cavity of the inferior turbinates was reduced from 0.4 to 0.6 cm/sec; in some patients, a decrease in bloodflow was noted on the side of atrophic rhinitis with COVID-19. In the complex treatment of people with atrophic rhinitis who have had COVID-19, the inclusion of apricot oil leads to a total positive effectiveness of up to 81%.
Keywords: atrophic rhinitis; Dopplerography; apricot oil.
Introduction. Atrophic rhinitis is a polyetiological disease, which is based on progressive degenerative changes in the mucous membrane and receptor apparatus of the nasal cavity. The disease can be primary due to diseases such as: heredity, endocrine imbalance, vitamin deficiency and nutritional dystrophy, Klebsiella ozaenae infection, diphtheroids, Proteus vulgaris, Escherichia coli, autoimmune diseases. It can also be secondary after such effects in the nasal cavity as: excessively radical surgical interventions, trauma, radiation treatment, exposure to environmentally unfavorable environmental factors, dry or humid air, harmful chemical compounds, wood, coal, cement dust. [1,5,6,10, 13].
The causative agent of COVID-19, like other respiratory viruses, can cause atrophic rhinitis, which, due to the ongoing pandemic, is most relevant at present. 90-98% of all cases of acute rhinosinusitis are of viral etiology. Accordingly, the choice of treatment tactics with antibacterial drugs in some cases is not justified and leads to an increase in antibiotic resistance.
The nasal cavity itself is lined with mucous membrane, which consists of the epithelial layer, the basement membrane and the lamina propria. According to electron microscopic studies, 4 types of cells are distinguished in the nasal epithelium of an adult; ciliated, goblet-shaped short and long intercalated epithelial cells [2,3,8].
The respiratory and glandular epithelium provide innate nonspecific defense mechanisms, such as mucociliary transport and secretion of bactericidal products (serous and mucous secretions of the sublytic glands contain o-1-antitrypsin, lysozyme, mucosomal enzymes, interferon, growth factors, transferrin, cytoketic peptide antibiotics, immunoglobulins) [4,7, 12].
Progressive atrophy of all components of the mucous membrane (epithelium, glands and blood vessels) affects mainly the nasal turbinates. Morphologically, it is manifested by metaplasia of the epithelium from single-row cubic to multi-layered squamous with a complete absence of cilia and goblet cells, atrophy of the serous and mucous glands, chronic infiltration of the lamina propria with granulations and scar formation. These destructive changes lead to thinning of the mucous membrane with a sharp decrease in its regenerative abilities. According to a number of authors, a decrease in the density and reduction of blood vessels, an increase in the thickness of
elastic fibers with the proliferation of connective tissue and the number of muscle fibers of blood vessels, characteristic of obliterating endarteritis, have also been reported [4,5,11].
The viscous secretion secreted by the remaining glands stagnates in the nasal cavity, subsequently drying out and forming crusts. Expansion of the cross-section of the nasal cavity and exposure to an increased volume of air stream contribute to the progress of degenerative processes of the mucous membrane [9,13].
Based on the above, we set the goal of the study: To increase the efficiency of diagnosis and complex treatment of atrophic rhinitis in patients who have suffered COVID-19.
Research objectives:
1. To assess the degree of damage to the nasal cavity in patients with COVID-19 based on Dopplerography of the vessels of the nasal cavity.
2. To develop an algorithm for the complex treatment of atrophic rhinitis in COVID-19.
Material and research methods. We observed 40 children aged 3 to 18 years with a diagnosis of atrophic rhinitis after COVID-19, of which 22 were girls (55.6%) and 18 boys (44.4%). The study was conducted at the Department of Otorhinolaryngology at TashPMI clinic for the period from 2020 to 2023. The comparison group consisted of 20 sick children aged 3 to 18 years with atrophic rhinitis without COVID-19.
Research methods: Clinical and anamnestic research methods, general ENT examination, laboratory tests, Dopplerography of the vessels of the nasal cavity.
Ultrasound examination with Dopplerography was carried out using a Voluson 730 Expert device. A linear multifrequency sensor with a frequency range of 10-16 MHz was installed on the area of the border of the bone and cartilaginous part of the nasal wings, the area of the projection of the lateral wall of the nasal cavity. An echoscopy of the middle and inferior turbinates was performed: scanning was carried out with a depth of 5-45 mm in B-mode, Doppler color mapping, pulsed wave Doppler, with frequent pulse repetition of 0.1-1.3 kHz, at a location angle of 0-40°, control volume 1.0 mm. First, the vessels were visualized, and we differentiated them from the arterial spectrum. The values of linear blood flow velocity were recorded based on the maximum values of the sound signal during its pure reproduction, this was achieved by changing the location angle and scanning depth (0.1 mm step). There were no complications during the study.
Research results. All patients complained of severe dryness in the nose, pain when pressing on the wings of the nose, moderate difficulty in nasal breathing, discharge streaked with blood and distortion of the sense of smell, manifested in the presence of persistent odors of rotten onions, metal, urine, acetone, disinfectants, and a cloying sweet odor, burning from familiar things and food. The majority of patients surveyed were diagnosed with a new coronavirus infection within six months, laboratory confirmed using a PCR test.
We conducted a Doppler examination of the vessels of the nasal cavity before treatment. Blood flow parameters in the common, external, and internal carotid arteries corresponded to normal age-related indicators characteristic of healthy people. The average Doppler indices of LSC in the vessels of the inferior turbinates of healthy people (control group) are equal in aa. nasalisposteriordextra 0.7 ± 0.1 cm/sec, in aa. nasalisposterior sinistra 0.8 ± 0.2 cm/sec. In atrophic rhinitis with Covid, before treatment, blood flow in the vessels of the nasal cavity of the inferior turbinates was reduced from 0.4 to 0.6 cm/sec; in some patients, a decrease in blood flow was noted on the side of atrophic rhinitis with Covid-19.
Indicators of Dopplerography in patients before treatment of atrophic rhinitis n=40
All patients were examined and treated in accordance with the recommendations for organizing the provision of medical care to patients with COVID-19 infection, approved by the Ministry of Health of the Republic of Uzbekistan.
Comprehensive general and local conservative therapy was used. To remove crusts, systematically irrigate or wash the nasal cavity 1 -2 times a day with an isotonic solution of sodium chloride (saline solution) with the addition of iodine (6-8 drops of 10% alcohol solution of iodine per 200 ml solution). Apricot oil was added to the generally accepted complex therapy. Apricot oil contains oleic acid, which allows the oil to be well absorbed, retains moisture, enhances the penetration of other active components into the nasal mucosa, and also improves the activity of blood vessels. Oil was dripped 2-3 drops into the nose 3 times a day for a month.
After the therapy, we conducted a control Doppler examination of the vessels. With repeated ultrasound 6 months after treatment of atrophic rhinitis and with the exception of Covid-19 in the analysis of the turbinates - the inferior turbinates, the blood flow in the vessels of the nasal cavity has become up to normal from 0.5 to 0.7 cm/sec. Based on the above, it can be done the following conclusions:
1. Dopplerography of the nasal cavity revealed reliable indicators of blood flow in a. Nasalis posterior dextra et sinistra. The average Doppler indices of LSC in the vessels of the inferior turbinates of healthy people (control group) are equal in aa. Nasali sposterior dextra 0.7 ± 0.1 cm/sec, in aa. Nasalis posterior sinistra 0.8 ± 0.2 cm/sec. In atrophic rhinitis with Covid, before treatment, blood flow in the vessels of the nasal cavity of the inferior turbinates was reduced from
0.4.to 0.6 cm/sec; in some patients, a decrease in blood flow was noted on the side of atrophic rhinitis with Covid-19.
2. In the complex treatment of persons with atrophic rhinitis who have suffered from Covid-19, the inclusion of apricot oil leads to a total positive effectiveness of up to 81%.
Indicators of Dopplerography in patients after treatment of atrophic rhinitis n=40
REFERENCES
1. Avdeeva KS, Fokkens WJ, Reitsma S. Towards a new epidemiological definition of chronic rhinitis: prevalence of nasal complaints in the general population. Rhinology. 2021;59(3):258-266. https://doi.org/10.4193/Rhin20.637.
2. Kannan S.R., Spratt A.N., Sharma K. et al. Omicron SARS-CoV-2 variant: Unique features and their impact on pre-existing antibodies Autoimmun 2022;126:102779. DOI: 10.1016/j.jaut.2021.102779
3. Soler ZM, Patel ZM, Turner JH, Holbrook EH. A primer on viral-associated olfactory loss in the era of COVID-19. Int Forum Allergy Rhinol. 2020;10(7):814-820.
4. Tai J, Shin JM, Park J, Han M, Kim TH. Oxidative Stress and Antioxidants in Chronic Rhinosinusitis with Nasal Polyps. Antioxidants (Basel). 2023;12(1):195. https://doi.org/10.3390/antiox12010195.
5. Testa D, Marcuccio G, Lombardo N, Cocuzza SG, Guerra G, Motta G. Role of a-Tocopherol Acetate on Nasal Respiratory Functions: Mucociliary Clearance and Rhinomanometric Evaluations in Primary Atrophic Rhinitis. Ear Nose Throat J 2021;100(6):NP290-NP295. https://doi.org/10.1177/ 0145561319870483.
6. Testa D, Marcuccio G, Panin G, Bianco A, Tafuri D, Thyrion FZ et al. Nasal mucosa healing after endoscopic sinus surgery in chronic rhinosinusitis of elderly patients: role of topical alpha-tocopherol acetate. Aging Clin Exp Res. 2017;29(Suppl. 1):191-195.
7. Abdullaev Kh., Ibraeva S., Aimukhamedov A. Results of instrumental diagnostic methods in recognizing sinusitis with orbital complications // Journal of Biomedicine and Practice. -2021. - T. 1. - No. 3/1. - pp. 247-254.
8. Zakharova GP, Yanov YuK, Shabalin VV. Mucociliary system of the upper respiratory tract. St. Petersburg: Dialogue; 2010. 360 p.
9. Karneeva OV, Gurov AV, Karpova EP, Tulupov DA, Ryazantsev SV, Garashchenko TI, etc. Acute sinusitis: clinical recommendations. M.; 2021. 51 p.
10. Kirichenko IM, Popadyuk VI, Kozlova NS. Nasal obstruction syndrome after a new coronavirus infection caused by the "omicron" strain (clinical observation). RMJ. 2022;(2):46-49.
11. Atkhamova, S. (2024). HYPERTENSIVE CONDITIONS DURING PREGNANCY. A MODERN VIEW OF THE PROBLEM. (LITERATURE REVIEW). Science and innovation, 3(D5), 462-467.
12. Zufarova, S., & Turakulova, S. (2024). WAYS TO CORRECT MENSTRUAL DYSFUNCTION IN WOMEN WITH OBESITY. Science and innovation, 3(D5), 527-531.
13. Абдуллаев, Р. Н., Абдуллаева, М. А., & Собирова, М. Р. (2018). Интраоперационный метод лечения и профилактики спаечной болезни малого таза у пациенток с трубно -перитонеальным бесплодием. Москва. Проблемы науки,(11), 35.
14. Зияева, Э. Р., Рузиева, Н. Х., & Собирова, М. Р. К. (2022). СИНДРОМ ХРОНИЧЕСКОЙ ТАЗОВОЙ БОЛИ ПРИ ХРОНИЧЕСКОМ САЛЬПИНГООФОРИТЕ-ТОВРЕМЕННЫЙ ВЗГЛЯД НА ПАТОГЕНЕЗ. Re-health journal, (2 (14)), 1-5.
15. Зияева, Э. Р., Абдуллаев, Р. Н., & Собирова, М. Р. (2018). ИЗМЕНЕНИЕ НЕСПЕЦИФИЧЕСКИХ ФАКТОРОВ ЗАЩИТЫ БОЛЬНЫХ ХРОНИЧЕСКИМ САЛЬПИНГООФОРИТОМ ПОД ДЕЙСТВИЕМ КОМПЛЕКСНОЙ ФИЗИЧЕСКОЙ РЕАБИЛИТАЦИИ. In Молодежь-практическому здравоохранению (pp. 415-418).
16. Alieva, M. A., & Sobirova, M. R. (2023). JINSIY A'ZOLAR PROLAPSI BO'LGAN AYOLLARNI JARROHLIK YO'LI BILAN DAVOLASHNI SAMARADORLIGI. Евразийский журнал медицинских и естественных наук, 3(4 Part 2), 65-70.
17. Piskunov GZ, Piskunov SZ. Clinical rhinology. 3rd ed. M.: Medical Information Agency; 2017. 750 p.
18. Rasulova N. A., Kuziev O. A. Microbiological aspects of chronic purulent sinusitis in patients with HIV infection // Young scientist. - 2017. - No. 21. - pp. 170-172.
19. Rasulova N.A., Abdullaev Kh.N., Salomov K.M., Yakubov M.M. Immunoreaction in Chronic Purulent Sinusitis in Girls of Puberty International Journal of Psychosocial Rehabilitation 3776-3781. 2020;