COMPARATIVE CHARACTERISTICS OF DIFFERENT ENDOTYPES OF CHRONIC RHINOSINUSITIS

Abstract

Chronic rhinosinusitis is the most common reason for visiting an otolaryngologist. Although data on the prevalence of rhinosinusitis are inconsistent, the average global prevalence was 11.61 ± 5.47%, with a range from a minimum of 1.01% to a maximum of 57.6%. Based on the consensus document EPOS 2020 (European Position Paper on Rhinosinusitis and Nasal Polyposis), chronic rhinosinusitis is divided into polypous and rhinosinusitis without polyps. A special type is polypous rhinosinusitis, which is characterized by a low response to conservative therapy and frequent relapses after surgical treatment. These serious medical and social problems features stimulate the study of the pathogenesis of the formation of nasal polyps. This review provides information about the immunological features and dysfunctions leading to the appearance of chronic rhinosinusitis with or without polyps. The purpose of this review is to study, according to the literature, the influence of the first line of defense, congenital and acquired components. immunity to the pathogenesis of polyposis and nonpolyposis CRS.

The article provides a review of foreign scientific literature. The authors conducted a scientific search on the topic of the immune response in the formation of chronic rhinosinusitis with and without polyps. We used appropriate keywords and filters in the PubMed and Google Scholar search engines, in the Scopus, Web of Science, MedLine, The Cochrane Library, EMBASE, Global Health, and CyberLeninka databases. It is described in detail that all parts of the immune system do not fully perform their functions. The first line of defense of the nasal and sinus mucosa is the respiratory epithelium and mucociliary clearance, which form a mechanical barrier to infectious and other penetrating agents. At the next stage, cells and the innate immune response system, the complement system, take part in the elimination of external pathogenic agents. Presentation of an antigen epitope to lymphocytes generates a specialized adaptive immune response. Tissue remodeling is one of the most relevant aspects of the pathogenesis of CRS. It has been established that in PRS the synthesis of periostin increases, tissue eosinophilia progresses, the production of cystatin SN, IL-25 and the level of fibroblasts increases, the level of TLR2, TLR4, TGF-B and collagen production decreases, the extracellular neutrophil traps and the level of M1 macrophages increase. Further study of the links in the immunological pathogenesis of CRS will allow us to develop a personalized algorithm for the diagnosis and treatment of such patients.