Comparative characteristics of the formation of various forms of chronic rhinosinusitis with a refractory course in patients in an industrial metropolis

Introduction. Chronic rhinosinusitis is a heterogeneous inflammatory disease of the mucous membrane of the nasal cavity and paranasal sinuses, the clinical significance of which is determined by the duration of symptoms, the frequency of exacerbations, high-quality treatment, as well as the impact on quality of life. In an industrial metropolis, the analysis of the refractory course of the disease, including the regional aerogenic background, is of additional importance.

Aim. To evaluate the impact of anthropogenic stress on the formation and features of the refractory course of various forms of chronic rhinosinusitis in patients living in a megalopolis with a developed heavy industry.

Materials and methods. A retrospective comparative analysis of 152 patients was performed: 72 patients with chronic rhinosinusitis and 80 patients with polypous rhinosinusitis. In each phenotypic group, refractory and non-refractory course was distinguished and clinical symptoms were evaluated. Statistically significant differences were considered at p < 0.05.

Results. A refractory course was detected in 52 of 152 patients (34.2%). Among patients without nasal polyposis, the refractory variant accounted for 29 out of 72 cases, among patients with polypous rhinosinusitis – 23 out of 80 cases. In both phenotypic groups, the refractory course was accompanied by higher values of SNOT-22 before and after surgery, greater severity of nasal congestion, abnormal discharge, and facial pain according to VAS. At the same time, the severity of CT changes did not differ statistically significantly between the refractory and non-refractory course in either non-polypous or polypous forms.

Conclusion. The refractory nature of chronic rhinosinusitis in megalopolitan residents is more associated with clinical severity, quality of life, impaired mucociliary clearance, and repeated need for antibacterial therapy. The results obtained confirm the need for phenotype-based follow-up of patients after surgical treatment and more accurate consideration of comorbid and regional risk factors.

1. Fokkens WJ, Lund VJ, Hopkins C, Hellings PW, Kern R, Reitsma S et al. European Position Paper on Rhinosinusitis and Nasal Polyps 2020. Rhinology. 2020;58(Suppl. 29):1–464. https://doi.org/10.4193/rhin20.600.

2. Shisheva AK, Korkmazov MYu. Socio-economic aspects of optimizing hospital care for patients with pathology of the nose and paranasal sinuses in a large industrial city. Vestnik Yuzhno-Uralskogo Gosudarstvennogo Universiteta. Seriya: Obrazovanie, Zdravookhranenie, Fizicheskaya Kultura. 2011;(26):62–66. (In Russ.) Available at: https://www.elibrary.ru/oghxwh.

3. Savlevich EL, Pelishenko TG, Kozlov VS, Koryagin FN, Koryagina TS. Perioperative management of patients with operated nasal cavity and paranasal sinuses. Rossiiskaya Otorinolaringologiya. 2021;20(4):102–109. (In Russ.) https://doi.org/10.18692/1810-4800-2021-4-102-109.

4. Orlandi RR, Kingdom TT, Smith TL, Bleier B, DeConde A, Luong AU et al. international consensus statement on allergy and rhinology: rhinosinusitis 2021. Int Forum Allergy Rhinol. 2021;11(3):213–739. https://doi.org/10.1002/alr.22741.

5. Зябкин ИВ, Карнеева ОВ, Авербух ВМ, Вахрушев СГ, Свистушкин ВМ, Носуля ЕВ и др. Хронический синусит: клинические рекомендации. М.; 2025. Режим доступа: https://cr.minzdrav.gov.ru/preview-cr/955_1.

6. Ким ИА, Носуля ЕВ, Рязанцев СВ, Егоров ВИ, Карпищенко СА, Карнеева ОВ и др. Полипозный риносинусит: клинические рекомендации. М.; 2024. Режим доступа: https://cr.minzdrav.gov.ru/preview-cr/890_1.

7. Lengina MA, Korkmazov MYu, Karpov IA, Uchaev DA, Mochalov YuA, Voevodina PA, Trikula OV. About adverse events of targeted therapy for polypous rhinosinusitis. Russian Journal of Immunology. 2024;28(1):157–162. (In Russ.) https://doi.org/10.46235/1028-7221-16970-OTA.

8. Korkmazov MYu, Lengina MA, Dubinets ID, Kravchenko AYu, Klepikov SV. Some immunological aspects of targeted therapy of polypous rhinosinusitis. Russian Journal of Immunology. 2023;26(3):301–306. (In Russ.) https://doi.org/10.46235/1028-7221-8955-SIA.

9. Fokkens WJ, Viskens AS, Backer V, Conti D, De Corso E, Gevaert P et al. EPOS/EUFOREA update on indication and evaluation of Biologics in Chronic Rhinosinusitis with Nasal Polyps 2023. Rhinology. 2023;61(3):194–202. https://doi.org/10.4193/Rhin22.489.

10. Korkmazov MYu, Langina MA, Korkmazov AM. Biochemical indicators of the nature of oxidative stress depending on the performed postoperative therapy in patients who have undergone intra-nasal surgery. Bulletin of Otorhinolaryngology. 2016;81(S5):33–35. (In Russ.) Available at: https://www.elibrary.ru/ylvebm.

11. Korkmazov AM, Korkmazov MYu. Methods of correction of phagocyte functional disorders and local manifestations of oxidative stress in the nasal mucosa using ultrasonic cavitation. Russian Journal of Immunology. 2018; 21(3):325–328. (In Russ.) https://doi.org/10.31857/S102872210002404-9.

12. Bachert C, Han JK, Wagenmann M, Hosemann W, Lee SE, Backer V et al. EUFOREA expert board meeting on uncontrolled severe chronic rhinosinusitis with nasal polyps (CRSwNP) and biologics: definitions and management. J Allergy Clin Immunol. 2021;147(1):29–36. https://doi.org/10.1016/j.jaci.2020.11.013.

13. Grayson JW, Li W, Ho J, Alvarado R, Rimmer J, Sewell WA, Harvey RJ. Topography of polyp recurrence in eosinophilic chronic rhinosinusitis. Int Forum Allergy Rhinol. 2020;10(5):604–609. https://doi.org/10.1002/alr.22529.

14. Korkmazov MYu, Kazachkov EL, Lengina MA, Dubinets ID, Korkmazov AM. Cause-effect factors of rhinosinusitis poliposa development. Russian Rhinology. 2023;31(2):124–130. (In Russ.) https://doi.org/10.17116/rosrino202331021124.

15. Laidlaw TM, Mullol J, Woessner KM, Amin N, Mannent LP. Chronic rhinosinusitis with nasal polyps and asthma. J Allergy Clin Immunol Pract. 2021;9(3):1133–1141. https://doi.org/10.1016/j.jaip.2020.09.063.

16. Hopkins C, Gillett S, Slack R, Lund VJ, Browne JP. Psychometric validity of the 22-item Sinonasal Outcome Test. Clin Otolaryngol. 2009;34(5):447–454. https://doi.org/10.1111/j.1749-4486.2009.01995.x.

17. Korkmazov AM. The topical issues of the treatment of the patients presenting with rhinosurgical problems during the early postoperative period. Russian Rhinology. 2018;26(1):38–42. (In Russ.) https://doi.org/10.17116/rosrino201826138-42.

18. Popadyuk VI, Karpov IA, Lengina MA, Korkmazov AM, Kornova NV. Seawater with silver ions in the elimination therapy of polypous sinusitis. Meditsinskiy Sovet. 2025;19(7):46–53. (In Russ.) https://doi.org/10.21518/ms2025-133.

19. Krivopalov AA, Moroz NV, Belicheva EG, Lengina MA. Phage therapy in overcoming antibiotic resistance in chronic rhinosinusitis. Russian Bulletin of Otorhinolaryngology. 2023;88(6):48–55. (In Russ.) https://doi.org/10.17116/otorino20238806148.

20. Hopkins C, Browne JP, Slack R, Lund VJ, Brown P. The Lund-Mackay staging system for chronic rhinosinusitis: how is it used and what does it predict? Otolaryngol Head Neck Surg. 2007;137(4):555–561. https://doi.org/10.1016/j.otohns.2007.02.004.

21. Zorina IG, Legoshina SB, Sokolov VD. Influence of priority pollutants in atmospheric air on the structure of morbidity in cities participating in the federal project “Clean Air”. International Research Journal. 2023;(8):134. (In Russ.) https://doi.org/10.23670/IRJ.2023.134.25.

22. Leland EM, Vohra V, Seal SM, Zhang Z, Ramanathan M Jr. Environmental air pollution and chronic rhinosinusitis: a systematic review. Laryngoscope Investig Otolaryngol. 2022;7(2):349–360. https://doi.org/10.1002/lio2.774.

23. Leland EM, Zhang Z, Kelly KM, Ramanathan M Jr. Role of environmental air pollution in chronic rhinosinusitis. Curr Allergy Asthma Rep. 2021;21(8):42. https://doi.org/10.1007/s11882-021-01019-6.

24. Korkmazov MYu. Chronic tonsillitis and analysis of physical methods of exposure. Bulletin of Otorhinolaryngology. 2006;(S5):299–300. (In Russ.) Available at: https://www.elibrary.ru/sicbel.

25. Korkmazov MYu, Yastremsky AP, Kornova NV, Lengina MA, Korkmazov AM. Therapeutic and diagnostic approaches in the treatment of chronic tonsillitis. Meditsinskiy Sovet. 2022;16(20):90–99. (In Russ.) https://doi.org/10.21518/2079-701X-2022-16-20-90-99.

26. Smith KA, Smith TL, Mace JC, Rudmik L. Endoscopic sinus surgery compared to continued medical therapy for patients with refractory chronic rhinosinusitis. Int Forum Allergy Rhinol. 2014;4(10):823–827. https://doi.org/10.1002/alr.21366.

27. Korkmazov MYu, Lengina MA, Korkmazov AM, Kravchenko AYu. Effectof post-COVID syndrome on the quality of life of patients with allergic rhinitis and eosinophilic phenotype of chronic polyposis rhinosinusitis. Medical Journal of the Russian Federation. 2023;29(4):277–290. (In Russ.) https://doi.org/10.17816/medjrf472079.

28. Savlevich EL, Doroschenko NE, Slavinskaya IS, Farikov SE. Important factors of the inflammatory process in the oropharynx and optimal treatment regimes selection. Meditsinskiy Sovet. 2017;(16):48–54. (In Russ.) https://doi.org/10.21518/2079-701X-2017-16-48-54.

29. Korkmazov AM, Dubinets ID, Lengina MA. Possibilities of topical antioxidant protection of operated cavities in practical otorhinolaryngology. Bulletin of Otorhinolaryngology.2017;82(S5):14–15. (In Russ.) Available at: https://www.elibrary.ru/ylwhjs.

30. Peters AT, Spector SL, Hsu J, Hamilos DL, Baroody FM, Chandra RK et al. Diagnosis and management of rhinosinusitis: a practice parameter update. Ann Allergy Asthma Immunol. 2014;113(4):347–385. https://doi.org/10.1016/j.anai.2014.07.025.

31. Peters AT, Tan BK, Stevens WW. Consultation for Chronic Rhinosinusitis With Nasal Polyps and Asthma: Clinical Presentation, Diagnostic Workup, and Treatment Options. J Allergy Clin Immunol Pract. 2024;12(11):2898–2905. https://doi.org/10.1016/j.jaip.2024.07.019.

32. Soler ZM, Jones R, Le P, Rudmik L, Mattos JL, Nguyen SA et al. SNOT-22 outcomes after sinus surgery: a systematic review and meta-analysis. Laryngoscope. 2018;128(3):581–592. https://doi.org/10.1002/lary.27008.