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Children's and adults' rhinosinusitis are two diseases that have both similarities and differences in anatomy, epidemiology, causes, pathogenesis, diagnosis and treatment. At the same rhinosinusitis is one of the most common in otorhinolaryngology's practice, both in children and adults. The of adults paranasal sinuses (PNS) anatomy differs from children's PNS anatomy. Although ostiomeatal complex occlusion is recognized as a major cause of poor ventilation and drainage of the adult paranasal sinuses, it does not have a strong effect on pediatric rhinosinusitis, but adenoids play a key role. Adenoids are bacteria and biofilms reservoirs that cause chronic refractory rhinosinusitis regardless of pharyngeal tonsil size. The prevalence of chronic rhinosinusitis (CRS) is lower in children than in adults. Diagnosis of children's rhinosinusitis is more difficult because nasal cavity endoscopic examination is performed rarely due to the occasional need of general anesthesia during the procedure. Moreover, it's necessary to take into account prevailing etiological role of viruses in ARS at children's age and chronic adenoiditis often accompanies pediatric CRS, which requires attention prescribing medical therapy as the basis of rhinosinusitis treatment. The DysheLORz based on Pelargonium sidoides roots is highly effective and safe for children's and adults ARS and CRS treatment, both as monotherapy and in combination with topical steroids and antibiotics. This herbal medicine immunomodulatory effect is mediated mainly by stimulating the production of TNF-α, IL-1, IL-12 and IFN-γ. It activates macrophages and improves their phagocytic activity. IL-12, together with TNF-α, enhances NK and cytotoxic CD8 + lymphocytes' activity against infected cells. IL-12 effect on Th1 lymphocytes maturation provides a link between innate and adaptive immunity. This is also increasing MCP-1, IP-10 and MIP-1β chemokines synthesis and decreasing MIP-1α, ENA-78, GROα and IL-8 production in PNS and nasal mucosa. This leads to decrease of neutrophils chemotaxis to the inflammation site, and decline of serine proteases concentration (neutrophils main enzymes), that increases mucous membrane epithelial barrier permeability, reducing bacterial infections risk. Additionally, Pelargonium sidoides increases epithelial cells beating cilia frequency and inhibits hemagglutinin and neuraminidase present on influenza virus surface. The drug increases antimicrobial peptides production as defensins, human neutrophil peptides (HNP) and bactericidal permeability-increasing protein (BPI), which is also important for rapid inflammation regression in rhinosinusitis. It causes bacterial adhesion to epithelial cells inhibition, phagocytosis stimulation, nitric oxide (NO) release and oxidative burst. The medicine had a direct effect on Streptococcus pneumoniae, Staphylococcus aureus, Neisseria, Moraxella catarrhalis and Haemophilus influenza . Based on these data, it is possible to explain the high effectiveness and safety of the drugs based on Pelargonium sidoides in ENT organs inflammation treatment, for both adults and children over 1 year old.

Objective: The aim of this study was to compare the effects of azoximer bromide and surgery on the quality of life of patients with chronic rhinosinusitis (CRS) without polyps. We also wanted to examine changes in the patient's emotional state and the nature of their complaints., Material and Methods: The results of using the Visual Analogue Scale (VAS) and the Sino-Nasal Outcome Test-22 (SNOT-22) questionnaire in patients with CRS without severe or moderate-severe polyps, before treatment and 3 months after treatment, are presented. Patients, depending on their choice, were treated with functional endoscopic intervention or a course of 6 mg/ml azoximer bromide (1 ml per day, a course of at least 10 days)., Results: The median [interquartile range] score for VAS in patients before azoximer bromide treatment was 6.7 [6.3; 7.05] points, after treatment 4.2 [3.50; 4.70] points. The median [interquartile range] of VAS scores in patients before surgical treatment was 6.4 [6.1; 6.9] points, and after 4.8 [4.50; 5.30] points. The median [interquartile range] of the SNOT-22 score before azoximer bromide treatment was 33 [32; 36] points, after treatment - 24 [22; 25] points. The median [interquartile range] of the SNOT-22 score before surgery was 34 [32; 36] points, after treatment - 19 [18; 21.25] points., Conclusion: Azoximer bromide treatment and surgery improve the quality of life of patients with CRS (according to the visual analog scale and all SNOT-22 domains) during a control survey after 3 months ( p <0.001). Surgical treatment has a stronger impact on the quality of life, which is more noticeable in the influence on the domains "Rhinological symptoms", "Extranasal symptoms", "Ear/facial symptoms" ( p <0.05). According to the domains "Psychological dysfunction", "Sleep dysfunction", surgical intervention had no advantages in affecting the quality of life, compared with taking azoximer bromide ( p <0.05).

Background: Acute bacterial sinusitis is one of the most common causes of prescribing systemic antibacterial drugs in otorhinolaryngology. With bacterial etiology of the disease, beta-lactam antibiotics are prescribed, in particular cefixim. Cefixim in the form of dispersible tablets has high clinical and bacteriological efficiency, as well as good tolerability in patients with acute sinusitis., Objective: To study the therapeutic equivalence of two drugs of cefixim (reproduced drug Cefixim Express and reference drug Suprax Solutab) in patients with acute bacterial sinusitis., Material and Methods: 60 adult patients with a diagnosis of acute bacterial sinusitis took part in a randomized open comparative clinical study. Patients of group 1 ( n =30) received the drug Cefixim Express in the form of dispersible tablets 400 mg once a day. Group 2 ( n =30) received Suprax Solutab in the form of dispersible tablets 400 mg once a day. The duration of treatment course was 7 days. All patients conducted general clinical and otorhinolaryngological examinations, assessment of symptoms of acute sinusitis, assessment of the general clinical impression of the therapy, tolerance of treatment, analysis of the frequency of unwanted phenomena before treatment, 3 days after the beginning of therapy and after the course completion (7 days)., Results: Recovery occurred in 63.3% of patients in group 1 according to the inspection on the 7 th day of treatment and in 66.67% of patients in group 2. The rate of clinical symptoms regression by the end of therapy was comparable in the comparison groups. Hyperemia of the nasal mucosa, purulent nasal discharge and difficulty in nasal breathing ( p <0.01) regressed by the 7 th day in patients of both treatment groups. The incidence of adverse reactions on the 7 th day of treatment in group 1 was 10%, in group 2 - 6.7% ( p >0.05)., Conclusion: The drug Cefixim Express has high therapeutic effectiveness in the treatment of acute bacterial sinusitis, comparable to Suprax Solutab. Cefixime EXPRESS has demonstrated a good tolerability and a favorable safety profile.

This publication discusses polypragmasia and drug interactions in the treatment of uncomplicated acute rhinosinusitis in children and adults. Treatment of rhinosinusitis on an outpatient basis in multimorbid patients may be accompanied by multiple prescriptions, which increases the risk of drug interactions. The article reflects the most significant inappropriate combinations of both medicines and biologically active additives, herbal preparations. The advantages of using drugs with proven effectiveness, in particular intranasal glucocorticosteroids, are considered.

Chronic rhinosinusitis (CRS) with nasal polyps is the most severe form of inflammatory diseases of the paranasal sinuses, especially in combination with comorbid asthma. A new avenue for the personalized treatment of severe forms of eosinophilic inflammation are biologics based on humanized monoclonal antibodies., Objective: To study the effectiveness of targeted therapy in patients with CRS with nasal polyps and comorbid asthma., Material and Methods: 19 patients selected for biological therapy according to international criteria were studied. The patients were randomly divided into 2 groups. The first group included 10 patients treated with dupilumab. Dupilumab was administered subcutaneously 300 mg every 2 weeks for 24 weeks. Group 2 included 9 patients treated with reslizumab for severe eosinophilic asthma with comorbid CRS with nasal polyps. Reslizumab was administered intravenously 3 mg/kg body weight once every 4 weeks for 24 weeks. These patients constituted the comparison group. Both drugs are used in treatment of eosinophilic inflammation but have different biological targets., Results: Comparative analysis of the dynamics of the main indicators characterizing the clinical course of CRS with nasal polyps and asthma (SNOT-22, control of asthma symptoms - ACT, the results of SCT of the paranasal sinuses according to the Lund-Mackay score) revealed a positive trend in patients of both groups, more pronounced in patients receiving dupilumab., Conclusion: Changes in CT of the paranasal sinuses, characterized by the Lund-Mackay score, the results of SNOT-22 and ACT are the most demonstrative and can be used to assess the results of treatment with biologics in patients with chronic rhinosinusitis with nasal polyps.

Recurrent chronic rhinosinusitis with nasal polyps (CRSwNP) with a predominant Th2 endotype of inflammation, including associated with bronchial asthma and/or allergic rhinitis, aspirin triad, refers to diseases with an insufficient level of control, despite the use of a wide range of options for conservative and surgical treatment., Objective: To analyze our own experience, clinical and organizational features of the application of the method of biological therapy in patients with severe forms of recurrent CRSwNP., Material and Methods: 25 patients with severe and moderate forms of CRSwNP were examined, who, in a round-the-clock hospital (model CSG 36.018) was treated with Dupilumab, in the form of subcutaneous injections of 300 mg/2 ml 1 every two weeks. The diagnosis was confirmed on the basis of anamnestic data, SNOT-22 quality of life questionnaires, visual endoscopic examination, evaluation of CT data (Lund-Mackay scale), laboratory data. The effectiveness of treatment was monitored after 16 weeks, based on endoscopic examination data, evaluation of CT and SNOT-22 data. In 3 observations, a study of pathomorphological material for tissue eosinophilia was performed., Results: The duration of the course of treatment ranged from 10 to 56 weeks. The most striking clinical effect was observed for signs such as sense of smell and nasal breathing (in some cases-after the first injection). The degree of regression of polyps according to CT and endoscopic examination was more prolonged in time, the same dynamics was observed in the level of total IgE. In a number of patients, the phenomenon of eosinophilia growth was observed against the background of treatment (with regression of clinical symptoms). Pathomorphological examination confirmed a high level of tissue eosinophilia as one of the fundamental signs of Th2 inflammation. One patient with concomitant chronic tubar dysfunction had an improvement in hearing. All patients with AD noted a subjective improvement in disease control (a decrease in the frequency and severity of choking attacks). The cancellation (break in treatment) of treatment was accompanied by a gradual return of symptoms in all patients at various times., Conclusions: Patients who have not achieved an acceptable level of control of CRSwNP,that meets the criteria of Th2 inflammation can be considered as candidates for the use of targeted biological therapy. With strict compliance with the selection criteria, there is a good clinical effect, primarily in relation to nasal symptoms (sense of smell and nasal breathing) and improved control of asthma symptoms.

Treatment of patients with fungal sinusitis, in some cases, does not lead to complete sinus sanitation, which may be due to insufficient surgical intervention and/or incorrectly selected antimycotic therapy. Treatment of such patients must necessarily include the complete removal of fungal masses from the affected sinus and the further use of antimycotics that ensure complete elimination of the pathogen. A clinical case of chronic fungal operated isolated sphenoiditis caused by the fungus Schizophyllum commune is presented. For extensive drainage of the sphenoid sinus, the patient underwent translamellar sphenoidotomy on the right with further antifungal therapy.

Introduction: The issues of epidemiology, etiopathogenesis, diagnostics and clinic of acute catarrhal rhinosinusitis are considered, the possibility of using the herbal medicinal product Sinupret extract in the treatment of patients with acute viral rhinosinusitis is substantiated., Objective: To evaluate the efficacy and safety of using the drug Sinupret extract in patients with acute viral rhinosinusitis., Material and Methods: A comparative study of the efficacy and safety of clinical use in patients of the drug Sinupret extract in patients with acute viral rhinosinusitis was carried out in comparison with symptomatic treatment., Results and Discussion: After analyzing and processing the results obtained using statistical methods for the main group, a faster rate of decrease in the severity of complaints (data with the use of the MSS visual analogue scale), the severity of inflammation in the nasal cavity and nasopharynx, the amount of discharge from the nose and its viscosity were confirmed. Restoration of respiratory function according to rhinomanometry and mucociliary transport according to the results of the saccharin test also occurred more quickly in patients of the main group compared to the control group. The effectiveness of using Sinupret extract is also confirmed by the results of photoplethysmography., Conclusions: The use of the drug Sinupret extract not only contributes to a more rapid improvement in the general well-being of patients and a decrease in the severity of complaints, but also leads to an improvement in the objective picture of the disease (rhinoscopy, the results of anterior active rhinomanometry, saccharin test) compared with the control group, favorably affects the quality life of patients, causes a decrease in economic and social costs against the background of the development of acute viral rhinosinusitis.

Purpose: Improving of otitis media with effusion (OME) with rhinosinusitis (RS) and adenoiditis treatment effectiveness., Materials and Methods: The study included 112 patients 12-18 y.o. with otitis media with effusion, who were divided into 2 groups depending on the treatment scheme. The Group I (the main group) patients treatment included Traumeel S and Euphorbium compositum Nasentropfen S in addition to the standard treatment, and the Group II (comparison), children were prescribed standard therapy. Patients of both groups were divided into 3 subgroups depending on the upper respiratory tract inflammation symptoms: A - patients with adenoiditis; B - with rhinosinusitis and C - combination of adenoiditis and rhinosinusitis. The comparison group (groups IIB and IIC) treatment scheme (children with rhinosinusitis) included topical corticosteroids and the main group patients didn't receive corticosteroids. All patients went through complaints and anamnesis collection, routine otorhinolaryngological and instrumental examination before and after treatment., Results: Analysis of treatment results demonstrated high efficacy of multicomponent drugs with low doses of active ingredients in the therapy of patients with OME, regardless of comorbid pathology. Significantly better results were obtained in the patients treated with bioregulatory drugs when comparing the outcomes of OME therapy in combination with adenoiditis (groups IA and IIA). Comparable efficacy results were obtained in the treatment group of patients with OME associated with RS (in groups IB and IIB as well as in groups IC and IIC), where GCS was received in the comparison group. The high efficacy and safety of bioregulatory drugs makes the use of these agents a promising treatment for patients with OME, RS and adenoiditis.

Annotation: Dornase alfa (Pulmozyme, Tigerase) is a purified solution of recombinant human DNase, clinically developed for the treatment of pulmonary diseases in patients with cystic fibrosis (CF). The action of the drug is aimed at destroying the viscous secretion, rich in DNA strands of neutrophils, through their fragmentation, the density of the secretion decreases, and the aeration of the lower respiratory tract improves. The similarity of pathological processes with the formation of viscous exudate on the surface of the mucous membrane in diseases of the upper respiratory tract and ear initiated studies on the use of Dornase alpha in otorhinolaryngology., Material and Methods: The analysis of materials of domestic and foreign authors on the effectiveness of the use of the drug Dornase alfa in otorhinolaryngology was carried out., Results: The review included 132 patients (10 studies) in whom Dornase alfa was used to treat CF-associated nasal and paranasal sinus diseases. Analysis of the literature revealed only 3 studies, one of which consisted of two parts, examining the effect of Dornase alpha on middle ear exudate: two studies were demonstrated in an animal model; one - in vitro on samples of middle ear effusion which were aspirated through a myringotomy incision from patients with recurrent acute otitis media; and one in clinical 40 patients (40 ears) for hydrolysis of exudate in the tympanostomy tubes., Conclusion: Analysis of studies on the use of Dornase alfa demonstrates an improvement in clinical symptoms in all patients with CF and chronic rhinosinusitis. In experimental studies on an animal model, as well as in vitro research on exudate from the middle ear, Dornase alfa has demonstrated high efficacy and safety. Dornase alfa is a drug with high potential, further research is needed for wider use in ENT practice, especially in otiatrics.

Objective: The study was performed to assess the endoscopic state of the nasal mucosa after the use of local anti-inflammatory and antibacterial therapy, in particular, Polydexa nasal spray with phenylephrine containing Dexamethasone sodium metasulfobenzoate + Neomycin + Polymyxin B + Phenylephrine, and for the treatment of granulomatosis with polyangiitis., Material and Methods: The study included 940 patients who underwent examination and treatment for chronic rhinosinusitis in the clinic of otorhinolaryngology of I.P. Pavlov SPbSMU surgical treatment of the paranasal sinuses underwent 907 patients. In the postoperative period, the first group (211 patients) underwent toileting of the nasal cavity. The second group (307 patients) received irrigation therapy. The third group (389 patients) received a topical treatment combined of Polydexa with phenylephrine. The dynamics of the condition was assessed on the 1st, 3rd and 7th days of treatment, the evaluation of the effectiveness of the treatment was carried out on the 3rd and 7th days. Differential diagnosis with granulomatosis with polyangiitis was carried out in 33 patients. All patients with granulomatosis with polyangiitis showed signs of chronic rhinosinusitis. Patients were prescribed local anti-inflammatory and antibacterial therapy with Polydexa with phenylephrine for 7 days with endoscopic control of the nasal cavity., Conclusion: The use of the combined topical drug Polydexa with phenylephrine in patients with chronic rhinosinusitis and in patients with granulomatosis with polyangiitis has a positive effect, which reduces the clinical manifestations of chronic rhinosinusitis.

Due to the high recurrence rate and the variety of complex pathogenesis mechanisms, chronic rhinosinusitis with nasal polyps is difficult to treat. In addition, the disease reduces the quality of life of patients and carries a large financial burden on the healthcare system, therefore, a personalized approach to the treatment of this pathology is becoming popular today. In order to determine which drug route would be most rational for a particular patient, key concepts such as phenotyping, endotyping and genotyping of chronic rhinosinusitis with nasal polyps were introduced. This approach has expanded the understanding of the etiological aspects of the disease and the pathogenetic mechanisms of the formation of nasal polyps. In this regard, immunotherapy of chronic rhinosinusitis with nasal polyps began to develop, consisting in the use of monoclonal antibodies to the substrates of the immune system, which are key figures in the development of certain types of inflammatory reactions of the mucous membrane of the nasal cavity and paranasal sinuses. The use of biological agents represents the first steps in targeted therapy, which is a transition to personalized treatment of patients with chronic rhinosinusitis with nasal polyps. Further studies in the field of immunological mechanisms of the formation of various phenotypes of chronic rhinosinusitis with nasal polyps from the standpoint of proteinomics, transcriptomics and epigenetics give hope for the development of a new drug-based treatment for this disease, which can significantly reduce the need for surgical treatment of patients with this pathology.

Chronic polypous rhinosinusitis (CPR) is characterized by refractory to drug therapy and a high potential for recurrence after surgical treatment. One of the important factors limiting the effectiveness of drug therapy of CPR, in particular intranasal glucocorticosteroids (inGCSs), is the insufficient level of adherence to treatment of patients with CPR., Objective: Generalization of data on the significance and ways to increase adherence to treatment of patients with CPR., Material and Methods: Materials of scientific publications included in the Cochrane Library, Russian Science Citation Index, MEDLINE, PubMed information bases were used as a data source. The material was selected based on the following keywords: "chronic rhinosinusitis", "nasal polyps", "intranasal glucocorticosteroids", "adherence to treatment"., Results: Despite the fact that inGCSs are one of the main pathogenetically justified methods of treating CPR, their use is limited by many factors, one of which is the level of patient compliance with the treatment regimen., Conclusion: Improving adherence to treatment is one of the important reserves for increasing the effectiveness of drug therapy for chronic polypous rhinosinusitis.

Cystic fibrosis (cystic fibrosis) is an important medical and social problem. The main clinical manifestations that determine the prognosis and outcome of this disease are changes in the respiratory and digestive systems. In recent years, there has been an understanding of the importance of assessing pathological changes in the nasal cavity and paranasal sinuses in patients with cystic fibrosis., Research Objectives: Assess the efficacy of topical antibacterial therapy in adult cystic fibrosis patients after surgery on nasal cavity structures and paranasal sinuses., Material and Methods: In the clinic for ear, nose and throat diseases at Sechenov University, 46 adult patients with cystic fibrosis and chronic rhinosinusitis were observed; all patients underwent extended endoscopic polysinusotomy. According to clinical studies, Isofra nasal spray is highly effective and safe in the treatment of patients with infectious diseases of the nasal cavity, nasopharynx and paranasal sinuses., Findings: The use of Isofra nasal spray (the active ingredient is framycetin sulfate) in our clinic in patients with cystic fibrosis against the background of basic therapy (inhalation with bronchodilators and mucolytics, intranasal topical steroids), had a positive effect on the microbial landscape in the nasal cavity in patients with cystic fibrosis in the postoperative period and allowed to reduce the need for the appointment of systemic antibacterial drugs.

The Aim of the Study: Was to summarize data on the role and place of herbal remedies, in particular, the extract from the roots of Pelargonium sidoides (EPs 7630) in the treatment of acute sinusitis., Material and Methods: Materials of scientific publications included in the Cochrane Library, information bases of the RSCI, MEDLINE, PubMed were used as a data source. The choice of material was carried out according to the keywords: epidemiology of acute sinusitis, modern treatment of acute sinusitis, colds, herbal remedies, Pelargonium sidoides ., Results: Analysis of published clinical trial data demonstrates evidence that EPs 7630 is significantly superior to placebo in reducing the duration and severity of symptoms of acute respiratory infection and indicates the advisability of including an extract from Pelargonium sidoides (EPs 7630) roots in OS treatment protocols. The high safety profile and clinically significant efficacy of this drug make EPs 7630 an important component of drug therapy for acute sinusitis.

Chronic rhinosinusitis (CRS) with polyps is associated with eosinophilic inflammation, in which the key mediator is interleukin - 5 (IL-5) and is often combined with asthma., Research Objectives: To evaluate the therapeutic potential of reslizumab-humanized anti-IL-5 monoclonal antibody for the treatment of CRS with polyps in patients with severe asthma., Patients and Methods: We investigated the cases of 9 patients with severe asthma treated with intravenous reslizumab at a dose of 3 mg per 1 kg of weight with regularity once in 4 weeks. The presence of CRS with polyps was revealed in 7 of 9 patients, SCT scanning of the paranasal sinuses indicated changes in all the patients, 2 patients had symptoms of chronic non-allergic rhinitis (NARES).The treatment effectiveness control was carried out after 6 months from the beginning of the treatment by the dynamics of nasal symptoms (SNOT-22), endoscopic image of the nose, total polyp score (TPS), changes in the SCT of the paranasal sinuses on the Lund-Mackay scale, rhinocytogram, the content of eosinophilic cationic protein in the blood, the level of systemic eosinophilia. The effectiveness of asthma control was assessed by the reduction of the frequency of asthma exacerbations, the need for systemic corticosteroids, spirometry data and Asthma Control Test (ACT) results. Along with a marked improvement in asthma control, 8 out of 9 patients displayed clinical, endoscopic, radiological signs of weakening of nasal symptoms. More significant improvement in asthma control was achieved in patients having CRS with polyps. In the group of patients having CRS with polyps, it was possible to detect anamnestic presence of NARES symptoms in the early stages of the disease. This indicates that NARES can be a precursor to the development of eosinophilic, non-IgE-induced asthma and nasal polyps., Conclusion: Treatment with reslizumab in patients with eosinophilic asthma and concomitant CRS with polyps and chronic non-allergic rhinitis (NARES) leads not only to improved control of asthma symptoms, but also to a significant regression of nasal symptoms.

Objective: To analyze and summarize data on terminology, etiology, diagnostic criteria for acute sinusitis., Data Sources: Publications (articles and related abstracts) submitted to the PubMed database. The choice of material was carried out, according to the keywords: cold, acute viral sinusitis, acute bacterial sinusitis, post-viral sinusitis, acute respiratory viral infection, diagnosis of acute sinusitis., Results: The published research results indicate the existence of certain disagreements regarding the terminology, diagnostic criteria, indications for diagnostic studies in acute sinusitis. The data on the etiology, pathogenesis, and diagnostic features of acute sinusitis are presented in the current guidelines, reviews and publications of the results of clinical trials.

In an open, randomized prospective comparative clinical study in parallel groups of patients with a diagnosis of acute respiratory infection, acute rhinosinusitis, 107 children aged 4-5 years took part. The purpose of this study was to compare the effectiveness of various treatment regimens for acute viral rhinosinusitis in children. We compared the treatment effectiveness of acute viral rhinosinusitis using the herbal medicine Sinupret in the form of oral drops, standard treatment and standard treatment supplemented with topical antibacterial drugs. The objectivity of treatment effectiveness evaluation was based on the complaints' dynamics, the changes' presence in the mucous membrane of the nasal cavity within 10 days: at the initial visit, after 3 days, on the 7 th and 10 th days after the initial examination. A follow-up visit was also scheduled for the 14 th day. The analysis of the obtained data revealed that the Sinupret usage in the complex treatment of children with viral etiology acute rhinosinusitis contributes to a more pronounced positive symptoms' dynamics compared to children who did not receive Sinupret. Sinupret eliminates mucostasis, which contributes to a faster restoration of the drainage and ventilation function of the auditory tube, restores mucociliary clearance, improves the condition and well-being of children, improves the effectiveness of therapy and shortens the treatment time.

Acute bacterial rhinosinusitis (ABRS) is one of the most common diseases in outpatient practice with a steady tendency to increase of complicated forms in recent years. The risk of antibiotic resistance makes it necessary to search for effective pathogenetic methods of ABRS treatment., Objective: To evaluate the efficacy of inhalation therapy with compressor nebulizer using Fluimucil Antibiotic IT in the treatment of ABRS and acute laryngotracheitis in outpatient practice., Material and Methods: Patients with ABRS were divided into two sex- and age-matched groups of 26 people each. The first group was treated with 250 mg of Fluimucil Antibiotic IT inhalations by the use of Norditalia HI-NEB compressor nebulizer once a day. The second group was treated with amoxicillin/clavulanate 875 mg + 125 mg orally two times a day., Results: In the first group, the cough disappeared significantly earlier (on day 5-6) than in the second group (on day 7-8). In the first group, nasal congestion also disappeared significantly earlier (on day 3-5) than in the second group (on day 4-6). There was no significant difference in the reduction of intoxication syndrome and nasal secretions in both groups., Conclusion: Local antibacterial and mucolytic therapy in the initial stages of ABRS and acute laryngotracheitis reduces rhinological symptoms and coughing, similar to systemic antibacterial therapy. The use of Fluimucil Antibiotic IT in the early stages of the treatment provides an opportunity to avoid systemic antibiotics, which reduces the risk of antibiotic resistance as well as side effects in patients.

The purpose of the study was to summarize data on modern antibiotic therapy for acute sinusitis, the role and place of topical antibacterial drugs, in particular Fluimucil-Antibiotic, in modern treatment strategies for this disease., Methods: Search in the PUBMED electronic database (articles and related abstracts) for the keywords «acute sinusitis", «antibiotics», «thiamphenicol glycinate acetylcysteine» «biofilm», «respiratory tract infection», «N-acetylcysteine»., Results: The published research results indicate the high antibacterial activity of the Fluimucil-Antibiotic, in particular, for the topical drug use in the form of inhalations, applications, irrigation, and instillations. The published research results indicate a wide spectrum of antimicrobial action of Fluimucil-Antibiotic, its ability to destroy biofilms and prevent their formation, good pharmacokinetics, safety, which makes it possible to consider it as a potential treatment option for acute sinusitis in everyday practice.

Presented the results of the clinical study of 30 patients with moderate rhinosinusitis (13 (43.3%) men, 17 (56.7%) women, age from 18 to 68 years). Among those patients, the inflammation of one paranasal sinus was observed in 7 (23.3%) cases, polysinusitis was observed in 23 (76. 7%) cases. All patients were randomized into 2 groups of 15 people. In both groups, patients received systemic antibiotic therapy, nasal irrigation therapy, and NSAIDs. In the control group, topical decongestants were used; in the experimental group the antimicrobial drug Polydexa with phenylephrine was used as a local therapy. The purpose of the study was to evaluate the clinical efficacy of Polydexa with phenylephrine in the complex treatment of moderate acute rhinosinusitis. The evaluation criteria were statistically significant comparison of clinical and laboratory parameters of both groups. Confirmed the anti-inflammatory, antimicrobial effects of the drug, made conclusions about the significant clinical efficacy, tolerability, positive effect on mucociliary clearance and safety of nasal spray Polydexa with phenylephrine.

The objective of the present study was to elucidate the possible correlations between the vitamin D 3 level in the blood serum and lactase gene polymorphism (LCT-13910 T>C) in the patients presenting with chronic polypous rhinosinusitis (CPRS). The study included 50 patients with this condition and 14 subjects comprising the control group. The variants of lactase gene polymorphism (LCT-13910 T>C) were identified with the use of polymerase chain reaction (PCR) in real time. The total level of serum vitamin D 3 (VD 3 ) was determined by means of the immunochemical analysis (the electrochemiluminescence technique). In the group of patients presenting with chronic polypous rhinosinusitis, the level of VD 3 in the blood serum ranged from 48 nm/l to 85 nm/l (mean 60 nm/l) compared with that in the patients of the control group (from 78 nm/l to 112 nm/l; mean 97 nm/l) . The level of vitamin D 3 'below the normal values' was documented in 71% of the patients with CPRS in comparison with 7% in the control subjects. Lactase gene polymorphism (LCT-13910 CC, CT) suggesting pronounced and latent hypolactasia was identified in 94% of the patients with CPRS compared with 78.6% in the control group. The occurrence of the CC genotype in the patients of both study groups was virtually identical: 52% in the patients presenting with chronic polypous rhinosinusitis and 57% in the control group. CT polymorphism was identified in 42% of the patients with CPRS and in 21% of the control subjects. The significant difference between the patients of the two groups was documented for the occurrence of TT polymorphism: 6% among the patients with CPRS and 21% in the controls (i.e. much higher in the healthy subjects). There was no significant difference between the serum levels of vitamin D 3 either among the patients with CPRS having LCT-13910 gene polymorphisms (CC, CT, TT) or among the control subjects. It is concluded that the study revealed the higher levels of vitamin D 3 in the blood sera from the control subjects in comparison with that in the patients with chronic polypous rhinosinusitis. Moreover, the patients of the latter group more frequently exhibited the variant of the LCT CT-13910 gene polymorphism suggesting latent hypolactasia whereas the subjects comprising the control group more frequently had the variant of the LCT CT-13910 gene polymorphism indicative of the normal tolerance of lactose.

The guidelines of the European position paper on rhinosinusitis and nasal polyps (EPOS, 2012) ascribe the highest strength and the most comprehensive evidence-based significance to the application of intranasal glucocorticosteroids (inGCS) as the first-line therapy for the patients presenting with acute and polypous rhinosinusitis; moreover they are recommended as the medications of choice for the treatment of chronic rhinosinusitis in the absence of polyps. The author presents the data concerning the mechanism of action, clinical effectiveness, and safety of inGCS used for the treatment of acute, recurrent, and chronic rhinosinusitis. It is shown that mometason furoate produces the favourable therapeutic effect and is possessed of beneficial pharmacodynamic and pharmacokinetic properties in the cases of its topical application. The comparative randomized clinical study (RCS) of the new preparation of mometason furoate in the form of the intranasal spray (manufactured by 'Teva' Ltd.) registered in the Russian Federation in 2015 has demonstrated that it can be considered as a therapeutic equivalent to nasonex.

The present study included 60 children at the age from 6 to 10 years undergoing a course of out-patient and in-patient treatment of acute rhinosinusitis (ARS). Thirty of these patients were given Myrtol standardised in the dose of 120 mg thrice daily for 7 days, in addition to traditional therapy.With convincing objective data for acute bacterial rhinosinusitis (in accordance with the criteria of EP3OS 2012), antibacterial preparations were prescribed to the children. The remaining patients received either conventional (symptomatic, irrigation) therapy or systemic antimicrobial agents. The analysis of characteristics of the visual-analog scale reflecting the severity of rhinorrhea, basal congestion, and coughing has demonstrated a significant (р<0,05) difference between the two groups of children in terms of manifestations of the clinical symptoms within days 7 and 14 after the onset of the treatment. For basal congestion, the difference was apparent as soon as day 3 after the beginning of therapy. The duration of the treatment with intranasal vasoconstrictive medications used for symptomatic therapy by the patients given Myrtol standardized was 2.2±0.4 days in comparison with 3.6±0.5 days in the control group. None of the patients treated with GeloMyrtol exhibited any adverse reaction attributable to the action of the medication in being studied. The study has demonstrated that using Myrtol standardized for the treatment of the uncomplicated forms of acute rhinosinusitis in children is clinically effective, safe, and convenient method for the management of ARS in children. And it can be recommended for the wide practical application.

The authors discuss the mechanism of action, effectiveness, and safety of intranasal glucocorticosteroids (inGCS) used to treat acute, recurrent and chronic rhinosinusitis (RS). The last version of the European guidelines concerning the application of inGCS assigns the highest level of evidence-Ia and the highest strength of recommendations-A to these medications when applied for the treatment of acute and polypoid rhinosinusitis. Moreover, they acquire the status of the agents of choice for the therapy of chronic RS without polyps. Mometasone furoate is one of the best explored preparations of this group of medicines. It is possessed of favourable pharmacodynamic and pharmacokinetic properties when prescribed for local application. The new mometasone furoate preparation in the form of an intranasal spray Dezrinit produced by "Teva" Ltd. was registered in the Russian Federation. In a comparative randomized clinical trial (RCT), the preparation was shown to be an equivalent to the Nasonex spray.

Acute rhinosinusitis is leading in frequency of antibiotic prescribing all over the world. At the same time the problem of antibiotic resistance and safety of antimicrobial drugs becomes more relevant and international. The article describes the basic mechanisms of bacterial resistance and growth of side effects when using macrolides, respiratory fluoroquinilones and β-lactam antibiotics of different types. Formation of IgE-mediated cephalosporin allergy is associated with the side R1 chain. The R1 structure of cephalosporins I and II generations is similar to penicillins, thus creating conditions for cross-allergy progression. R1 of cephalosporins III and IV generations is represented by a qualitatively different chemical compound (aminothiazol-oxime group) that increases the level of tolerance to these antibiotic types. The data of surveillance study are given to evaluate the efficacy and safety of the new drug Spectracef (active substance is cephalosporin of III generation Cefditoren) when treating acute bacterial rhinosinusitis on an outpatient basis.

The article summarizes 15 years of experience of the use of moxifloxacin (Avelox) in Russia in patients with acute bacterial rhinosinusitis. Emphasize its high bactericidal activity against a broad spectrum of microorganisms- from basic agents to the atypical and anaerobic microflora. The results of these studies suggest the continued effectiveness of the dosage of 400 mg a short course (7 days) over 15 years of practical use of the drug, which in its clinical efficacy is superior to amoxicillin/clavulanate, cefuroxime axetil and levofloxacin. The safety profile of moxifloxacin, studied at the population level is not associated with an increased risk of adverse effects in compliance with the dosing regimen, taking into account the indications and contraindications.

The objective of the present publication was to report the result of the evaluation of the clinical effectiveness of azithromycin (Sumamed) antimicrobial therapy used for the treatment of bacterial acute rhinsinusitis (ARS) in the patients presenting with concomitant pathology of the respiratory and cardiovascular systems. Dynamics of the reversal of the clinical symptoms of bacterial ARS in the patients of the study group is described. Neither adverse side effects nor complications in response to the treatment were documented. 98.6% of the patients recovered from the disease within 7 days after the onset of the treatment. It is concluded that antimicrobial therapy with the use of azithromycin (Sumamed) based at the outpatient settings provides a highly efficient tool for the treatment of the patients presenting with concomitant pathology of the respiratory and cardiovascular systems.

The authors overview the articles concerning the treatment of sinusitis with the use of mucolytic preparations published in the Russian-speaking and foreign literature during the period from 1987 to 2013. Special attention is given to GeloMyrtol and GeloMyrtol forte therapy. The analysis of the papers of interest has demonstrated that the herbal medicinal products based on standardized myrtol have a number of advantages over other preparations of the same type. It is concluded, taking into consideration the evidence-based effectiveness of GeloMyrtol and simplicity of its application, that this remedy can be prescribed to the patients suffering from sinusitis.

The objective of the present investigation was to estimate the effectiveness and safety of rinorin used for the prevention and treatment of infectious complications of allergic rhinitis in the children. A total of 70 children varying in the age from 5 to 15 years and presenting with the mild and moderate-to-severe form of seasonal allergic rhinitis were included in the study; they were divided into two groups. The study failed to reveal statistically significant difference between the groups in terms of adverse reactions to the treatment with rinorin. During the 21 day study period, infectious rhinitis was diagnosed in 2 (5.7%) children given rinorin compared with 5 (14.3%) ones in the control group (p>0.05). However, the patients of the latter group suffered a more severe form of this infectious complication of allergic rhinitis. It is concluded that rinorin is characterized by a high level of safety even though the antimicrobial potency of benzalkonium chloride, its active ingredient, needs further studies and evaluation.

Acute rhinosinusitis is a challenging clinical problem due to its high prevalence. The overwhelming majority of the cases of acute rhinosinusitis (ARS) have viral etiology. Clinical manifestations of viral and bacterial rhinosinusitis can be very similar. Similar expert communities have proposed their recommendations on diagnostics and treatment of acute rhinosinusitis in the recent decade. These recommendations are underlain by the principles of evidence-based medicine, take into consideration the result of reliable investigations, and reflect the opinions of leading specialists in otorhinolaryngology, allergology and immunology. The present review contains the analysis of consensus documents and recommendations. The results of ongoing research provide convincing evidence of the effectiveness of intranasal application of corticosteroids in the patients presenting with acute rhinosinusitis. Antibacterial therapy of acute rhinosinusitis is indicated only in the case of severe or complicated clinical course of the disease.

A number of clinical cases of inflammatory changes in the nasopharynx rhinosinusitis apply to the area of auditory tube with the development of exudative otitis media. The objective of the present simple open study was to estimate the effectiveness and safety of the treatment of moderately severe acute rhinosinusitis associated with exudative otitis media in the children and adolescents with the use of sinuforte as starting monotherapy. The study included 47 patients at the age from 7 to 15 years. The results obtained indicate that the effectiveness of this treatment is comparable in terms of duration with that of traditional therapy. However, the use of sinuforte as initial monotherapy has some advantages over the traditional modality in that it reduces the drug loading and offers a simple scheme of the treatment with proven safety. Taken together, these advantages provide a conclusive argument in favour of selecting Sinuforte as initial therapy of the above ENT pathology.

The objective of the present study was to estimate the effectiveness of the long-term treatment with low doses of macrolides for the prevention of early relapses of polypous rhinosinusitis in the postoperative period. A total of 66 patients at the age from 18 to 77 years presenting with the clinical diagnosis of bilateral polypous rhinosinusitis were randomly allocated to 3 groups; fifty five patients completed the study. All the patients underwent endoscopic polysinusotomy. All of them were given basal therapy with mometasone furoate at a daily dose of 400 mcg throughout 6 month postoperative period. The patients of groups 1 (n=22) and 2 (n=14) additionally received daily doses of 25 mg clarithromycin during 6 and 3 months respectively. The patients of group 3 were given basal therapy alone. All the patients were followed up within 6, 12, and 24 weeks after surgery with the use of a visual-analog scale, SNOT-20 questionnaire, acoustic rhinometry and rhinomanometry, endoscopic study of the nasal cavity, computed tomography of paranasal sinuses, determination of saccharine transport time, evaluation of olfactorial sense, and measurement of the eosinophilic cationic protein level in the nasal secretion. It was demonstrated that the patients treated with clarithromycin show significantly better outcomes of therapy compared with controls (p<0.05), the effectiveness of the 6 month clarithromycin therapy being higher than that of the 3 month treatment. The exception was the results of estimation of clinical symptoms and signs based on the visual-analog scale and the acoustic rhinometric data that did not reveal significant differences between the groups. The patients of the control group given no clarithromycin significantly more frequently developed relapses of polypous rhinosinusitis (p=0.02).

The objective of the present work was to substantiate rational pharmacotherapy allowing not only to affect the pathogen but also to restore the initial state of the compromised immune system of the patient. This paper is focused on the markers of the immunodeficiency state in the patients presenting with acute and chronic bacterial rhinosinusitis taking into consideration the nature of the pathogen. A rationale is presented for the management of this pathology with the use of the natural topical immunostimulator IRS-19 that can be recommended for the introduction into combined therapy of acute and chronic rhinosinusitis for the achievement of well-apparent and stable results.

The objective of this study was to estimate the clinical and immunological efficacy of local immunotherapy with the use of a cycloferon solution. The authors describe a new highly efficacious method for the treatment of allergic rhinosinusitis by means of the intranasal introduction of the cycloferon aerosol (125 mg/ml). A total of 79 patients presenting with this pathology were included in the study. Comparative evaluation of clinical and immunological efficiency of intranasal aerosol therapy using the cycloferon solution and its standard parenteral administration has demonstrated the high efficiency and safety of intranasal aerosol therapy in a group of immunocompromised patients with allergic rhinosinusitis. The study revealed correlation between clinical symptoms and characteristics of the patients' cytokine status which suggests the high informative value of measuring principle cytokine levels and especially their local fractions.

The objective of the present investigation was to study dynamics of the olfactory function in the patients presenting with polypous rhinosinusitis receiving medicamental therapy and in different periods after the surgical intervention. A total of 40 patients were available for the examination in the "Sniffin Sticks" test. The patients of group 1 (n=20) were treated with intramuscular injections of dexamethasone (8 mg twice daily) with gradual tapering the dose during 10 days. The patients comprising group 2 underwent bilateral endoscopic polysinusotomy. Both treatment modalities were followed by momethasone fuorate therapy 6 months in duration. Examination of the patients on the first control visit (i.e. within 1 month after the onset of the treatment) revealed the significant improvement of all measured olfactory parameters that were not significantly different between the two groups. On the second control visit (within 4 months after the onset of the treatment), the patients of group 1 showed a significantly impaired ability to identify smells although other olfactory parameters remained virtually unaltered as compared with those on the first visit. At the same time, no significant impairment of the olfactory function was apparent in the patients of group 2. It is concluded that the patients having non-obstructive polyps in the nasal cavity should be advised in the first place to undergo a course of glucocorticosteroid therapy rather than surgical treatment because the results of conservative therapy and endoscopic polysinusotomy do not differ significantly, at least within the first 4 months after the beginning of the treatment.

The objective of the present study was to estimate the therapeutic efficacy and safety of myrtol standardized (gelomyrtol forte) and acetylcysteine given to 11 and 13 patients respectively presenting with sinobronchial syndrome. Dynamics of clinical and roentgenological signs and symptoms in these patients was investigated throughout the period of therapy. The best clinical results were obtained using myrtol standardized. Specifically, the summary score characterizing the change of clinical symptoms decreased from the initial value of 32 to 0.73 on the 7th day after the initiation of therapy and to 0.18 after its termination. The decrease of the same parameter in the group of the patients treated with acetylcysteine to 1.3 and 0.38 (mean score for the group) was documented on days 7 and 10 after the beginning of therapy respectively.

The objective of the present work was to study specific immunogenetic characteristics of 1-beta interleukin (IL 1-beta) production and estimate the possibility of using recombinant IL 1-beta for the treatment of recurrent suppurative rhinosinusitis. It was shown that the low production of IL 1-beta attributable to the combination of genotypes +3953>T *C/*C and -511C>T *C/*TAND *t/*t is associated with a relapse of suppurative rhinosinusitis. The patients presenting with this disorder are in need of dispensary examination and repeated administration of recombinant IL 1 beta (betaleukin) during the period of exacerbation of suppurative rhinosinusitis.

The objective of the present study was to estimate the informative value of the variations in the levels of the principal cytokines for the evaluation of the efficacy of local immunotherapy in the immunocompromised individuals presenting with allergic rhinosinusitis (ARS). The study was focused on the analysis of the outcomes of the treatment with the use of a new highly effective therapeutic modality based on the intranasal administration of a cycloferon aerosol solution (125 mg/ml) used in allergologic practice. The main criterion for the efficacy of this treatment was variations of IL-4, IL-8, TNF-alpha, and interferon-gamma levels. The method for the measurement of concentrations of the principal cytokines may be recommended for the evaluation of the efficacy and prognosis of the treatment of allergic rhinosinusitis.

The objective of the present work was to study the principal causative agents of acute bacterial rhinosinusitis (ABRS) and the mechanisms underlying the development of its relapses. The secondary objective was to consider problems related to the antibacterial treatment of this pathology and suggest approaches to their solution. The results of analysis of the causes behind relapses of acute bacterial rhinosinisitis are presented, the recommendations on the choice of antibacterial preparations are proposed.

The present study included 37 patients at the age from 18 to 65 years suffering polypous rhinosinusopathy (PRS). Endoscopic examination of their nasal cavity and anterior rhinoscopy revealed the presence of large- and medium-sized polyps (stages II-III according to the classification of G.M. Portenko).. All the patients were treated with longidase either injected directly into the polyps at a dose of 3,000 IU or used to irrigate the affected nasal mucosa (10 seances). Positive effect of the treatment was documented in 32 (86%) patients of both groups who reported restoration of nasal breathing, showed improved functional characteristics, and significantly reduced size of local polyps upon the endoscopic examination of the nasal cavity. It is concluded that longidase is an efficacious and safe preparation for the conservative treatment of polypous rhinosinusitis.

Article is dedicated to therapeutic effect of long-term therapy clarithromycin in patients with varying severity of chronic polypous rhinosinusitis. The effectiveness of therapy based on monitoring of symptoms and quality of life on a scale of SNOT-20 in an open clinical trial in the treatment in patients with varying degrees of severity of chronic polypous rhino sinusitis with the macrolide Klaсid 500 SR was assessed in three months. As a result of investigations, good and excellent effect was observed mainly in patients with mild to moderate disease. Obviously, the duration of therapy should be in cases with severe forms of chronic polypous rhino sinusitismore than 3 months.

The objective of the present study was to estimate the influence of Eurespal (Fenspiride) on the changes of fibrous coating in the nasal cavities, transport function of ciliated epithelium, and dynamics of electrochemical properties of the nasal secretion by means of direct joulemetry following surgical intervention on paranasal sinuses (PNS). The study included 30 patients aged from 18 to 65 years presenting with chronic purulent sinusitis in the phase of exacerbation, polypous rhinosinusitis, and acute pyogenic process in PNS. The results of the study indicate that the use of Eurespal significantly accelerates the recovery of the transport function of intranasal mucociliated epithelium which results in a faster regression of the fibrous coat on intranasal mucosa and mucosal oedema. These changes lead to the improvement of drainage and aeration of the paranasal sinuses.

The objective of the present work was to assess the efficacy of the treatment of chronic rhinosinusitis (CR) in the patients treated with sinuforte using the contact microendoscpic technique. This randomized open clinical and instrumental study included 30 patients presenting with chronic rhinosinusitis. All of them were treated with sinuforte as monotherapy at a dose of 1.3 mg per procedure given once daily during 7 consecutive days. The efficacy of the treatment was evaluated by means of endoscopic and microendoscopic examination supplemented by functional tests on days 1, 2, 4, 6, and 8 after the beginning of therapy. In addition, a questionnaire study was carried out. It was demonstrated that the use of sinuforte for the treatment of the patients with chronic rhinjsinusitis is safe and efficacious as confirmed by the morphological picture revealed by contact microendoscopy.

The present randomized open study included 30 patients with acute suppurative rhinosinusitis. The efficacy of the treatment was estimated from the dynamics of the patients' subjective sensations and the objective assessment of clinical manifestations of the disease on days 1, 3, 5, and 7 after the onset of therapy. All the patients were prescribed treatment with sinuforte (one dose administered daily into each half of the nasal cavity at one and the same time). It was shown that monotherapy with sinuforte for the treatment of patients presenting with acute suppurative rhinosinusitis of moderate severity ensured the recovery in 73% of the cases.

The objective of the present study was to evaluate efficiency, safety, and tolerability of two single doses of sinuforte (INVAR, Russia) used in the combined treatment of rhinosinusitis (including that with concurrent exudative otitis media) in children at the age from 5 to 12 years. The data obtained suggest high efficiency of sinuforte in the treatment of mild and moderately severe acute rhinosinusitis and exudative otitis media. Inclusion of sinuforte in combined therapy of these conditions makes it possible to avoid drainage procedures and decreases duration of antibacterial treatment. Simultaneous acceleration of the recovery of functional activity of endonasal mucosa suggests pronounced anti-recurrent action of sinuforte.

The objective of the present study was to evaluate effectiveness of secretolytic, secreto-stimulating therapy in 40 patients presenting with acute rhinosinusitis. It was confirmed that acute inflammation results in suppression of local protective mechanisms acting in nasal cavity mucosa. Secretolytic and anti-inflammatory activity of Sinuforte was shown to induce these mechanisms; there is correlation between this effect and clinical picture of the disease. Parallel analysis of the results of traditional treatment of sinusitis and secretolytic, secretion-stimulating therapy has demonstrated high efficiency of the latter modality in patients suffering acute rhinosinusitis.

Chronic polypous rhinosinusitis (CPS) is currently regarded as a condition requiring medicamentous therapy rather than surgical treatment at the early stages. The choice of therapeutic modalities depends on pathogenetic mechanisms underlying formation of polyps. The International Consensus Conference on Nasal Polyposis (2006) and European documents EAACI - EP3OS (2007) recommend topical (endonasal) glucocorticoids, systemic antibiotics (long-term treatment with low doses of macrolides), antimycotic preparations, and other pharmaceuticals as the main medicinal products for the management of polypous rhinosinusitis (PR). Based on the concept of CPS as an immune-dependent condition, the authors developed the rationale for the use of immunomodulators in combination with etiotropic drugs (antiviral, antibacterial, and antimycotic) for the management of this disease. Advantages of Imunofan application (both local and systemic) during surgical intervention for the treatment of nasal polyps are discussed. It is concluded that combined medicamentous treatment restricts the growth and recurrence of nasal polyps.