Koshel I. Chronic productive rhinosinusitises: features and diagnostics.

Dissertation for receiving scientific degree of candidate of medical sciences in profession 14.01.19 - otorhinolaryngology. - SI "Institute of otolaryngology named after prof.O.S. Kolomiychenko of the Academy of Medical Sciences of Ukraine", Kyiv, 2010. Dissertation is dedicated to an up-to-date objective - increase effectiveness of diagnosing prevalent (pansinusitis) forms of chronic productive rhinosinusitises. With an objective to improve complex diagnostics of productive pansinusitises features of clinical flow, architectonics of nasal cavity, endorhinoscopic and SCT semiotics, hereditary predisposition and functional state of nasal epitheliocytes' genome of 334 patients with chronic rhinosinusitis, 220 of which - had productive and mixed forms and 64 - productive pansinusitis were researched. 60 patients were studied as control group. Diagnostic criteria of productive pansinusitises were determined and included clinical-endoscopic (sex, age, character and prevalance of pathological alterations in sinuses, type and severity of the disease), X-ray (features of SCT anatomy and semiotics) and genetic (type of inheritance, cytogenetic indices of functional state of genome) characteristics. Diagnostic algorithm was developed based on the determined characteristics and includes 3 stages: clinical-roentgenological diagnostics, if needed - SCT of paranasal sinuses in frontal projection, clinical-genealogical and cytogenetic investigation. Implementation of this algorithm allows to diagnose multifactorial nature of the lesion in 29,09 % of patients with productive processes, and in 19,16 % of in-patients with chronic rhinosinusitis. It is very important in medical practice. In case, if beginning and espacially progress of sinusitis is stipulated by multifactorial mechanisms, timely complex diagnostics will allow to conduct appropriate treatment measures and prevent progression of the disease and in future - possibly to prevent the disease itself.