Liječenje nosne polipoze

master's thesis

• Title (english): Treatment of nasal polyposis
• Author: Ivana Fumiš
• Mentor: Marko Velimir Grgić (mentor)
• Committee member: Jakov Ajduk (predsjednik povjerenstva)
• Committee member: Mihael Ries (član povjerenstva)
• Committee member: Marko Velimir Grgić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Othorhinolaryngology and Head and Neck Surgery); Zagreb
• Defense date and country: 2019-07-12, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Otorhinolaryngology

Abstract

Polip je čvorić ili masa na širokoj bazi ili uskoj peteljci izdignuta iznad razine sluznice iz koje histogenetski potječe. Nosna polipoza (NP) je oblik kroničnog rinosinuitisa, karakteriziran oteklinama nazalne i sinusne sluznice te je jedna od češćih bolesti u otorinolaringologiji. U većini slučajeva dijagnosticira se između 40. i 60. godine života. Etiologija nije razjašnjena, ali dvije su velike patogenetske teorije – infektivna i alergijska. Oboljeli imaju neugodne simptome poput nosne kongestije i sekrecije te smanjenog osjeta njuha i okusa, koji im ovisno o intenzitetu narušavaju kvalitetu života. Zbog otežane sinusne drenaže, postoji sklonost egzacerbacijama u obliku akutnog virusnog ili bakterijskog rinosinuitisa. Dijagnoza nosne polipoze postavlja se na temelju kliničkog pregleda i prednje rinoskopije, a ukoliko je njome nemoguće vizualizirati polipe, primjenjuje se nosna endoskopija. U slučaju potrebe za kirurškim liječenjem, nužno je napraviti CT snimku paranazalnih sinusa. Nosna se polipoza ne može u potpunosti izliječiti, nego je cilj terapije postići zadovoljavajuću kontrolu simptoma. Početna terapija je konzervativna. Najčešće se primjenjuju kortikosteroidi, antihistaminici te nosni dekongestivi, a u slučaju egzacerbacije, potreban je i antibiotik. Neuspjeh konzervativne terapije indikacija je za funkcionalnu endoskopsku kirurgiju sinusa - najprihvaćeniju tehnika kirurškog liječenja nosne polipoze. Kod jednog su dijela oboljelih za uspostavu kontrole simptoma dovoljni lokalni kortikosteroidi, dok kod drugih niti višestruke operacije ne rezultiraju većim i dugoročnim poboljšanjem. Zbog takvih teško liječivih slučajeva proveden je velik broj istraživanja o učinku raznih drugih lijekova na simptome nosne polipoze (npr. biološka terapija, kapsaicin). S obzirom na varijabilan tijek bolesti, istražuju se i prediktorni čimbenici za ishod liječenja, kako bi se omogućilo bolje informiranje pacijenata te bolje planiranje postoperacijskog praćenja i liječenja.

Abstract (english)

Polyp is a nodule or mass on a wide base or a narrow pedicle, elevated above the level of the mucosa from which it is histogenetically derived. Nasal polyposis is type of chronic rhinosinusitis, characterized by swelling of nasal and sinus mucosa. It is one of the most common otorhinolaryngological conditions. Most people are diagnosed between the ages of 40 and 60. Etiology is still not clarified, but there are two major pathogenetic theories – infection related and allergy related. The patients present with symptoms such as nasal congestion, secretion and decreased sense of smell and taste, which, depending on their intensity, disturb the quality of life. Due to the obstructed drainage, patients are prone to exacerbations in the form of acute viral or bacterial rhinosinusitis. Diagnosis of nasal polyposis is based on clinical examination and anterior rhinoscopy. When it is impossible to visualize polyps via rhinoscopy, nasal endoscopy is performed. If surgical treatment is needed, it is necessary to perform a preoperative CT scan of paranasal sinuses. The goal of therapy is control of the symptoms. Initial therapy is conservative. Corticosteroids, antihistamines and nasal decongestants are most commonly used. In case of exacerbation, an antibiotic is prescribed. The failure of conservative therapy is an indication for FESS (functional endoscopic sinus surgery). In some patients improvement is noted only by using local corticosteroids, whereas others do not experience major or long-term improvement even after multiple surgeries. Because of these cases of refractory disease, a large number of studies on the effects of various drugs on nasal polyposis have been carried out (e.g. biological therapy, capsaicin). Given the variable course of the disease, predictive factors for outcome of the treatment are also being investigated. It could provide better information to the patient and better planning of postoperative follow-up and treatment.

• Keywords: polip; nosna polipoza; kronični rinosinuitis; funkcionalna endoskopska kirurgija sinusa
• Keywords (english): polyp; nasal polyposis; chronic sinusitis; functional endoscopic sinus surgery
• Language: croatian
• URN:NBN: urn:nbn:hr:105:863289
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2020-02-24 15:01:47