THE EFFECTIVENESS OF PHARMACOLOGIC TREATMENT FOR REGRESSION OF CLINICAL SYMPTOMS AND INDICATIONS FOR SURGICAL TREATMENT OF CHRONIC NASOPHARYNGITIS ASSOCIATED WITH EPSTEIN-BARR VIRUS
Authors: Koshel I. V. , Leta O. I. 
Published: January 2023

Chronic nasopharyngitis (CNP) associated with Epstein-Barr virus (EBV) is etiopathogenetically based on the virus-induced chronic inflammation of the pharyngeal tonsil. Studies using immunological methods have shown that EBV is involved in the hypertrophy of the lymphoid tissue of the pharynx in children and adolescents, since the lymphoid tissue of the pharyngeal tonsil is the site of primary infection and persistence of the virus. The surgery does not often resolve the problem in 19-26% of patients. Therefore, there are many questions regarding the choice of the adequate therapy that would show its effectiveness.

Objective: to evaluate the effect of treatment of CNP associated with Epstein-Barr virus with the phytoneering extract BNO 1030 on the dynamics of the main clinical symptoms and associated indications for surgery.

Material and methods. A total of 108 outpatients divided into two groups: experimental (n-54) and control (n-54). Verification of EBV was carried out according to the ELISA reaction profile: IgM-VCA/IgG-EA/IgG-EBNA. All the patients were prescribed a background treatment and the experimental group additionally received BNO 1030. The evaluation of the effectiveness of treatment was based on the analysis of the dynamics of clinical symptoms, the degree of hypertrophy of the pharyngeal tonsil, and the existence of indications for surgical treatment. Symptom assessment was performed on V1 (day 0), V2 (day 51), V3 (day 101), V4 (day 141). Indications for surgical intervention (adenotomy) were determined on V4 together with the patient's parents.

Results. Clinical symptoms of CNP include runny or stuffy nose, postnasal drip, nasal voice, posterior cervical lymphadenopathy. Symptoms were rated, on average, from 0 to 3 points on a 4-point MSS scale that corresponds to the moderate course of CNP. At V1, both groups showed comparable symptom scores.

The use of the phytoneering extract BNO 1030 in addition to background therapy in patients of the main group proved its clinical efficacy. At V3 and V4, in patients of the main group, there was observed a clinically significant decrease in the severity of nasal congestion, nasality, enlarged cervical lymph nodes (p<0.05). There was insignificant difference between the groups in the dynamics of nasal discharge and postnasal drip symptoms at all visits (р> 0,05).

The analysis of the dynamics of indicators of pharyngeal tonsil hypertrophy in both groups of patients was carried out before the operation. There are significant differences between hypertrophy indicators between V1 and V4 (p<0.05). After eliminating the operated patients, there were no differences between the groups in the degree of hypertrophy (p> 0.05). The need for surgery decreased in patients of the main group. A 14.8% decrease in adenotomy rate was observed: from 53.7% in the control group to 38.9% in the main group (p<0.05). Conservative treatment was prolonged in 61.1% of patients in the main group and 46.3% of patients in the control group.

No patient developed side effects.

Conclusions: the adequate pharmacologic treatment of CNP associated with EBV has improved clinical symptoms and reduced the indications for surgical treatment in 61.1% of patients.