Zaporozhchenko P. Clinical and immunological parallels of conservative treatment of various forms of chronic nasopharyngitis and prevention of the complications

The dissertation presents the results of a comprehensive clinical, instrumental and immunological examination and conservative treatment of patients with chronic nasopharyngitis with various intercurrent conditions of the nasopharyngeal zone in children. The aim of the study was to increase the effectiveness of conservative treatment of chronic nasopharyngitis in patients with and without pharyngeal tonsil hypertrophy, to reduce the risk of complications by developing a method of immunomodulatory substantiated pharmacotherapy of various etiopathogenetic variants of pharyngeal tonsillitis depending on the associated conditions of the nasopharyngeal zone using the mucosalvaccine Lantigen B for systemic use. The results of the study determined that patients with isolated chronic nasopharyngitis have frequent acute viral rhinosinusitis (77.4%) as a trigger factor for exacerbations with subsequent prolonged activation of opportunistic and pathogenic bacterial flora after exacerbations, patients with chronic nasopharyngitis with hypertrophy of the pharyngeal tonsil have a bacterial factor in both periods of the disease (75.6%), and patients with chronic nasopharyngitis with allergic rhinitis have allergic (34.2%) and viral (45.9%) (recurrent respiratory viral infections) during periods of exacerbations and bacterial and allergic in the period between exacerbations. After analyzing all the indicators of our study before and after 8-week vaccination, a clinically satisfactory immunorehabilitation result, which showed comparable positive changes with the results of cytological, microbiological and immunological status, was noted in 51 out of 62 (82.3%) patients of the main group 1 (chronic nasopharyngitis), in 20 out of 41 (48.8%) patients of the main group 2 (chronic nasopharyngitis with hypertrophy of the pharyngeal tonsil) and in 85 out of 111 (76.6%) patients of the main group 3 (chronic nasopharyngitis with allergic rhinitis), while in patients of the control group 2 (patients with chronic nasopharyngitis who were treated standardly without mucosal immunization with Lantigen B) – 8 out of 35 (22.9%) at p<0.05 for OG 1 and OG 3. The prophylactic efficacy of the mucosal vaccine Lantigen B after 26 weeks in patients with chronic nasopharyngitis without local comorbid conditions, against the background of allergic rhinitis and with hypertrophy of the pharyngeal tonsil was proven with a significant statistical difference (p<0.05) in the number and severity of acute respiratory viral infections compared to the comparison group, whose patients were treated without immunocorrection. Patients with chronic nasopharyngitis without local comorbid conditions significantly (p<0.05) showed positive dynamics in such complications as acute bacterial rhinosinusitis, chronic rhinosinusitis without polyps, acute otitis media and secretory otitis after immunocorrection. Patients with chronic nasopharyngitis with pharyngeal tonsil hypertrophy significantly (p<0.05) showed positive dynamics in relation to such complications as acute bacterial rhinosinusitis and secretory otitis media after immunocorrection. Patients with chronic nasopharyngitis with allergic rhinitis significantly (p<0.05) showed positive dynamics in relation to such complications as the number of acute otitis media during acute respiratory diseases and secretory otitis media both in the acute period and between them after immunocorrection. The need for final adenotomiesisverylikelylow (p<0.01) in patients with chronic nasopharyngitis without local intercurrent conditions and with allergic rhinitis after treatment with immunocorrection due to the likely leveling of the frequency and duration of acute respiratory diseases and the frequency of complications. The duration of the postoperative period in chronic nasopharyngitis with persistent complications is significantly (p<0.05) reduced when using immunocorrection with a mucosal vaccine as preoperative preparation. Immunocorrection with a mucosal vaccine as preoperative preparation before adenoidectomy in chronic nasopharyngitis with chronic rhinosinusitis without polyps statistically significantly (p<0.05) showed a reduction in the elimination time of chronic purulent inflammation of the ethmoidal labyrinth in children in the postoperative period.