Acute Rhinitis Chronic Rhinitis Acute Rhinosinusitis Chronic Rhinosinusitis Nasal endoscope Surgery Otorhinolaryngology The Third Affiliated Hospital of Sun Yat-sen University Zhang Gehua [email_address]
Actue Rhinosinusitis 20 min Chronic Rhinosinusitis 20 min Nasal endoscope surgery 15 min Schedule
Conclusion & Questions 10 min
Definition Characterized ------ runny nose and stuffiness, usually caused by the common cold
Acute Rhinitis: An acute condition which affects the nasal mucous caused by inflammation.
Symptoms latent period: 1~3days Course: 7 ～ 10days Sneezing, Runny nose (watery & clear ---thicker & yellow -green)
Others: Headaches, Decrease in ability to smell, Nasal obstruction
Complications Sinuses (maxillary sinusitis, frontal sinusitis and some other kinds of sinusitis) Eye mucosa (conjunctivitis) Other respiratory organs (pharyngitis,
laryngitis, tracheitis, bronchitis, pneumonia)
Treatment Decongestants: which help open clogged nasal passages (<7days) Antihistamines: which help dry a runny nose
Cough syrups: which may make coughing easier by thinning secretions or suppressing cough
Chronic rhinitis is usually an extension of acute rhinitis caused by inflammation or an infection. Definition
------It also may occur with diseases such as syphilis, tuberculosis, rhinoscleroma , rhinosporidiosis, leishmaniasis, blastomycosis, histoplasmosis, and leprosy.
pus-filled discharge from the nose
nasal spray (nasonex, flonex) partial inferior turbinectomy Treatment
inferior turbinate ablation…....
Anatomy Frontal sinus eye Maxillary sinus Inferior turbinate Middle turbinate Uncinate process
Sinus Drainage Schema
Anterior ethmoid Middle meatal Sphemoid Sphenoethmiodal recess Olfacotory cleft Sinus Drainage
Posterioe ethmoid Supper meatal
Deﬁnitions of rhinosinusitis ------ based on the duration clinical signs and symptoms Acute rhinosinusitis : <4 weeks Subacute rhinosinusitis : 4 to 12 weeks Chronic rhinosinusitis : >12 weeks Recurrent acute rhinosinusitis : ≥4 episodes/yr (each episode lasting ≥7 to 10 days plus no intervening signs of CRS) Acute exacerbation of chronic rhinosinusitis :sudden worsening of CRS, return to baseline after treatment
1996,American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS)
Definition Acute rhinosinusitis (ARS) implies that the duration of the condition is less than 1 month.
Acute Rhinitisinusitis : Inﬂammatory and/or infectious condition of 1 or more of the paranasal sinus cavities.
Epidemiology 0.5 to 2% of cold result in ARS (acute rhinosinusitis) Up to 1 in 20 URI (upper respiratory tract infections) lead to ABRS (acute bacterial rhinosinusitis) One billion cases of acute viral rhinosinusitis can be anticipated annually 20 million cases of ABRS are expected annually Approximately 2% of people with acute viral rhinosinusitis go on to develop ABRS The diagnosis of ABRS accounted for 21% and 9% of all adult and pediatric antibiotic prescriptions, respectively
Affects 32 million US adults annually
Cost Resulted in 11.7 million ofﬁce visits as well as 1.2 million hospital outpatient unit visits
Generated direct annual costs in excess of $3.4 billion in that same year
Pathogenesis Influenza A and B viruses Bacterial: Streptococcus pneumoniae Haemophilus inﬂuenzae, Moraxella catarrhalis Streptococcus intermedius, Streptococcus pyogenes, Staphylococcus aureus anaerobic bacteria
Respiratory symcytial virus
eustachian tube dysfunction
Diagnosis The clinical signs and symptoms lack sensitivity (69%) and speciﬁcity (64%). when a viral URI does not resolve after 10 days or is worsening at 5 to 7 days. ------facial pressure/pain ------decreased/absent olfaction
------fever, cough, fatigue, dental pain, and/or ear pressure.
Complications Intracranial Complications Meningitis Epidural Abscess Subdural Abscess Intracerebral Abscess Preseptal Cellulitis Orbital Cellulitis Subperiosteal Abscess Orbital Abscess Cavernous Sinus Thrombosis
Treatment In the adult population with mild disease and no antibiotics in the prior 6 weeks the following choices may be considered: amoxicillin/clavulanate, amoxicillin, cefpodoxime proxetil, cefuroxime axetil, or cefdinir In patients with β-lactam allergies, trimethoprim-sulfamethoxazole, docycline, azithromycin, clarithromycin, erythromycin, or telithromycin may be used Bacteriologic failure rates range from 20 to 25%. In those patients who have received antimicrobials in the prior 6 weeks, ﬂuoroquinolones or higher dose amoxicillin clavulanate may be considered
Failure to respond to treatment within 72 hours requires a switch to another antimicrobial and/or reevaluation of the patient
Treatment In the pediatric population, the choices are similar to the adult population with 2 exceptions: ------dosing is based upon weight ------ﬂuoroquinolones are not an option in the pediatric population A 10-day treatment course with 1 of the above antimicrobials is recommended
An inappropriate antibiotic of insufficient duration may prolong infection and potentially morbidity of the disease.
Chronic rhinosinusitis (CRS): is a clinical disorder that encompasses a heterogeneous group of infectious and inﬂammatory conditions affecting the paranasal sinuses.
There were 18.3 million patient ofﬁce visits for CRS despite many patients not seeking medical attention.(2001) CRS affects men and women equally, but subtypes of CRS appear to have different gender distributions. For example, CRS with NPs associated with aspirin-sensitivity has a female predominance of 2:1 Epidemiology
Sinus disease is more common in the Midwest and South than in the northeast and western United States and the incidence is lower during the summer months compared to the other seasons.
Sinusitis or Rhinosinusitis Sinusitis was the commonly accepted terminology for inﬂammation of the paranasal Sinuses Now- ----- Sinusitis has gradually been phased out in favor of rhinosinusitis because nasal inﬂammation
almost always coincides with inﬂammatory paranasal
Heller cells, silent sinus syndrome or a narrow frontal sinus …… ------Intrinsic factors leading to ciliary dysfunction include primary ciliary dyskinesia or Kartagener syndrome. ------Extrinsic factors that disrupt mucociliary clearance include injury by environmental irritants, endogenous mediators of inﬂ ammation, or surgical trauma. Bone may play an active role in the disease process and that, at a minimum; the inﬂammation associated with CRS may spread through the Haversian system within the bone. CRS without NP ------ ETIOLOGY AND PATHOPHYSIOLOGY
Recent investigations have found that bacteria such as P. aeruginosa form bioﬁlms in the sinuses that may lead to recalcitrant sinus disease……
Allergic Fungal Rhinosinusitis: Eosinophilic Chronic Rhinosinusitis Ig E Independent Fungal Inflammation CRS with NP ------ ETIOLOGY AND PATHOPHYSIOLOGY
Aspirin-Sensitive Nasal Polyposis
Symptoms History of URI or allergic rhinitis, History of previous episodes of sinusitis Pressure, pain, or tenderness over sinuses (Increased pain in the morning, subsiding in the afternoon) Nasal obstruction or congestion, causing difficulty breathing through nose
Malaise, Low-grade temperature
Symptoms Persistent nasal discharge, often purulent
Mouthing breathing, snoring
Clinical Presentations Nasal mucosa is reddened or swollen Percussion or palpation tenderness over a sinus Nasal discharge, thick, sometimes yellow or green Postnasal discharge in posterior pharynx Difficult transillumination
Swelling or boggy pale turbinates
History and Physical Examination: Nasal obstruction, nasal congestion, and postnasal discharge are the most common symptoms Tenderness to palpation or percussion in the periorbital, forehead, or cheek areas. allows the assessment of mucosal hyperemia, edema, the gross appearance and sites of origin of NPs, and septal deformities or other anatomic abnormalities impacting sinus drainage. Laboratory: Allergy testing, Elevated IgE…… Evaluation
Radiology: coronal CT scan, MRI
Imaging studies (CT scanning)
Anterioe ethmoid Middle meatal Sphemoid Sphenoethmiodal recess Olfacotory cleft Posterioe ethmoid Supper meatal Pus ： Middle meatal Anterior sinus Diagnosis
Olfacotory cleft Posterior sinus
Complications of Sinusitis Orbital cellulitis or abscess, Vision problems Meningitis, Brain abscess
Cavernous sinus thrombosis
Systemic Corticosteroid Therapy Topical Corticosteroid Therapy Management
Other Medical and Ancillary Therapies
Avoid upper respiratory infections Carefully manage your allergies Prevention
Avoid cigarette smoke and polluted air
Endoscopic Sinus Surgery
What is ESS Endoscopic sinus surgery ------ is a procedure used to remove blockages in the sinuses .
This surgery does not involve cutting through the skin, as it is performed entirely through the nostrils. Therefore, most people can go home the same day.
Advantages Creates less discomfort after surgery Requires less packing in the nose after surgery Has a faster recovery period
Has a higher success rate
Surgical Technique Sphenoidotomy with Ethomoidectomy Frontal Recess Surgery ( Draf Type 1 )
Frontal Sinusotomy ( Draf Type 2 )
Postoperative Care Medical therapy-----antibiotic, saline spray, Local management of the postoperative cavity: -----remove nasal package (48 h after operation) -----nasal endoscopy and cleaning of the cavity (around 1 week after operation)
Follow up-----at least 6 months!
Follow up after ESS 2009 年 6 月 1 日 2008 年 10 月 8 日 2008 年 9 月 8 日 2008 年 8 月 18 日 2008 年 7 月 31 日 2008 年 7 月 14 日
pituitary adenoma resection
adenoidal hypertrophy Adenoidectomy
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