A. Lupyr’s research while affiliated with Kharkiv National Medical University and other places

Objective: The aim is to identify the etiology, clinical and morphological features of rhinosinusitis in patients in post-COVID-19 period. Patients and methods: Materials and methods: In the present study, it was carried out the analysis of 11 cases of rhinosinusitis, which developed after COVID-19 infection. The diagnosis of rhi¬nosinusitis was established on the basis of anamnesis, clinical and laboratory examination, specialized instrumental examination (rhinoendoscopy, X-ray, magnetic resonance imaging, spiral and 3D computed tomography). All patients underwent endoscopic sanitation of the nasal cavity, expansion of the maxillary anastomosis, maxillary sinusotomy, sanitation of the maxillary sinuses and removal of pathologically altered tissues. Microbiological examination of the swab from the nasal cavity was carried out in all patients. Histological and morphometric research methods were used during the morphological study of surgical material. The nonparametric Mann-Whitney U test was used to compare the means in the groups. Results: Results: The conducted comprehensive study made it possible to identify chronic atrophic rhinosinusitis at the stage of exacerbation caused by associations of bacteria and fungi in patients in post-COVID-19 period. Among bacteria, the authors most often noted Staphylococcus aureus, Staphylococcus epidermidis, Klebsiella pneumonia, Streptococcus pneumonia and Enterococcus faecalis. Among fungi, there were Aspergillus, Candida, Mucor and Coccidioides. Fungal infection was characterized by invasion into the mucous membrane of the nose and paranasal sinuses. In patients in post-COVID-19 period the invasive bacterial-fungal chronic atrophic rhinosinusitis at the stage of exacerbation was predominantly bilateral, characterized by the involvement of several or all paranasal sinuses in the process. Patients with such pathology complained of periodic fever, headaches and malaise; nasal congestion and constant difficulty in nasal breathing; yellowish-greenish-reddish discharge from the nasal cavity, sometimes with a fetid odor; discomfort and pain in the area of paranasal sinuses; immobility of the eyeball, hyposmia or anosmia; reduction or complete loss of vision. Frequent risk factors for the development of invasive bacterial-fungal chronic atrophic rhinosinusitis at the stage of exacerbation in patients in post-COVID-19 period were the information about moderate or severe course of this infection in anamnesis; comorbidities (predominantly diabetes mellitus, hypertensive disease and ischemic heart disease). Conclusion: Conclusions: The study conducted by the authors made it possible to identify the etiological, clinical and morphological features, as well as risk factors of rhinosinusitis in patients in post-COVID-19 period. This information will contribute to a better understanding of such pathology by the doctors and improve the diagnostic and treatment process.

Background. There are many questions regarding the peculiarities of the course of odontogenic maxillary sinusitis, the likelihood of complications and the correct dosage of load during dental implantation. Purpose – to identify changes in minimal bone density in chronic odontogenic maxillary sinusitis and to compare it with chronic rhinogenic catarrhal maxillary sinusitis and physiological state of maxillary sinus. Materials and Methods. Our study involved 10 patients with chronic odontogenic maxillary sinusitis, 10 patients with chronic maxillary non-polyposis sinusitis of rhinogenic etiology, combined with hyperplasia of the sinus mucosa up to 1 cm. The control group comprised 10 patients with physiological condition of maxillary sinuses. In all subjects minimal bone density of superior, medial and inferior walls of maxillary sinus was analyzed. Results. The study showed that the maximum in physiological conditions is the minimal density of the upper wall of the maxillary sinus, the minimum is the lower wall. The minimal density of the lower wall was shown to undergo a statistically significant reduction in chronic catarrhal maxillary sinusitis only by 2%, the upper by 5%, the medial by 4% compared with the intact sinus, but with the odontogenic nature of maxillary sinusitis, this figure was 31% in the lower wall, 27% in the medial region. Only the density of the upper wall of the maxillary sinus remained quite stable, it decreased relative to the physiological one only by 6%. Conclusions. Minimal physiological densitometric parameters of lower, medial and upper walls were calculated. The reduction of minimal density of bone tissue in the cases of rhinogenic chronic catarrhal maxillary sinusitis. In the cases of chronic odontogenic maxillary sinusitis, maximum significant decrease of minimal density of both lower and medial walls is determined.

Objective: The aim: Was to evaluate the anatomical variability of the frontal and maxillary sinuses, ostiomeatal complex components (OMC) and to identify factors that contribute to complications of inflammatory processes and development of odontogenic maxillary sinusitis. Patients and methods: Materials and methods: The study involved assessment of 100 spiral computed tomograms (SCT) of human patients without pathological processes in the PNS area. The basic parameters of the anatomical structure of the ostiomeatal complex (the area of the hooked process and the middle nasal conch, their transverse dimensions, the density and dimensions of the natural connection), the thickness and the density of the lower wall of the maxillary and frontal sinuses were determined. These parameters were investigated by the method of uncertainty calculation. Results: Results: The findings showed that the bone density of the maxillary sinus on the left was 57.713 ± 440.356 Hu (minimum), 1101.507 ± 613.4882 Hu (maximum); 96.2752 ± 395.0 and 1028.691 ± 620.4051 on the right, respectively, the density of the inferior frontal sinus wall on the right was 5.5179 ± 276.43 and 831.1607 ± 732.274, on the left 12.069 ± 310.56 and 898.293 ± 748, respectively. In the same way, the probable OMC structure parameters, in the range ± U at the confidence level p = 0.95, were calculated. Conclusion: Conclusions: Thus, some variants of the anatomical structure of the ostiomeatal complex can be a prerequisite for hypoventilation of PNS and, as a consequence, lead to inflammatory processes in them. Features of the same structure of the walls of the PNS are a prerequisite for the propagation of the inflammatory process in the surrounding tissues and the development of complications.

Medical specialists face a number of difficulties with processing of data obtained during spiral computed tomography (SCT). One of them is the objective selection of points for calculating the morphological characteristics of bone tissue.The goal of our study was to optimize interpretation of the data of radiological methods used for assessment of the paranasal sinuses with estimation of measurement uncertainty.

Spiral computed tomography (SCT) is the most accessible and informative imaging method. Medical specialists face a number of difficulties with searching of CT-images. The goal of our study was to optimize interpretation of the data of radiological methods used for assessment of the paranasal sinuses (PNSs) with estimation of measurement uncertainty. The results of this study allow us to objectively assess the condition of the bone tissue and increase the efficiency of SCT examination of the PNSs, obtained taking into account both the minimum and maximum bone thickness, giving a possibility to predict the course of pathological processes in the PNSs, depending on their anatomical features. After studies, data were obtained to optimize the assessment of morphological parameters of the bone tissue of the paranasal sinuses (bone thickness and density). Potential fluctuations have been identified that should be considered when interpreting the results of calculating indices of PNS bone thickness and density.

AGE FEATURES OF BONE TISSUE DENSITY IN THE POSTERIOR AND INFERIOR WALLS OF THE FRONTAL SINUSGargin V.V., Lupyr A.V., Alekseeva V.V., YurevychN.O.Chronic rhinosinusitis is a significant social, medical and economical problem. Elderly patients are unique among all groups of patients. The purpose of our study was to determine physiological variability of frontal sinus in the posterior and inferior walls and to compare it with variability in purulent-polypous rhinosinusitis. Subjects and methods: The study involved SCT examination of 40 male patients: 10 tomograms of patients aged 30-40 and 10 of patients aged 75-85. The tomograms of patients without ENT diseases were used for the control group. The study group included tomograms of patients aged 30-40 and 75-85 with chronic rhinosinusitis. Results. An average bone density of the posterior and inferior walls of the frontal sinuses was calculated. The bone density of the group aged 30-40 was 191.5±11.6ͦHu in the inferior wall, 176.6±21ͦHu in the posterior and 169.1±16.8ͦHu and 164±21ͦHu in the group aged 75-85 according to the above order. The study showed pronounced changes in the bone density in purulent-polypous frontal sinusitis. In the group aged 30-40 it was as follows: 120.1±8.3ͦHu, 162.1±24ͦHu in the inferior wall and 101.4±6.95ͦHu, 127.4.8 ±15.4ͦHu in the posterior wall. Conclusions: It can be assumed that the decrease in the bone density is associated with age. And it is more severe in case of chronic frontal sinusitis.Key words: Frontal sinus, CT, elderly, bone density. ВІКОВІ ОСОБЛИВОСТІ ЩІЛЬНОСТІ КІСТКОВОЇ ТКАНИНИ ЗАДНЬОЇ ТА НИЖНЬОЇ СТІНКИ ЛОБНОГО СИНУСУАлєксєєва В.В., Гаргін В.В., Лупир А.В., Юревич Н.О.Хронічний риносинусит є значною соціальною, медичною та економічною проблемою. Пацієнти похилого віку займають особливе місце серед усіх пацієнтів. Метоюнашого дослідження стало визначення фізіологічної вікової мінливості задньої та нижньої стінок лобної пазухи та порівняння її з такою при хронічних гнійно-поліпозних фронтитах.Матеріали та методи. Ми дослідили результати 40 комп'ютерних томограм людей чоловічої статі: 10 томограм чоловіків 30-40 років та 10 - 75 - 85 років. без ознак ЛОР-патології та по 10 томограм пацієнтів віком від 30 до 40 років і 75 до 85 років з хронічним гнійно – поліпозним фронтитом. Результати. Була підрахована середня щільність кісткової тканини задньої та нижньої стінок фронтального синуса. Щільність кісткової тканинив групі чоловіків 30-40 років склала: в області нижньоїстінки 191,5 ± 11,6ͦHu. задньої - 176,6 ± 21ͦHu, а в групі чоловіків 75-85 років:. 169,1 ± 16,8ͦHu і 164 ± 21ͦHu. згідно до наведеного вище порядку. Ми відмітили також зміни щільності кісткової тканини при гнійно-поліпозному фронтальному синуситі. У віці від 30 до 40 років вона склала: в області нижньої стінки – 120,1 ± 8,3ͦHu, а задньої стінці - 162,1 ± 24ͦHu (група віком 30 – 40 років) та 101,4 ± 6,95ͦHu, 127,4,8 ± 15,4ͦHu відповідно (група чоловіків 75 – 85 років)Висновки: Можна припустити, що вік впливає нащільність нижньої та задньої стінки кістковоїтканини лобного синусу. В той же час наявність хронічного запального процесу (хронічного гнійно – поліпозного фронтального синуситу) посилює цей вплив.Ключові слова: фронтальний синус, CКT, старіння, щільність кісток. ВОЗРАСТНЫЕ ОСОБЕННОСТИ ПЛОТНОСТИ КОСТНОЙ ТКАНИ ЗАДНЕЙ И НИЖНЕЙ СТЕНКИ ЛОБНОГО СИНУСААлексеева В.В., Гаргин В.В., Лупырь А.В., Юревич Н.А.Хронический риносинусит является значительной социальной, медицинской и экономической проблемой. Пациенты пожилого возраста занимают особое место среди всех групп пациентов. Целью нашего исследования стало определение физиологической возрастной изменчивости задней и нижней стенок лобной пазухи и сравнение ее с таковой при хронических гнойно-полипозных фронтитах. Материалы и методы: мы исследовали результаты 40 компьютерных томограмм людей мужского пола: 10 томограмм мужчин 30-40 лет и 10 – 75 - 85 лет без признаков ЛОР-патологии и по 10 томограмм пациентов в возрасте от 30 до 40 лет и 75 до 85 лет с хроническим гнойно - полипозных фронтитом. Результаты. Была подсчитана средняя плотность костной ткани задней и нижней стенок фронтального синуса. Плотность костной ткани в группе мужчин 30-40 лет составила: в области нижней стенки 191,5 ± 11,6ͦHu. задней - 176,6 ± 21ͦHu, а в группе мужчин 75-85 лет:. 169,1 ± 16,8ͦHu и 164 ± 21ͦHu. согласно приведенному выше порядке. Мы отметили также изменения плотности костной ткани при гнойно-полипозных фронтальном синусите. возрасте от 30 до 40 лет она составила: в области нижней стенки - 120,1 ± 8,3ͦHu, а задней стенке - 162,1 ± 24ͦHu (группа в возрасте 30 - 40 лет) и 101,4 ± 6,95ͦHu, 127 , 4,8 ± 15,4ͦHu соответственно (группа мужчин 75 - 85 лет). Выводы: Можно предположить, что возраст влияет на плотность нижней и задней стенки костной ткани лобного синуса. В то же время наличие хронического воспалительного процесса (хронического гнойно - полипозного фронтального синусита) усиливает это отрицательное влияние.Ключевые слова: фронтальный синус, CКT, старение, плотность кости

Objective. Determining the anatomical variability of the upper maxillary sinus and ostiomeatal complex components as well as on the basis of the obtained data the selection of the optimal access to the zones of the maxillary sinus to choose sinusitis treatment method, which allows minimizing intra- and postoperative complications. Methods. The results of studies of the paranasal sinuses of 30 patients conducted on the spiral computed tomography were studied: 10 with the subtotal reduction of pneumatization of the maxillary sinus and 10 patients with hyperplasia of the mucous membrane. The control group included 10 SCTs of healthy individuals. The average volume, bone density of the maxillary sinus, the average size of the inferior nasal turbinate, the size, density of processus uncinatus under physiological and pathological conditions, the correlation between these parameters were determined. Results. A significant correlation (r=0.96, 0.96, 0.95, and 0.9 in the physiological state and r=0.95, 0.94, 0.97, and 0.91 in sinusitis) was noted between the volume, thickness and the density of the walls of the maxillary sinus. A moderate correlation was between the volume of the sinus, the thickness and density of the processus uncinatus, the volume of the sinus and the longitudinal size of the inferior turbinate in the unchanged sinus (r=0.65, 0.68 and 0.66). A very strong correlation was between the thickness of the upper wall and the volume of the sinus (r=0.96). A strong positive linear relationship (r=0.72) is noted between the volume and thickness of the medial wall (p<0.05). The reliable (p<0.01) strong (r=0.75) interconnection was between the thickness of the processus uncinatus and the average sinus volume. Very strong linear correlation was between the density of the middle and upper walls of the maxillary sinus in physiological and pathological conditions (r=0.9 and 0.84) Conclusions. Spiral computed tomography is a diagnostically significant method for the study of the maxillary sinuses. Parameters of the paranasal sinuses necessary for successful endoscopic rhinosurgery were determined. The obtained data helps to choose access during endoscopic operations, to prevent intra-, postoperative complications, to predict the likelihood of intracranial or intraocular spread of the pathological process. Keywords: paranasal sinuses, maxillary sinus, density, processus uncinatus, inferior turbinate.

Aim - Improvement of polypous rhinosinusitis anti-relapse treatment efficacy by distinguishing of the core meaningful factors of the disease's development. The study included 300 patients with polypous rhinosinusitis aged 18-77 years. Comprehensive evaluation of the data is done by means of factor analysis by the method of the main components with subsequent varimax-rotation of the factor axes. The critical value of p-level was 0.05. As a result of the factorial analysis, 6 main factors were identified, the joint action of which explains 53.72% of the variability of indicators for the polypous rhinosinusitis. The factor analysis allowed to distinguish the groups of indicators and estimate the specific weight of individual pathogenetic factors in the development of polypous rhinosinusitis, which might be conditionally combined under the general names of «clinic-immune», «clinic-pathomorphological», «immunoregulatory», «clinical-microbiological», «violation local protection»,»epidemiological and demographic «factors. The effect of two of the most powerful factors («clinical-immune» and «clinic-pathomorphological factor») is explained by 46.47% of the variability of indicators. Factor estimates for the most potent «clinically-immune-causative factor» with a high degree of reliability distinguished groups of patients with the first identified polypous rhinosinusitis and its relapse. Perspectives of further investigations are related to mathematical modeling of the pathological process using artificial neural networks.