Koshel I. Aspirin-intolerant polypous rhinosinusitis: mechanisms of the development, diagnosis and treatment

The dissertation is devoted to the improvement of treatment efficiency in patients with aspirin-intolerant polypous rhinosinusitis by studying the mechanisms of disease development thereby improving the methods of diagnosis and combination therapy. The study included 290 patients (183 (63,10 %) males and 107 (36,90 %) females) divided into three groups: Group I included 94 (32,41 %) patients with aspirin-intolerant polypous rhinosinusitis; Group II comprised 123 (42,41 %) patients with polyposis associated with the alterations in the nasal aerodynamics; Group III included 73 (25,17 %) patients with polyposis associated with hyper-IgE syndrome. A fundamentally new view of the mechanisms of developing aspirin-intolerant polypous rhinosinusitis which consists in primary genetically predetermined reduction in constitutive cyclooxygenase expression being not induced by aspirin. The leading role of metabolically determined inflammation being determined by alternative pathway metabolites of arachidonic acid metabolism on the one hand and by a deficit in prostanoids, i.e. the expected products of the cyclooxygenase pathway acting as physiological antagonists on the other hand has been scientifically proven. Comorbid diseases (bronchial asthma, thrombocytopathy) have a syndromic character as well as a common etiopathogenetic mechanism in primary constitutive cyclooxygenase deficiency syndrome. The methods of refining diagnosis and pathogenetic treatment of patients with aspirin-intolerant polypous rhinosinusitis have been developed and substantiated.