Dysfunction of the mucous membrane in the pathogenesis of chronic diseases of the nasal cavity

Performing not only respiratory, but also protective, olfactory, aesthetic and a number of other functions, the nose is an important part of the upper respiratory tract. The mucous membrane of the nasal cavity is the first protective barrier of the body that protects against the effects of adverse environmental factors, carrying out warming, purification and neutralization of the inhaled air. This mission is provided by the activity of the multilayered columnar ciliated epithelium, consisting of three main types of cells: ciliate, goblet and basal. The main protective mechanism in the nasal cavity is mucociliary clearance, carried out by means of nasal mucus and beating of cilia unidirectional towards the nasopharynx with a frequency of up to 1000 per minute. Violation of the integrity and disruption of the physiological functions of the mucous membrane of the nasal cavity leads to the development of pathological processes, which in turn can lead to a failure in the work of other organs and systems of the body. To date, about 16-18% of all diseases of the ENT organs are chronic forms of rhinitis. According to the ICAR classification, which is based on the pathophysiological mechanisms of the development of rhinitis, allergic and non-allergic forms are distinguished. Common to various forms is the effect of certain factors on the mucous membrane of the nasal cavity and, as a consequence, a violation of the mechanisms of its work.

One of the forms of chronic rhinitis, caused by thinning of the mucous membrane and severe disorders of mucociliary transport, is atrophic rhinitis. The main symptoms of the disease are dryness, the formation of crusts in the nasal cavity, periodic bleeding. The approach to the treatment of acute and chronic processes against the background of atrophic changes in the nasal cavity should be comprehensive and aimed at restoring the physiological functions of the mucous membrane and the mechanisms of mucociliary transport.

1. Piskunov G.Z., Piskunov S.Z. (eds.) Clinical rhinology. 3rd ed. Moscow: Medical news agency; 2017. 216 p. (In Russ.)

2. Pluzhnikov M.S., SHanturov A.G., Lavrenova G.V., Nosulya E.V. Mucous membrane of the nose. Homeostasis and homeokinesis mechanisms. St Petersburg: Medicina; 1995. 107 p. (In Russ.)

3. Ryazancev S.V. Modern decongestants in the complex therapy of acute and chronic diseases of the upper respiratory tract. Rossiyskaya otorinolaringologi-ya = Russian Otorhinolaringology. 2005;(6):71-74. (In Russ.) Available at: https://scholar.google.com/scholar_host?q=info:Mi0plIaU-VUJ:scholar.google.com/&output=viewport&pg=71&hl=en&as_sdt=0&oi=scholarr.

4. Kryukov A.I., Kunelskaya N.L., Tsarapkin G.Y., Tovmasyan A.S., Artem'eva-Karelova A.V. Chronic rhinitis: a modern view of the problem. Lechebnoye delo = General Medicine. 2017;(4):22-26. (In Russ.) Available at: https://cyberleninka.ru/article/n/hronicheskiy-rinit-sovremennyy-vzglyad-na-problemu/viewer.

5. Caffier P.P., Frieler K., Scherer H., Sedlmaier B., Goktas O. Rhinitis medicamentosa: therapeutic effect of diode laser inferior turbinate reduction on nasal obstruction and decongestant abuse. Am J Rhinol. 2008;22(4):433-439. https://doi.org/10.2500/ajr.2008.22.3199.

6. Sibbald B., Rink E. Epidemiology of seasonal and perennial rhinitis: clinical presentation and medical history. Thorax. 1991;46:895-901. https://doi.org/10.1136/thx.46.12.895.

7. Mareev O.V., Lucevich S.I., Mareev R.O., Ivlev I.I. Differential diagnosis of chronic hypertrophic rhinitis using laser Doppler flowmetry. In: Materials of the XVII Congress of Otorhinolaryngologists of Russia. St Petersburg; 2006, pp. 304-305. (In Russ.)

8. Kim J.Y., Kim D.K. Chronic Rhinosinusitis and Increased Risk of Depression and Anxiety-Reply. JAMA Otolaryngol Head Neck Surg. 2019;145(7):690. https://doi.org/10.1001/jamaoto.2019.0917.

9. Alt J.A., Smith T.L., Mace J.C., Soler Z.M. Sleep quality and disease severity in patients with chronic rhinosinusitis. Laryngoscope. 2013;123:2364-2370. https://doi.org/10.1002/lary.24040.

10. Passali D., Anselmi M., Lauriello M., Bellussi L. Treatment of hypertrophy of the inferior turbinate: long-term results in 382 patients randomly assigned to therapy. An Otol Rhinol Laryngol. 1999:108(6):569-575. https://doi.org/10.1177/000348949910800608.

11. Rice D.H., Kern E.B., Marple B.F., Mabry R.L., Friedman W.H. The turbinates in nasal and sinus surgery: a consensus statement. Ear, Nose Throat J. 2003;82(2):82-84. https://doi.org/10.1177/014556130308200202.

12. Deitmer T., Scheffler R. The effect of different preparations of nasal decongestants on ciliary beat frequency in vitro. Rhinology. 1993;31(4):151-153. Available at: https://pubmed.ncbi.nlm.nih.gov/7511251/.

13. Stepanov E.N. The role of microcirculation disturbance in the nasal mucosa in the pathogenesis of various forms of chronic rhinitis. Prakticheskaya medicina = Practical Medicine. 2011;(3):11-14. (In Russ.) Available at: https://cyberleninka.ru/article/n/rol-narusheniya-mikrotsirkulyatsii-slizistoy-obolochki-polosti-nosa-v-patogeneze-razlichnyh-form-hronicheskogo-rinita/viewer.

14. Karpova E.P., Baratashvili A.D. Phenotypic classification of rhinitis and basic principles of therapy. RMJ. 2019;3(8):33-36. (In Russ.) Available at: https://www.rmj.ru/articles/pediatriya/Fenotipicheskaya_klassifikaciya_rinitov_i_osnovnye_principy_terapii/.

15. Settipane R.A., Charnock D.R. Epidemiology of rhinitis: allergic and nonaller-gic. Clin Allergy Immunol. 2007;19:23-34. Available at: https://pubmed.ncbi.nlm.nih.gov/17153005/.

16. Small P., Kim H. Allergic rhinitis. Allergy Asthma Clin Immunol. 2011;7:S3. https://doi.org/10.1186/1710-1492-7-S1-S3.

17. Kaliner M.A. Classification of nonallergic rhinitis syndromes with a focus on vasomotor rhinitis, proposed to be known henceforth as nonallergic rhinopathy. World Aller Org J. 2009;2(6):98-101. https://doi.org/10.1097/WOX.0b013e3181a9d55b.

18. Wheatley L.M., Togias A. Clinical practice. Allergic rhinitis. N Engl J Med. 2015;372(5):456-463. Available at: https://pubmed.ncbi.nlm.nih.gov/25629743/.

19. Lopatin A.S., Varvyanskaya A.V. Vasomotor rhinitis: pathogenesis, clinical picture, diagnosis and possibilities of conservative treatment. Prakticheskaya pulmonologiya = Practical Pulmonology. 2007;(2):33-38. (In Russ.) Available at: https://cyberleninka.ru/article/n/vazomotornyy-rinit-patogenez-klinika-diagnostika-i-vozmozhnosti-konservativnogo-lecheniya/viewer.

20. Dutt S.N., Kameswaran M. The aetiology and management of atrophic rhinitis. J Laryngol Otol. 2005;119(11):843-852. https://doi.org/10.1258/00222150 5774783377.

21. Magyar T., Lax A.J. Atrophic rhinitis. In: Brogden K.A., Guthmiller J.M. (eds.). Polymicrobial Diseases. ASM Press; 2002, pp. 169-197. https://doi.org/10.1128/9781555817947.ch10.

22. Shah K., Guarderas J., Krishnaswamy G. Empty nose syndrome and atrophic rhinitis. Ann Allergy Asthma Immunol. 2016;117(3):217-220. https://doi.org/10.1016/j.anai.2016.07.006.

23. Karpishhenko S.A., Lavrenova G.V., Kulikova O.A. Modern therapy for atrophic rhinitis. Lechebnoye delo = General Medicine. 2018;(1):36-40. (In Russ.) Available at: https://cyberleninka.ru/article/n/sovremennaya-terapiya-atroficheskogo-rinita/viewer.

24. Vasina L.A. Restoration of the structure and functions of the nasal mucosa in the postoperative period in patients with curvature of the nasal septum and chronic hypertrophic rhinitis. Vestnik otorinolaringologii = Bulletin of Otorhinolaryngology. 2009;(2):33-35. (In Russ.) Available at: https://www.elibrary.ru/item.asp?id=13332580.

25. Bende M. Nasal mucosal blood flow in atrophic rhinitis. J ORL. 1985;47(4):216-219. https://doi.org/10.1159/000275773.

26. Gurov A.V., Jushkina M.A. Possibilities of therapy for atrophic rhinitis of various etiology. Meditsinskiy sovet = Medical Council. 2018;(20):100-106. (In Russ.) https://doi.org/10.21518/2079-701X-2018-20-100-106.

27. Bunnag C., Jareoncharsri P., Tansuriyawong P., Bhothisuwan W., Chantarakul N. Characteristics of atrophic rhinitis in Thai patients at the Siriraj Hospital. Rhinology. 1999;37(3):125-130. Available at: https://pubmed.ncbi.nlm.nih.gov/10567992/.

28. Su S.B., Wang B.J., Tai C., Chang H.F., Guo H.R. Higher prevalence of dry symptoms in skin, eyes, nose and throat among workers in clean rooms with moderate humidity. J Occup Health. 2009;51(4):364-369. https://doi.org/10.1539/joh.Q8002.

29. Garcia G.J., Bailie N., Martins D.A., Kimbell J.S. Atrophic rhinitis: a CFD study of air conditioning in the nasal cavity. J Appl Physiol (1985). 2007;103(3):1082-1092. https://doi.org/10.1152/japplphysiol.01118.2006.

30. Qi B., Fan L., Jiang H., Zhang L., He X., Wan T., Cai C. et al. Protective effect of estrogens replacement on apoptosis cells of nasal mocosas in ovariectomized rats. Lin Chuang Er Bi Yan Hou Ke Za Zhi. 2005;19(5):222-224. Available at: https://pubmed.ncbi.nlm.nih.gov/15934292/.

31. Ly T.H., deShazo R.D., Olivier J., Stringer S.P., Daley W., Stodard C.M. Diagnostic criteria for atrophic rhinosinusitis. Am J Med. 2009;122(8):747-753. https://doi.org/10.1016/j.amjmed.2008.12.025.

32. Ho J.C., Chan K.N., Hu W.H., Lam W.K., Zheng L., Tipoe G.L. et al. The effect of aging on nasal mucociliary clearance, beat frequency, and ultrastructure of respiratory cilia. Am J Respir Crit Care Med. 2001;163(4):983-988. https://doi.org/10.1164/ajrccm.163.4.9909121.

33. Moore E.J., Kern E.B. Atrophic rhinitis: a review of 242 cases. Am J Rhinol. 2001;15(6):355-361. Available at: https://pubmed.ncbi.nlm.nih.gov/11777241/.

34. Bojko N.V., Kolmakova T.S., Bykova V.V. Biochemical indicators of compensation for post-hemorrhagic anemia in patients with nosebleeds. Vestnik otorinolaringologii = Bulletin of Otorhinolaryngology. 2010;(4):13-16. (In Russ.) Available at: https://www.elibrary.ru/item.asp?id=18260980.

35. Onerci T.M. (ed.). Nasal physiology and pathophysiology of nasal disorders. Berlin Heidelberg: Springer; 2013.

36. Sonnemann U., Schemer O., Werkhauser N. Treatment of rhinitis sicca anterior with ectoine containing nasal spray. J Allergy (Cairo). 2014;2014:273219. https://doi.org/10.1155/2014/273219.

37. Hildenbrand T., Weber R., Brehmer D. Rhinitis sicca, dry nose and atrophic rhinitis: a review of the literature. Eur Arch Otorhinolaryngol. 2011;268(1):17-26. https://doi.org/10.1007/s00405-010-1391-z.

38. Karpishchenko S.A., Lavrenova G.V., Kulikova O.A., Kucherova L.R., Zubareva A.A., Arustamyan I.G. Wegener's granulomatosis. Folia otorhinolaryngologiae et pathologiae respiratoriae. 2016;22(4):42-55. (In Russ.) Available at: https://foliaopr.spb.ru/wp-content/uploads/2017/09/Folia_22_4_2016.pdf.

39. Karpishhenko S., Lavrenova G., Kulikova O. Rhinitis sicca anterior. Vrach (The Doctor). 2017;(11):66-68. (In Russ.) Available at: https://vrachjournal.ru/ru/25877305-2017-11-20.

40. Miwa M., Nakajima N., Matsunaga M., Watanabe K. Measurement of water loss in human nasal mucosa. Am J Rhinol. 2006;20(5):453-455. https://doi.org/10.2500/ajr.2006.20.2938.

41. Brown C.L., Graham S.M. Nasal irrigations: good or bad? Curr Opin Otolaryngol Head Neck Surg. 2004;12(1):9-13. https://doi.org/10.1097/00020840-200402000-00004.

42. Boek W.M., Kele§ N., Graamans K., Huizing E.H. Physiologic and hypertonic saline solutions impair ciliary activity in vitro. Laryngoscope. 1999;109(3):396-399. https://doi.org/10.1097/00005537-199903000-00010.

43. Neher A., Gstottner M., Thaurer M., Augustijns P., Reinelt M., Schobersberger W. Influence of essential and fatty oils on ciliary beat frequency of human nasal epithelial cells. Am J Rhinol All. 2008;22(2):130-134. https://doi.org/10.2500/ajr.2008.22.3137.

44. Kehrl W., Sonnemann U. Dexpanthenol nasal spray as an effective therapeutic principle for treatment of rhinitis sicca anterior. Laryngorhinootologie. 1998;77(9):506-512. (In Germ.) https://doi.org/10.1055/s-2007-997014.

45. Slavin R.G. Treating rhinitis in the older population: special considerations. Allergy Asthma Clin Immunol. 2009;5(1):9. https://doi.org/10.1186/1710-1492-5-9.

46. Poljakov D.P. Ways to reduce the risks of using nasal decongestants. Remedium Privolzh'e = Remedium. Volga. 2016;5(145):34-35. (In Russ.) Available at: https://cyberleninka.ru/article/n/puti-snizheniya-riskov-primeneniya-nazalnyh-dekongestantov/viewer.

47. Ebner F., Heller A., Rippke F., Tausch I. Topical use of dexpanthenol in skin disorders. Am J Clin Dermatol. 2002;3(6):427-433. https://doi.org/10.2165/00128071-200203060-00005.

48. Rjazancev S.V., Fanta I.V., Pavlova S.S. Pharmacological import-substitution technologies in otorhinolaryngology. Meditsinskiy sovet = Medical Council. 2018;(20):84-88. (In Russ.) https://doi.org/10.21518/2079-701X-2018-20-84-88.

49. Hahn C., Bohm M., Allekotte S., Mosges R. Tolerability and effects on quality of life of liposomal nasal spray treatment compared to nasal ointment containing dexpanthenol or isotonic NaCl spray in patients with rhinitis sicca. Eur Arch Otorhinolaryngol. 2013;270(9):2465-2472. https://doi.org/10.1007/s00405-013-2362-y.

50. Hubner N.O., Siebert J., Kramer A. Octenidine dihydrochloride, a modern antiseptic for skin, mucous membranes and wounds. Skin Pharmacol Physiol. 2010;23(5):244-258. https://doi.org/10.1159/000314699.