Higher therapeutic potential following complex application of therapeutic physical factors in patients with chronic rhinosinusitis and nasal polyps

Objective. To analyze the most likely mechanisms for increasing the therapeutic potential of integrated use of therapeutic physical factors in rehabilitation of patients with rhinosinusitis and nasal polyps. Material and methods. The study included 120 patients with moderate-to-severe rhinosinusitis with nasal polyps and uncontrolled course of disease. All patients were randomized into 4 groups: group 1 (control, 30 patients) — only basic therapy including endonasal administration of Nasonex 2 doses 2 times a day, daily twice washing of nasal mucosa, subcutaneous administration of dupilumab 300 µg once every two weeks; group 2 (comparison group 1, 30 patients) — additional exposure to alternating magnetic field; group 3 (comparison group 2, 30 patients) — additional endonasal pulsed laser therapy; group 4 (main group, 30 patients) — complex physiotherapeutic treatment including alternating magnetic field and pulsed laser therapy. Clinical efficacy was assessed using computed tomography (Lund-Mackay score), endoscopic assessment of nasal polyps (Meltzer score), mean daily nasal congestion score (NCS), and quality of life questionnaire (SNOT-22). We additionally estimated immunocompetent system and microcirculation parameters of nasal mucosa. Clinical and functional state of patients was assessed before and after treatment. Results. The complex use of therapeutic physical factors had a significant therapeutic effect on clinical indicators of rhinosinusitis with decrease of serum markers of allergic inflammation and normalization of local hemodynamics in nasal mucosa and paranasal sinuses. Quantitative assessment of interaction between physical factors (synergy coefficient) indicates mutually potentiating effect of all parameters characterizing various functional systems. Synergy is based on phenomenon of functional cumulation. Moreover, additional increase in clinical effectiveness is due to long-term adaptation mechanisms associated with epigenetic regulation processes and genomic expression. Conclusion. Synergistic interaction of alternating magnetic field and low-intensity laser therapy in patients with rhinosinusitis and nasal polyps is based on potentiation of effects causing regression of clinical manifestations, improvement of tissue perfusion and reduced inflammation in nasal mucosa.