Treatment of monoclonal gammopathy of unknown origin in Germany

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The immune system is protected by the ENT organs from the penetration of infections and viruses. They are the site of inflammation due to the fact that, first of all, they are attacked by pathogenic microbes. Damage to the mucous membrane of the paranasal sinuses (cavities located in the bones of the skull and filled with air) is called sinusitis.

It is related to rhinitis, which is a common complication of ARVI, which is why the use of such a term as rhinosinusitis is common. If chronic sinusitis develops and treatment is performed incorrectly, complications arise that are difficult to treat.

Causes of development of chronic sinusitis

Our clinic specialists name several reasons for the development of the disease:

1. Ailments caused by the negative impact of viruses on the nasal cavity. Swelling and narrowing of the paranasal sinuses are observed. A thick secretion accumulates there. Purulent discharge may appear.
2. Bacterial infections. Mucus stagnation and oxygen deficiency experienced by tissues are a favorable environment for the development of opportunistic microflora.
3. Allergy.
4. Deviated nasal septum.
5. Fungal inflammation (antibiotics have a detrimental effect on the immune system and change the microflora, the infection ends up in the sinuses due to the roots of the teeth affected by caries).
6. Inhalation of toxic substances and chemicals (often observed in people working in hazardous industries).
7. Neoplasms in the nose (polyp, tumor).
8. Presence of a foreign object in the nose.
9. Caries.
10. Immunodeficiency.

Classification

When our otolaryngologists make a diagnosis, they use several classifications of the pathological condition, taking into account the severity: mild, moderate, severe.

Depending on where the inflamed area is located, the disease is classified differently:

• bilateral (the left and right sinuses belonging to the same type are affected);
• unilateral (symptoms are only on the right or left);
• polysinusitis (damage to more than 2 sinuses);
• monosinusitis (inflammatory process in one of the sinuses);
• rhinosinusitis (together with the sinuses, the nasal cavity also becomes inflamed);
• hemisinusitis (inflammation is one-sided, but several cavities are affected simultaneously);
• pansinusitis (all sinuses are affected, symptoms are typical for adult patients, treated with a set of measures).

Nature of inflammation:

1. Catarrhal chronic sinusitis. Symptoms and treatment for this type of disease are specific. A mucous-serous fluid flows from the nostrils. Treatment is carried out without taking antibacterial drugs.
2. Purulent. The deep layers of the paranasal sinuses are inflamed. Pus is released. Have to be treated with antibiotics.
3. Chronic polypous sinusitis. It is a poorly studied type of disease. It affects people who suffer from bronchial asthma or are allergic to non-steroidal anti-inflammatory drugs.

Location of inflammation:

• The maxillary sinus, located in the maxillary bone (sinusitis). It is considered the most common location of the disease. Characterized by severe headache, weakness, photophobia, and a feeling of fullness in the cheeks.
• Frontal sinus (frontitis). Symptoms: fever, photophobia, pain in the forehead, swelling of the mucous membrane.
• "Frontal labyrinth" (ethmoiditis). Symptoms include swelling of the eyelids, high body temperature, pressing pain in the nasal root, and decreased sense of smell.
• Sphenoid sinus (sphenoiditis). It is characterized by unpleasant sensations in the occipital region and eye sockets, and constant headache.

Considering the duration of the disease, there are three forms:

1. acute (caused by influenza, infections, prolonged rhinitis);
2. subacute;
3. chronic.

Sinusitis: symptoms, treatment and prevention

Many of us are familiar with the symptoms of a runny nose firsthand. The condition is not pleasant, is it? And with the onset of cold weather, the topic of all kinds of “nose problems” becomes especially relevant. How are we used to dealing with them? Drink more hot tea, take time off from work or school and rest for a day or two, or even endure a painful condition on your feet, taking mountains of advertised drugs. Indeed, quite often such “treatment methods” help, and we forget about the illness for a long time. But, unfortunately, the condition that we usually call a “runny nose” is not always as harmless as we are accustomed to think of it. After all, sometimes another, more serious disease can be confused with a runny nose. Today in our article we will talk about sinusitis

- a disease similar in symptoms to the common runny nose, but very dangerous due to its complications and ability to become chronic.
Egor Evgenievich Demidov, an otolaryngologist and phoniatrist at the SMITRA Clinic, will tell us what this disease is, how to treat it and how, if possible, to avoid it

What is sinusitis?

Sinusitis
is an inflammation of the mucous membrane of one or more paranasal sinuses. The paranasal sinuses (or sinuses) are cavities in the skull in the nose area that are filled with air. The sinuses perform a number of important functions: they form the skeleton and facial features, warm and moisturize the incoming air, and form the timbre of the voice. The inside of the sinuses is lined with mucous membrane and connected to each other by anastomoses. When inflammation occurs, mucus flows out and blocks the anastomosis, which leads to stagnation of fluid and accumulation of bacteria and pus.

Sinusitis is a collective term. Depending on which sinuses the inflammation occurs in, there are: sinusitis - inflammation of the maxillary sinuses, frontal sinusitis - inflammation of the frontal sinuses, ethmoiditis - inflammation of the ethmoid sinuses, sphenoiditis - inflammation of the sphenoid sinus. The maxillary, frontal and ethmoid sinuses are paired in the human body, so the inflammatory process in them can be either unilateral or bilateral.

Without adequate treatment, sinusitis easily becomes chronic, and in some cases can cause extremely serious complications, especially in children. Therefore, it is so important to recognize the disease in time and begin treatment.

Symptoms of sinusitis

In mild forms of the disease,
the symptoms are not pronounced and resemble the course of a common runny nose. The patient is concerned about difficulty in nasal breathing, mucous discharge from the nose, impaired sense of smell, a slight headache in the forehead or projection of the sinuses, a dry evening or night cough. Signs of general intoxication are absent or mild, the temperature remains within normal limits.

For moderate to severe forms of sinusitis

To the local signs, symptoms of general intoxication are added: the temperature rises to febrile levels (above 38°C), a feeling of heaviness appears in the paranasal sinuses when turning the head and bending, and in severe forms, swelling of the face and eyelids may occur. The severe form develops especially quickly in children.

Separately, it is worth mentioning such a symptom of sinusitis as headache

. Headache is a private companion of sinusitis and can manifest itself with varying intensity depending on the severity of the disease. The location of headaches due to sinusitis can also be different. With inflammation of the maxillary sinuses (sinusitis), pain will be felt in the area of ​​the nose and under the eyes, with inflammation of the frontal sinuses (frontitis) - in the forehead and bridge of the nose, with inflammation of the ethmoid sinuses (ethmoiditis) - in the area of ​​the bridge of the nose and on the forehead, with inflammation of the sphenoid sinus (sphenoiditis) - in the back of the head and upper forehead.

If symptoms of the disease occur, it is necessary to consult a doctor as soon as possible for examination, diagnostic procedures (in particular, x-rays of the sinuses) and treatment in order to reduce the duration of the disease and prevent the development of complications.

Causes of sinusitis

Most often, sinusitis becomes a complication of an untreated runny nose
. But other factors can also cause its appearance, such as:

• deviated nasal septum (congenital or resulting from injury);
• diseases of the upper jaw, teeth affected by caries;
• allergy expressed by rhinitis.

Why is sinusitis dangerous?

The most common complication in the absence of proper treatment for sinusitis is the transition of the disease to a chronic form.
Chronic sinusitis

characterized by a prolonged (lasting over 12 weeks) runny nose; constant feeling of a dry throat; dry cough, which manifests itself especially in the evening and at night; decreased sense of smell; subfebrile body temperature (up to 38°C).

In addition to becoming chronic, improper treatment of sinusitis can lead to serious complications associated with infection entering the general bloodstream, as well as damage to other tissues and organs located in the skull. Among them:

• otitis (inflammation of the outer or middle ear);
• phlegmon of the orbit (suppuration of the tissues that surround the eyeball);
• meningitis (inflammation of the pia mater).

These complications pose a threat to the patient’s life and can lead to disability. Therefore, to prevent the development of complications, you should refrain from self-medication and strictly follow the doctor’s recommendations.

Treatment of sinusitis

If the diagnosis of sinusitis is confirmed, the doctor will prescribe special therapy that will weaken the manifestations of the disease and speed up the onset of recovery.
The following means are used for the treatment of sinusitis: 1. Elimination-irrigation therapy.

Weak hypertonic solutions of sea water in the treatment of sinusitis are used to eliminate (remove) viruses and bacteria.

2. Vasoconstrictor drugs.

Drugs in this group eliminate swelling of the nasal mucosa in the shortest possible time; some can even be used in newborns. It is important to remember that long-term (more than 5 days) use of vasoconstrictor drugs can lead to severe swelling of the nasal cavity and even changes in the structure of the nasal mucosa, i.e. to the so-called drug-induced rhinitis.

3. Local glucocorticoids.

Glucocorticosteroids suppress the development of edema of the mucous membrane, restore the functional ability of the anastomosis to improve the outflow of sinus contents.

4. Local antibacterial therapy

. Antimicrobial drugs for local action on the mucous membranes can be prescribed in combination with the systemic use of antibiotics, and in some cases as an alternative method of treating acute sinusitis.

5. Antibacterial therapy.

For moderate and severe forms of sinusitis, the doctor may prescribe broad-spectrum antibiotics.
These drugs are used to destroy the causative agent of the disease, as well as to combat the inflammatory process. It is very important to take antibiotics strictly following your doctor's recommendations. 6. Mucolytic drugs.
Prescribed to reduce the viscosity of mucus and improve the evacuation of secretions.

7. Antiallergic drugs.

Prescribed if there are signs of allergic rhinitis.

The criteria for the effectiveness of treatment are the positive dynamics of the main symptoms of sinusitis (local pain or discomfort in the projection of the affected sinus, nasal discharge, body temperature) and the general condition of the patient.

Prevention of sinusitis

Prevention of sinusitis consists, first of all, in mandatory follow-up treatment of any runny nose and adequate treatment of the underlying disease (influenza and other infectious diseases, dental damage).
Also, in order to avoid the development of the disease and associated complications, it is recommended to promptly eliminate predisposing factors: deviated nasal septum and other anatomical disorders of the nasal cavity and sinuses.

It is equally important to maintain and strengthen the body’s overall immunity by taking vitamin and mineral complexes, proper nutrition and moderate physical activity.

Sinusitis is one of those diseases that creates a lot of discomfort for a person. And at the same time, it is one of the most common diseases in the world. According to statistics, about 10 million people suffer from this disease every year. But, unfortunately, not everyone takes sinusitis with due seriousness and thinks that the disease will go away on its own. Of course, this is not so, and sinusitis, like any other disease, requires treatment and prevention

. Therefore, if you experience any unpleasant sensations in the nose and sinuses, do not delay in contacting a doctor.

The specialists of the SMITRA Clinic have extensive experience in the treatment of sinusitis, conduct thorough diagnostics, and select effective treatment. Make an appointment with us and get a consultation at a time convenient for you.

Be healthy!

The material was prepared with the participation of Egor Evgenievich Demidov, an otolaryngologist and phoniatrist at the SMITRA Clinic. © 2010-2021 SMITRA.
All rights reserved. No material on this site may be copied or used without written permission except for private, non-commercial viewing.

Symptoms and signs of manifestation

The clinical picture resembles a cold. Therefore, many people visit the doctor when the disease is already advanced. The following symptoms should be considered:

• duration of runny nose more than 2 weeks;
• the discharge has a yellow-green tint (pus);
• decreased sense of smell, difficulty breathing;
• pain in the head, intensifying when a person tilts his head;
• in the projections of the sinuses there is a feeling of distension;
• fever, increased body temperature (acute form).

Treatment of chronic sinusitis

Before getting rid of a disease, you should find out what caused it, and also take into account the age of the patient.

If the disease occurs in an adult

Chronic sinusitis can be treated at the Yuzhny clinic. Treatment in adults depends on the cause that triggered the development of the disease. The nasal cavity in patients over 18 years of age is connected by thin passages to 7 cavities of the skull bones. They are called paranasal sinuses: 1 sphenoid, 2 maxillary, 2 frontal, 2 ethmoid. They are the site where mucus, a thick liquid secreted in the nose, is expelled. When the process of cleansing the sinuses is disrupted, it accumulates. This results in an illness that resembles rhinitis, but requires other therapeutic measures. You can get rid of the acute form in 30 days. Symptoms of the subacute form may persist for 1-3 months.

The clinic specialist will take into account the symptoms and select an individual treatment regimen. For example, chronic odontogenic maxillary sinusitis is treated with the use of antibiotics, catarrhal sinusitis is treated without the use of antibacterial agents. Vasoconstrictor drugs are recommended. They contain oxymetazoline, a substance that constricts blood vessels, which helps eliminate swelling, improve drainage and patency of the nasal sinuses.

These medications include Afrin nasal spray, which makes breathing easier, reduces the volume of secretions produced, and restores the mucous membrane. It has a number of advantages over analogues:

• is fixed in the affected area, which ensures a quick positive result;
• evenly distributed over the mucous membrane;
• special No Drip formula (consists of carmellose sodium, povidone, microcrystalline cellulose) does not get into the throat or flow out of the nasal passages;
• economical consumption;
• Dosage accuracy and ease of use are ensured by the pump.

The medicine is effective for allergic manifestations, and it is allowed to be used before the nasal rinsing procedure.

The child has

Chronic sinusitis in a child under 3 years of age is very rare, since the sinuses are not yet developed. It affects children over 5 years old. Possible pathologies:

• osteomyelitis of the skull bones (purulent melting of bone tissue);
• otitis (inflammation in the middle ear, where the infection penetrates from the nasopharynx through the Eustachian tube);
• phlegmon of the orbit (suppuration of the soft tissues surrounding the eyeball);
• encephalitis (inflammation develops in the brain tissue);
• meningitis (inflammation of the soft membrane of the brain).

Such conditions lead to disability (neurological disorders, blindness or deafness) and threaten life. Therefore, when a stuffy nose forces a small patient to breathe through the mouth, a cough and dry mouth are observed - you should consult an experienced pediatric otolaryngologist as soon as possible.

Diagnostics will include a number of actions:

• clinical analysis of urine, blood;
• radiography of the skull bones (the image will reflect the sinuses with esudate);
• examination of the nasal cavity with a special device equipped with a camera - a rhinoscope (the procedure is called rhinoscopy);
• bacteriological culture of fluid released from the nasopharynx.

Allergies that are not properly treated can lead to the development of chronic maxillary sinusitis. Then you will have to relieve inflammation and identify the allergen in order to avoid contact with it in the future. The duration of treatment depends on the severity of the condition. In case of complications, it will be recommended to visit a neurologist, ophthalmologist, or other highly specialized doctors.

Synovitis of the knee joint: symptoms and causes

Trauma is not the only possible cause of synovitis. With various autoimmune processes and metabolic disorders, this disease can also develop. Against the background of existing diseases (gonarthrosis) of the knee joint, inflammation can be secondary, and in this case we say that the patient has reactive synovitis of the knee joint.

As a rule, inflammation is aseptic in nature (that is, there is no infection) and is manifested by the formation of serous effusion. If an infection occurs, the nature of the synovial fluid changes, pus appears in it and purulent synovitis develops.

What manifestations indicate that the patient has synovitis of the knee joint? Symptoms appear gradually, over several hours or even days after the injury. The first sign will be an increase in the volume of the joint. The fluid seems to burst the intra-articular structures, deforms the contours of the knee, and makes movement difficult. Limitation of motor function is the second symptom, which is not always accompanied by pain. However, pain is still characteristic of this pathology, but it is not sharp, but dull, of medium intensity.

During an external examination, the doctor determines the increase in volume of the joint in the absence of inflammatory manifestations on the skin - the skin is not hyperemic, the temperature is not elevated. To clarify the diagnosis, joint puncture is of greatest importance: a needle is inserted into the joint cavity and part of the exudate is removed. It is examined for transparency, protein and blood cell content, and cultured for microorganisms.

Exacerbations without treatment

A person suffering from vasomotor rhinitis increases the likelihood of developing rhinosinusitis. The mucous membrane swells greatly, which leads to periodic repetition of the inflammatory process. When the disease is not combated, the infection will quickly spread throughout the body, leading to:

• otitis;
• acute bronchitis;
• pneumonia;
• meningitis;
• tonsillitis;
• sore throat;
• subdural or epidural brain abscess;
• blood poisoning;
• optic neuritis;
• conjunctivitis;
• the appearance of blood clots in the blood vessels of the head.

Prevention

Preventive measures for chronic odontogenic sinusitis include:

• improving the functioning of the immune system;
• timely elimination of colds and runny nose;
• maintaining a healthy lifestyle;
• hardening;
• no contact with substances that cause an allergic reaction;
• daily exposure to fresh air;
• taking minerals and vitamins;
• dental care;
• use of an air humidifier (room temperature should be 19-22 degrees Celsius, humidity – 60%).

If you have snot, experts recommend rinsing your nose with saline solution, monitoring the duration of the runny nose and the shade of the secretion.

Table: Current monitoring for patients with MGUS

Frequently Asked Questions About Chronic Sinusitis

People who are faced with an ENT disease want to know the answers to some questions related to getting rid of an otolaryngological problem.

How to cure chronic sinusitis once and for all?

To eliminate the disease, you should contact our medical center, equipped with modern equipment. Highly qualified doctors working at the Yuzhny clinic use methods provided in international practice to cope with the problem:

• rinsing the nose, including the paranasal sinuses according to Proetz;
• antifungal or antibacterial therapy;
• anti-inflammatory drugs, including corticosteroids;
• antihistamines;
• intranasal injections of drugs;
• endonasal novocaine blockade;
• anemization of the mucous membrane.

When is surgery needed?

In difficult cases, for example, when the nasal septum is deviated, conservative therapy is ineffective. Therefore, surgeons provide assistance. An operation performed to eliminate chronic sinusitis will eliminate the obstruction in the nasal cavity that prevents the complete cleansing of the sinuses. The procedure is carried out using an endoscope. It is an optical device that allows visual control of all actions.

Thanks to our reliable equipment, it will be possible in a short time, without incisions and harm to the patient’s health, to cope with the nuances of the abnormal structure of the nasal cavity, to cut out overgrown bone tissue, thick sections of the mucous membrane, cysts, and polyps.

The procedure involves inserting a special tube into the nose. On its sides there are 1-2 channels where surgical instruments are inserted. The video surveillance system helps the doctor examine the problem area and remove altered tissue and pus.

What to do if you have sinusitis?

An unadvanced disease can be corrected using conservative methods that can overcome infection, pain, and inflammation.
It is necessary to ensure that the mucus is removed freely, that is, the drainage of the sinuses is restored. This is achieved by vasoconstrictor drugs that eliminate swelling, which leads to the gradual release of stagnant contents. You can do inhalations. A nebulizer gives the best results. The drug is administered in pulsation mode and has the form of microscopic particles - this ensures access of active substances to distant inflamed areas. The therapy does not cause pain, its duration is 7-10 days. Washing is also performed using:

1. Sinus catheter YAMIK. A large negative pressure is created in the nose, which allows the pus to be pumped out. Then the antibiotic is administered in liquid form. Usually 3-5 manipulations are performed.
2. Suction aspirator “Cuckoo”. The first step is to narrow the blood vessels in the nasal cavity using a nasal spray. The second stage is the introduction of the medication into one nasal passage and suctioning it through the other. During the procedure, the patient has to say “ku-ku”. The third stage is the administration of the drug.

Before a specialist chooses how to treat chronic sinusitis, he will find out what reason caused the stagnation of the contents. Bacterial damage is treated with antibacterial drugs. If you use antibiotics for a virus, the functioning of the immune system will be disrupted, the microflora will change, and the pathological process will become chronic. Allergies will have to be treated with antihistamines. When an acute form is observed, absorbable agents are prescribed to prevent adhesions.

Physiotherapeutic procedures indicated:

• use of ultra-high frequencies (UHF);
• using current to administer medications (electrophoresis);
• complex effect of ultrasound and drugs (phonophoresis);
• applying electrodes to the inflamed area to reduce pain (diadynamic currents);
• laser exposure (quantum rays).

What are the first signs of chronic sinusitis in adults and children?

Signs of the disease in both young patients and adults are:

• prolonged runny nose (secretion is separated, where pus or blood is observed);
• periods when one or the other nostril is blocked;
• in the evening and at night there is a dry cough;
• feeling that the nasopharynx is dry;
• in the morning the runny nose becomes stronger;
• decreased sense of smell;
• swelling of the mucous membrane;
• the skin on the face becomes sensitive;
• refusal to eat;
• severe pain in the head, which is affected by the places where the problem area is located (it becomes stronger with physical activity).

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Risk of MGUS progression

With monoclonal gammopathy of unknown origin with heavy chain immunoglobulins, the risk of developing the disease into multiple myeloma or other malignant lymphoma is 1-1.5% per year, while with MGUS with light chains it is about 0.3% per year. However, the likelihood of malignancy in MGUS also depends on the individual abnormalities present in each individual patient. The main risk factors for malignancy in MGUS are:

• monoclonal protein (paraprotein, or M-protein) ≥ 15 g/l;
• abnormal coefficient of free kappa and lambda chains in blood serum;
• non-IgM MGUS.

As a rule, monoclonal gammopathy of unknown origin has no symptoms and is diagnosed as part of routine monitoring or when another disease is diagnosed in Germany. Read more about the methods for diagnosing MGUS in the article “Diagnostics of monoclonal gammopathy of unknown origin in Germany.”