Polish Journal of Otolaryngology最新文献

Understanding the appropriate use of diagnostics and treatment in acute rhinosinusitis is of immense importance given the high prevalence of this disease in the general population. The ability to differentiate between the principal phenotypes of acute sinusitis, namely acute viral infection (cold), acute post-viral sinusitis and acute bacterial sinusitis, determines the future management and is fundamental to providing rational therapeutic recommendations - especially as regards antibiotic treatment, which is very often overused in acute sinusitis even though bacterial phenotypes only account for 0.5-2% of all cases of the disease. The latest therapeutic recommendations contained in the EPOS2020 position paper introduce a system based on integrated care pathways (ICPs), which comprise pharmacy-supported self-care and e-health as the first level, followed by primary care as the second, with specialist care being reserved for patients who develop a more severe course of the disease, have suspected complications or suffer from recurrent acute sinusitis. Management of acute sinusitis is primarily based on symptomatic treatment modalities, with phytotherapeutic support, as well as on antiinflammatory treatment, while antibiotic therapy is used in very specific and limited indications. Complications are relatively rare in acute sinusitis and they are not considered to be associated with antibiotic intake. Considering the high prevalence of acute forms of sinusitis, their significant impact on quality of life and high direct and indirect costs of treatment, the right diagnosis and management, without unnecessary escalation of therapy, can substantially translate into a number of public health benefits.

The analysis of the study group of 124 patients revealed a statistically significant shortening of mechanical ventilation requirement period in patients in whom tracheotomy had been performed before hospitalization day 10 (G1). The average length of mechanical ventilation was shorter by 20.3 days in G1 as compared to G2. On average, the duration of ICU stay was shorter by 39.4 days in G1 as compared to G2. Total hospitalization time was also significantly shorter in this group of patients (G1). The overall length of hospital stay for patients in whom tracheotomy had been performed prior to hospitalization day 10 was on average 43.1 days shorter as compared to patients in whom the procedure had been performed at a later date. Tab. I. provides the comparison of the results obtained in both study groups. Statistically significant differences (p < 0.05) were demonstrated between G1 and G2 regarding the length of the mechanical ventilation, the length of ICU stay, and length of hospitalization. null null No statistically significant differences were observed in mortality rates between the study groups (Fig. 1.) (P = 0.256). The mortality rate in early tracheotomy group (G1) was lower and amounted to 2%. In patients in whom tracheotomy was performed on day 10 or later (G2), the mortality rate was slightly higher and amounted to 9%. In some patients, initiation of treatment was required due to pneumonia developing as a complication in mechanically ventilated patients and referred to as ventilator-associated pneumonia. This complication developed in 6 patients in G1 and 26 patients in G2. The study assessed the relationship between the occurrence of this complication and the timing of tracheotomy. Pneumonia was significantly more frequent in patients in whom tracheotomy had been performed on hospitalization day 10 or later (P = 0.011). null null The comparison of results is presented in Tab. II.</br> </br>Another analyzed aspect of the study consisted in the results obtained by the patients in the baseline evaluation of the level of consciousness as assessed using the Glasgow Coma Scale (GCS). Data were checked for potential correlation between the GCS scores and the timing of the tracheotomy and the lengths of mechanical ventilation, ICU stay, and hospitalization. Correlation between GCS scores and the duration of stay within the ICU was demonstrated with a statistically significant correlation coefficient (Spearman's rank coefficient in the range of -0.4 to -0.2). </br> </br>ICU stay and total hospitalization lengths were shorter in patients with higher baseline GCS scores compared to patients with lower baseline GCS scores. The results are illustrated graphically (Fig. 2., 3.).

Background A randomized, double-blind placebo-controlled study investigated the use of bacteriophages in the treatment of chronic rhinosinusitis with nasal polyps. Materials and Methods 40 adult patients with сhronic rhinosinusitis with nasal polyps were examined. All patients underwent functional endoscopic sinus surgery. After the surgery, 20 patients got the intranasal gel with a bacteriophages mixture (Otofag, Micromir, Russia) twice a day for ten weeks, and 20 patients got a placebo. Results On the 10th day, IL-1β secretion diminished (63 mg/ml versus 440 mg/ml in control). There was a decrease in the total number of microorganisms and Enterobacteriaceae (5.7 x 106 CFU/ml versus 1.2 x 109 CFU/ml in control), and the absence of Streptococci (versus 2.1 x 109 CFU/ml in control) on the 30th day of the treatment in the group with the bacteriophages. On the 10th day, a decrease in the activity of secretory IL-1β and IL-8 strongly and very strongly correlated with a total number of microorganisms (r = 0.7; r = 0.9 respectively), as well as secretory IL-8 with Enterobacteriaceae (r = 0.72) and Staphylococci (r = 0.65) in the active group treated with the bacteriophages. On the 30th day, the decrease in serum IL-1β significantly correlated with the total number of microorganisms (r = 0.80) and enterobacteria (r = 0.90) in the active group. Conclusions The administration of bacteriophages restored the balance of microorganisms in the nasal cavity and decreased the inflammatory response in chronic rhinosinusitis with nasal polyps. These changes, such as an inflammation dampening, could theoretically reduce the recurrent growth of polyp tissue in the future.