Rational approach to the treatment of acute rhinosinusitis in comorbides with dysosmia
Dysosmia is a frequent symptom in acute rhinosinusitis. Post-infectious dysosmia has a large share in the structure of olfactory disorders. The most common is postviral dysosmia. The sense of smell in acute rhinosinusitis can change both in the conductive and sensorineural types, but most often it is of a mixed nature, has an acute beginning and a favorable prognosis. There is also a transformation of the olfactory epithelium into a multilayer flat or respiratory epithelium. The pathogenesis of acute rhinosinusitis is based on an increase in edema of the mucous membrane of the upper respiratory tract and, as a result, the block of the natural sinuses of the paranasal sinuses, which leads to a violation of their ventilation and stagnation of secretions in the sinus cavity. For the treatment of acute rhinosinusitis, antibacterial, vasoconstrictive drugs, elimination and irrigation therapy are used.it is important to restore mucociliary transport, and therefore it is necessary to prescribe mucoactive and secretolytic drugs. A special role among these medicines is played by herbal preparations, among which one of the most effective and well-studied is a combined herbal preparation that includes Gentiana lutea, Primula veris, Rumex acetosa, Sambucus nigra, Verbena officinalis. Due to the anti-inflammatory and secretolytic effects, treatment regimens that include this drug provide high efficiency and optimal treatment times for patients with acute rhinosinusitis. Studies have shown that this drug has shown inhibitory activity in vitro against respiratory viruses, including respiratory syncytial virus, adenovirus and parainfluenza. In addition, it has been proven that when using this drug, a pronounced anti-inflammatory effect develops in the form of a decrease in prostaglandin E2 levels, cyclooxygenase-2 expression, tumor necrosis factor, and especially interleukin. In addition, the inclusion of this drug in the complex therapy of acute rhinosinusitis contributes to the restoration of olfactory function in the form of reducing the threshold of smell, increasing the ability to distinguish and identify odors. Data from the studies presented in the article demonstrate high efficacy and good tolerance of this drug.