This document discusses rhinosinusitis, including:
- The types of ENT referrals received and conditions referred for treatment.
- The classification, diagnosis, and treatment of acute and chronic rhinosinusitis.
- Guidelines for treating rhinosinusitis with antibiotics, steroids, and surgery.
- The role of imaging like CT and MRI in diagnosing rhinosinusitis.
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal, for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal, for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Granulomatous conditions in ENT are rare conditions that we come in contact with, we tend to overlook them because they are so rare, however some of the conditions like TB and syphillis and Mucormycosis of the Nose and PNS are seen in our clinics
this is a good summary from scotts brown chapter
Granulomatous conditions in ENT are rare conditions that we come in contact with, we tend to overlook them because they are so rare, however some of the conditions like TB and syphillis and Mucormycosis of the Nose and PNS are seen in our clinics
this is a good summary from scotts brown chapter
Rare presentation of left maxillary sinusitis: A Case Reportiosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
Clinical evaluation of Laryngopharyngeal reflux and its response to Proton P...AlkaKapil
Clinical evaluation of Laryngopharyngeal reflux and its response to Proton Pump inhibitors research paper : introduction and history , review of literature, clinical symptoms & findings, and management protocol. Laryngoscopic findings, methodology for study along with aims and objectives, observations made in the study and interpretation of results in graphical manner
Diptheria (Whooping cough) and PertussisPinky Rathee
Pertussis also known as whooping cough, is a highly contagious respiratory disease.
It is known for uncontrolled, violent coughing which often makes it hard to breath.
It is a serious bacterial infection caused by corynebacterium diptheriae that affects the mucous membranes of the throat and nose
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
2. Discolosures
• Grant/Research Support: no
disclosure
• Consultant: no disclosure
• Major Shareholder: Locumdoctor4u
Ltd. (Locum and Concierge Medical
Services)
• I will not be discussing “off-label”
uses of medications or investigations
3. ENT Referrals
i.
Most ENT referrals are linked to Audiological and
Otological problems.
ii.
Out of 271 consecutive referrals to the RHP ENT
Department triaged in 2011, 58% could be potentially
managed in Primary Care.
CLPCT NHS Survey 2011 – E Cervoni
GP Trainees 27/11/13,
Education Centre RPH
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4. ENT Referrals
i.
Snoring and sleep apnoea were relatively common reasons of
referrals.
ii. In a rather significant proportion of cases, relevant information,
with specific reference to the physical examination, were missing.
iii. Among the referrals redirected to the GPwSI in ENT, deafness with
wax, epistaxis and blocked nose were the most common
complaints.
GP Trainees 27/11/13,
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CLPCT NHS Survey 2011 – E Cervoni
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7. Rhinosinusitis
Inflammation of the nose and
Inflammation of the nose and
paranasal sinuses characeterized
paranasal sinuses characeterized
by the presence of 2 or more
by the presence of 2 or more
symptoms of which one MUST be
symptoms of which one MUST be
nasal obsteruction or rhinorrhoea
nasal obsteruction or rhinorrhoea
with:
with:
±facial pain/pressure
±facial pain/pressure
±hypo/anosmia
±hypo/anosmia
Associated with
and/or CT abnormal changes:
Endoscopic signs:
- polyps and/or
- polyps and/or
- purulent secretion from the middle
- purulent secretion from the middle
meatus and/or
meatus and/or
- oedema/mucosal
oedema/mucosal obstruction
obstruction
prevalent in the middle meatus
prevalent in the middle meatus
GP Trainees 27/11/13,
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- mucosal changes at the level
- mucosal changes at the level
of the osteo-meatal complex or
of the osteo-meatal complex or
of the paranasal sinuses
of the paranasal sinuses
7
8. CLASSIFICATION
on severity of the symptoms
Rhinosinusitis may be classified into mild, moderate or
severe on the basis of VAS score.
Mild = VAS 0 - 3 Moderate = >3 - 7 Severe = VAS >7 - 10
Mild = VAS 0 - 3 Moderate = >3 - 7 Severe = VAS >7 - 10
To assess the severity of the symptoms the patient is asked
to answer the following question:
How painful are the symptoms of your sinusitis?
How painful are the symptoms of your sinusitis?
No pain
10 cm
GP Trainees 27/11/13,
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Worst possible
pain
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9. CLASSIFICATION
on duration
12 weeks
ACUTE/RECURRENT
(complete resolution of the symptoms)
(complete resolution of the symptoms)
CHRONIC
(incomplete resolution of the symptoms)
(incomplete resolution of the symptoms)
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10. Acute Rhinosinusitis:
clinical features
Sudden onset of its symptoms of which one must be nasal
obstruction or rhinorrhoea
±facial pain/pressure
±facial pain/pressure
±hypo/anosmia
±hypo/anosmia
And duration <12 weeks
Presence of endoscopic signs of:
Presence of endoscopic signs of:
••Purulent secretion from the middle meatus
Purulent secretion from the middle meatus
••Oedema and/or obstruction of the middle meatus
Oedema and/or obstruction of the middle meatus
Presence of abnormal changes to CT imaging
Presence of abnormal changes to CT imaging
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11.
Acute rhinosinusitis:
types
Acute viral (common cold)
Duration of the symptoms < 10 days
Duration of the symptoms < 10 days
Acute post-viral
-- Symptoms oncrease after 5 days
Symptoms oncrease after 5 days
-- Persistence of the symptoms after 10 days, but for less than
Persistence of the symptoms after 10 days, but for less than
12 weeks
12 weeks
Bacterial post-viral
Presence of at the least 3 symptoms and/or signs:
Presence of at the least 3 symptoms and/or signs:
-Purulent secretion
-Purulent secretion
-Pain with unilateral preponderance
-Pain with unilateral preponderance
-Fever (>38 C)
-Fever (>38 C)
-Raised ESR and CPR
-Raised ESR and CPR
GP Trainees 27/11/13,
-Worsening of theEducation Centre RPHa phase of remission
-Worsening of the symptoms after a phase of remission
symptoms after
11
12. Acute rhinosinusitis:
differential diagnosis
Viral infection of the upper airways
Allergic rhinitis
Confirmed positivity to a common allergen
Confirmed positivity to a common allergen
It is characterized by rhinorrhoea (which is not
It is characterized by rhinorrhoea (which is not
purulent), senstion of nasal obstruction, itchy nose,
purulent), senstion of nasal obstruction, itchy nose,
sneezing (spontaneus regression of the symptoms
sneezing (spontaneus regression of the symptoms
or following treatment)
or following treatment)
Associated to ophtalmological symptoms/signs
Associated to ophtalmological symptoms/signs
Odontogenic
Absence of nasal signs and symptoms
Absence of nasal signs and symptoms
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13. CHRONIC RHINOSINUSITIS
Sudden appearance of two or more symptoms of which ine
should be nasal obstruction or rhinorrhoea
±facial pain/pressure
±facial pain/pressure
±hypo/anosmia
±hypo/anosmia
Duration >12 weeks
Presence of endoscopic signs of:
Presence of endoscopic signs of:
••Nasal polyps
Nasal polyps
••Muco-purulent secretion from the middle meatus
Muco-purulent secretion from the middle meatus
••Oedema and/or obstruction of the middle meatus
Oedema and/or obstruction of the middle meatus
Presence of CT abnormalities
Presence of CT abnormalities
GP Trainees 27/11/13,
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14. Types of chronic rhinosinusitis
With nasal polyps
Without nasal polyps
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16. This disequilibrium determines an activation of TH2 immune response.
The response is characterized by the production of cytokines which may
differ depending of the specific nature of the chronic inflammatory
response.
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17. Allergic fungal
rhinosinusitis
Usually unilateral, with occasional purulent secretion
Characterized by high levels of IL-4, IL-5 and IL-13.
The high levels of IL-5 observed on those patients affected by allergic fungal
rhinosinusitis highlights who this condition may be considered
independently from oesinophils dysfunction disease.
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19. Invasive form
• Acute fulminant
• Chronic: - granulomatous
- invasive
Non-invasive form
• Allergic fungal rhinosinusitis
• Fungal ball
GP Trainees 27/11/13,
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20. NOTE: surgery must be associated to antibiotic therapy and
corticosteroids aiming to reduce the inflammatory component
and/or infective.
There is scientific evidence to support the use of topical steroids,
antibiotics and antifungal drugs.
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21. Diagnosis is based on CT, MRI and pathology results
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22. Chronic rhinosinusitis:
- Without asthma or allergy
- Whitout asthma, but with allergy
- With asthma and allergy
- With asthma, but without allergy
- With allergy to aspirin
- Allergic fungal
- Cystic fibrosis
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23. DIAGNOSIS
- Anamnesis
- Anterior rhinoscopy
- Nasal endoscopy
- Nasal swab
- CT
- MRI
- Biofilm Research
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24. Little role of plain x-rays
(Skinner et al., 1991)
F.N.*
F.P.**
A.D.***
3%
20%
77%
Ethimoid
55%
-
36%
Sphenoid
43%
1%
52%
3%
4%
93%
Maxillary sinus
Nasal cavity
* False negatives: Rx normal/pathological
** mucosa
*** False positives: Rx pathological/ normal 27/11/13,
GP Trainees
mucosa Diagnostic accuracy: Education Centre RPH
Rx findings/Intraoperative findings in keeping with Rx
24
26. • Extension of the disease
• Presence of bone eroisions
• Presence
of
anatomical
variances
with
possible
operative challenges
ESTENSIONE DELLA PATOLOGIA
PRESENZA DI INTERRUZIONE DELLE LIMITANTI OSSEE
GP Trainees 27/11/13,
PRESENZA DI ANOMALIE ANATOMICHE
Education Centre RPH
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28. Does not offer details of bone structures
Does not offer details of bone structures
Overestimes presence of mucosal abnormalities
Overestimes presence of mucosal abnormalities
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29. Excellent visualization of soft tissues.
Excellent visualization of soft tissues.
Helpful to assess neoplastic pathology
Helpful to assess neoplastic pathology
Helpful to assess the extension of inflammatory processes.
Helpful to assess the extension of inflammatory processes.
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32. European guidelines
for the treatment of
rhinosinusitis and nasal
polyps
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33. “EVIDENCE BASED MEDICINE”
Categories
Ia
Evidence from meta-analysis of randomised controlled trials
Evidence from meta-analysis of randomised controlled trials
Ib
Evidence from at least one randomised controlled trials
Evidence from at least one randomised controlled trials
IIa
Evidence from at least one controlled study without randomisation
Evidence from at least one controlled study without randomisation
IIb
Evidence from at least one other type of quasi-experimental study
Evidence from at least one other type of quasi-experimental study
III
Evidence from non-experimental descriptive studies, such as
Evidence from non-experimental descriptive studies, such as
comparative studies, correlation studies, and case-control studies
comparative studies, correlation studies, and case-control studies
IV
Evidence from expert committee reports or opinions or clinical
Evidence from expert committee reports or opinions or clinical
experience of respected authorities, or both
experience of respected authorities, or both
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Shekelle et al., BMJ 1999
35. Acute rhinosinusitis: therapy
Antibiotic thereapy is indicated
only when strictly required
(confirmed bacterial infection,
fever and severe pain)
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36. Acute rhinosinusitis: length of antibiotic therapy
Short treatments appear to have the same effectiveness of longer antibiotic
courses
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39. Acute rhinosinusitis: combined therapy
(steroid and oral antibiotic)
Corticosteroids when combined with
oral antibiotics appear to be
particularly effective in producing a
prompt improvement of the
symptoms – evidenca IA
Duration of treatment 3-5 days
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40. Acute rhinosinusitis: complications
Between 3,7% and 20%
Can be:
• Orbital (60-75%) ,
• Intracranial (15-20%)
• Bones (5-10%).
Sinusites account for 10% of the intra-cranial complications, and up to 90% of the
orbital complications.
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42. Chronic rhinosinusitis without nasal
polyposis
topical steroids
Only 2 recent papers have reported a significant benefit of topical steroids versus
placebo.
Anatomical factors and type of device to affect effectiveness of the treatment.
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46. Chronic rhinosinusitis without nasal
polyposis
topical antibiotics
There is no evidence of benefits resulting from topical antibiotic therapy.
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47. Chronic rhinosinusitis without nasal
polyposis
oral antibiotics
There is no evidence of benefits from antibiotic therapy < 4 weeks(short term), if
there is no evidence of infection on the basis of microbiology results.
Macrolids are the only class of antibiotics to have shown some benefits (Ib)
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52. Rinosinusite cronica con poliposi nasale
terapia antibiotica sistemica
GP Trainees
Non ci sono evidenze sulla 27/11/13, antibiotica topica
terapia
Education Centre RPH
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54. WHY SURGERY?
Remove paranasal obstruction
Improve ventilation and drainage of sinuses
Reduce number of exacerbations
Reduce complications
Improve quality of life
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55. PROBABILITY OF SUCCESS OF
ENDOSCOPIC SURGERY
Maximal
Poor paranasal sinuses ventilation
Recurring sinusitis
Sinusitis affwecting only one sinus
“Fungus ball”
Mucocele
Antral polyp
Orbital/intra-cranial complications
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57. PROBABILITY OF SUCCESS OF
ENDOSCOPIC SURGERY
Rhinosinusitis with macropolyposis
Intermediate
Minimal
Rhinosinusitis with asthma
ASA-Syndrome
Cystic Fibrosis
Kartagener’s S.
Congenital disorders
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