Features of mucociliary transport in chronic rhinosinusitis in children of the Aral Sea Region: Endoscopy and computed tomography findings

Abstracts. Introduction. The relevance of the study is determined by a significant increase in the incidence of chronic rhinosinusitis in children in the Aral Sea Region, which is associated with unfavorable environmental factors and changes in immunoreactivity predisposing to the chronicity of inflammatory process. The assessment of clinical features, as well as the study of pathogenetic mechanisms and the state of the immune system in children living in an environmentally unfavorable zone, are of key importance for the improvement of the diagnostic methods and therapy of these diseases. The aim of this study is to analyze the characteristics of mucociliary transport revealed by endoscopic examination and computed tomography in children with chronic rhinosinusitis living in the Aral Sea Region. Materials and Methods. The study covered 137 children with chronic rhinosinusitis treated from 2018 to 2020 in different medical center of Uzbekistan. Endoscopy, computer tomography, and radiography, as well as nasal mucosa fluorescence test, were used for diagnosing. The analysis data were entered into tables and processed using statistical methods including the paired Student’s criterion. Results and Discussion. The study showed a significant inhibition of transport function of the mesenteric epithelium in children living in the ecologically unfavorable zone of the Aral Sea Region, which is manifested in the increase of saccharine test time up to 29.4±0.9 minutes in the main group. Endoscopic examination of the nasal cavity revealed pronounced hypertrophic and sub-atrophic changes in the mucosa, with predominance of sub-atrophy in 60.3% of children from the main group, which indicates a disorder in the functional activity of the mucosa and a decrease in its protective properties. In the group with chronic rhinosinusitis and nasal polyps, structural changes were found, including mucosal thickening and the presence of dry crusts, which confirms prolonged inflammation and disturbances in the aeration of nasal cavities. Conclusions. In children of the Aral Sea Region, chronic rhinosinusitis is characterized by a similar degree of severity of clinical symptoms for polypous and polyposis-free forms, with deterioration of the quality of life (less than 50 SF-36 scores). There is also a dissociation between clinical symptoms and scanty computer tomography picture, with the same distribution of pathological changes in the paranasal sinuses according to the Lund-Mackay scale (11.2±0.34 points).