Irrigation and elimination therapy and prevention of acute respiratory infections in children
Today, in the practice of a pediatric ENT specialist, the prevention and treatment of inflammatory diseases of the upper respiratory tract in children remain an urgent problem. In 25-50% of children there are various inflammatory diseases of the nose, nasopharynx and paranasal sinuses. According to statistics, the proportion of diseases of the paranasal sinuses is 12-14.5%, the ear – 28% and the nasopharynx – about 54%. Despite the progress of methods for the prevention and treatment of inflammatory diseases of the upper respiratory tract, an increase of 1.5–2.0% is observed annually in such patients. In this regard, the study of etiology, pathogenesis, and improvement of diagnostic and prophylactic methods does not lose its relevance.
Inflammation of the mucous membrane of the nasal cavity – rhinosinusitis – can be considered the most common disease in children. According to various authors, in recent years, the frequency of diseases of the nose and paranasal sinuses in children is 35–37%, of which 50% go into a chronic form [2-4]. Normally, the nose performs respiratory, protective, resonant and olfactory functions. Inflammatory changes in the nasal cavity lead to a violation of these functions. The hemodynamics of the skull are disturbed, since a less deep breath when breathing through the mouth leads to a decrease in negative pressure in the chest.
Physiological factors contributing to the development of ARI in children
A pediatric otorhinolaryngologist needs to consider the anatomical features of childhood. Young children, especially the first year of life, due to the anatomical and physiological features of the structure of the nasopharynx, are much more difficult to tolerate a violation of nasal breathing. The relatively large tongue, which occupies almost the entire oral cavity, does not allow the child to breathe through the mouth during swelling of the nasal passages. Violation of nasal breathing complicates the feeding process: the baby cannot suck, is forced to interrupt frequently, swallows air, as a result of which regurgitation, flatulence appear, sleep worsens, and the general condition is disturbed.
As a result of the anatomical and physiological characteristics, young children are at increased risk of developing complications of acute respiratory infection (ARI), such as acute otitis media, rhinosinusitis, tracheobronchitis, pneumonia. Thus, in the event of inflammation in the nasal cavity in infants and older children, the appointment of drugs that improve nasal breathing is required.
In the etiology of ARI, the leading role is played by viruses that cause acute inflammation of the nasal mucosa. Normally, microorganisms are adsorbed on the surface of the mucous membrane by mucus secreted by the secretory cells of the surface epithelium, and are excreted due to the vibrational movements of the cilia of a single-layer multilayer ciliated epithelium of the mucous membrane. If the protective barrier of the mucous membrane is inconsistent, the virus enters the cell, where its nucleic acids are released from the protein membrane. It is because of the immaturity of adaptive systems that children, especially young children, often suffer from acute respiratory infections.
The main bacterial pathogens of ARI are pneumotropic microorganisms, including pneumococcus and other gram-positive cocci, Haemophilus influenzae, Moraxella catarrhalis, atypical pathogens (mycoplasma, chlamydia), etc. The primary viral infection often leads to the activation of endogenous pathogenic conditionally. The reason for the easier transformation of this microflora into a pathogenic one in children is associated with individual characteristics of the immune response, impaired barrier function of the respiratory tract, decreased local immunity, and also with superinfection with bacterial agents. Infectious inflammation is the main pathogenetic link in the clinical manifestations of acute respiratory infections. Inflammation of the mucous membrane of the upper and lower respiratory tract contributes to the hypersecretion of viscous mucus, the formation of edema of the mucous membrane of the respiratory tract, and the violation of mucociliary transport. Against the background of acute rhinitis, an inflammatory reaction often develops in the paranasal sinuses due to swelling of the mucous membrane of the nasal cavity and blocking of the natural anastomoses of the sinuses, which leads to impaired ventilation and a delay in secretion in their lumen. Inflammation and impaired mucociliary clearance in the nasopharynx are accompanied by changes in the protective mechanisms of the mucous membrane of the auditory tube, which leads to the development of complications – eustachiitis, exudative otitis media, or acute purulent otitis media.
Principles of treatment and prevention of ARI in children
Given the characteristics of the pathogenesis of the disease in children
At a young age, the rational tactics for treating respiratory infections is the appointment of anti-inflammatory, antipyretic, symptomatic, and, if indicated, systemic antibiotic therapy. Among topical preparations (for endonasal use), decongestants and topical glucocorticosteroid preparations that have anti-edematous and anti-inflammatory effects are most widely used.