SINUSITIS TREATMENT IN PREGNANCY- PERSONALISED AND INTEGRATED MEDICINE

Abstract

Introduction. Sinusitis in pregnant patients is a disorder with incidence of around 3-4% worldwide, dependent from the impaired immune system. Long lasting symptoms are sometimes accompanied with nasal polyposis that is aggravated due to pregnancy hormones. The chronic condition has its relapses, with inflammatory or noninflamatory causes. Systematic analysis, diagnostic evaluations, treatment options must be personalized and dependent of the pregnancy trimester for a favorable pregnancy outcome with the help of integrated medicine. Methods. We present a pregnant patient in the second trimester of her third pregnancy. The symptoms that occurred in the 17.5 week of gestational age included headache, high body temperature, fatigue, muscle cramps, loss of appetite, nasal congestion and discharge. After clinical examinations of microbiological samples, nasal endoscopy, mechanical vacuum suction, chronic sinusitis aggravated by nasal polyposis with propagation from maxillary sinus was diagnosed. The treatment according to antibiogram and FDA approval for the trimester included local topic treatment with diluted cephalosporins, corticosteroids (fluticasone propionate),inhalations, antibiotics, probiotics and vitamins per os. Results and Discussion. Improvement of the subjective and objective symptomatology of the patient occurred after 5 weeks of treatment. Relapse occurred in the third trimester and two months postpartum. Immunopathohistologically, there is an antagonism of IgE, of interleukin IL-4, IL-5 and IL-13. The increase of IL-17 is proven for frequent exacerbations. Long lasting symptoms are sometimes accompanied with nasal polyposis that is aggravated due to pregnancy hormones. Conclusion. The immune system in pregnancy changes, with exaggerated inflammatory reaction inadequate to recover from sinusitis for a shorter period of time. Therefore, detailed examination and adequate therapy is obligatory as soon as the diagnosis is settled. All corticosteroids are not allowed in the second trimester due to proven unfavorable outcome for the fetus. Mechanical treatments and topic antibiotics were main therapeutic solution. Modern medicine aims to combine genetics and detection of the phenotype for chronic type of inflammation and the type of the immune response in order to stratify patients for appropriate treatment.