Professional Documents
Culture Documents
Februari 2017
RHINOSINUSITIS
dr. febriani Endiyarti Sp.THT-KL
Maxillary sinus
1. Ethmoidal bulla
2. Ethmoidal cells
3. Frontal sinus
4. Uncinate process
5. Middle turbinate
6. Inferior turbinate
7. Nasal septum
8. Ostiomeatal complex
A. Infections induce changes in sinus mucosa
Key
Ventilation
B: bulla ethmoidalis
and
IT: inferior turbinate
Drainage
MT: middle turbinate
MS: maxillary sinus
Inflammation
and
Remodeling
Aetiology of rhinosinusitis
Allergy Others
Seasonal Dental, periapical abcess
Perennial Underlying diseases, cystic
Infection fibrosis
2
Classification: chronic rhinosinusitis with and without nasal polyps
2 OR MORE MAJOR SYMPTOMS
DURATION
nasal blockage
ACUTE/intermittent < 12 weeks
anosmia/hyposmia
complete resolution of symptoms
purulent nasal discharge/post-nasal drip
CHRONIC / persistent > 12 weeks
facial pain/pressure
incomplete resolution of symptoms
AND EITHER
endoscopic findings of polyps
mucopurulent discharge
edema or obstruction
OR
CT scan abnormality: mucosal changes within ostiomeatal complex or sinus
cavity
EAACI Position Paper on Rhinosinusitis and Nasal Polyps, Allergy 2005: 60: 583-601
Hyposmia/Anosmia
Dental pain
Fever
Cough
Ear pain/fullness
3
MICROBIOLOGY
Normal sinuses: Free of growth
Acute rhinosinusitis:
Viral
Imaging of sinsuses
MRI: only recommended in tumor diagnosis
CT sinuses: current standard imaging
- Acute rhinosinusitis: only for possible complications
- Chronic sinusitis: only after 4+ weeks of treatment!
4
The signs and symptoms of acute sinusitis (>10 days and < 12 weeks):
Prerequisite symptoms
Cough
Supporting symptoms
Congestion
Facial pain/pressure
Post-nasal drip
Fever
Headache
Anosmia, hyposmia
Facial tenderness
Periorbital edema
Ear pain, pressure
Halitosis
Sore throat
Association between viral and bacterial sinusitis
infections
Viral infections
Self-limiting
2 to 3 acute viral respiratory infections per year (6-8 in children)
6
Strength of evidence for treatment of acute rhinosinusitis
in allergic patients
mucolytics no evidence D no
(3 studies)
An update on acute rhinosinusitis management: antibiotics in adults
7
An update on acute rhinosinusitis management: Antibiotics in acute rhinosinusitis?
Dont treat viral common cold with antibiotics
Use symptomatic treatment in mild acute rhinosinusitis
saline
decongestant
NSAID
Use topical steroids in acute and chronic sinusitis (evidence)
Prevalence approx. 2- 4%
Asthma in approx. 40-65%
8
EVIDENCE-BASED TREATMENT OF CRS
mucolytics IV (1) D no
systemic antimycotics VI D no
9
EVIDENCE-BASED LONG-TERM ANTIBIOTICS IN CRS
mentioned 50%
7/26 decrease of
acute
exacerbation by
52%
Clinical
improvement
and polyp
shrinkage in
68%
10