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Henochowicz PDF
Henochowicz PDF
Eyeball
Ethmoid sinus
Maxillary sinus
Nasal cavity
Nasal Polyp
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Rhinosinusitis
More accurate term than“sinusitis since almost always
preceded by or concomitant symptoms of rhinitis
Acute – Up to 4 weeks
Subacute – 4 to 12 weeks
Chronic – > 12 weeks
Acute vs. Chronic Rhinosinusitis
Usually very different conditions.
Major Minor
Anterior or posterior Head ache
purulent drainage Ear pain/pressure
Nasal obstruction
Halitosis
Facial pain or pressure or
congestion dental pain
Hyposmia or anosmia Fatigue
Fever (acute) Cough
JACI 2004
Obstruction of the OMU with Associated
Acute Sinusitis
Sinusitis in the
ethmoid sinus.
Sinusitis in the
maxillary sinus.
Local Factors Predisposing to
Rhinosinusitis
Allergic rhinitis Foreign body
URI Trauma
Eli O. Meltzer, MD, Claus Bachert, MD, PhD and Heribert Staudinger, MD
Factors
Eosinophil > 200/uL (OR=19.2, 95% CI=5.4-72.7
Asthma (OR=6.8, 95%CI=2.2-22)
Atopy (OR=4.3,95%CI=1.5-12.8)
Age>50 (OR=6.5,95%CI=2.0-22.2)
Perennial
None
Perennial and
seasonal
Emmanuel et al. Otolaryngol H&N Surg 2000; 123:687 and Ramandan et al. Am J Rhinol 1999;
13:345
Diagnosis of CRS
Physical examination
Endoscopy or anterior rhinoscopy
Purulent drainage
Edema or erythema of the middle meatus or ethmoid bulla
polyps
Sinus CT scan
Mucosal thickening
Air-fluid level
Corticosteroids
Decongestants
Muco-evacuants
Antihistamines
Non-pharmacologic treatment
v
Microbiology of Chronic
Rhinosinusitis
Not well defined because of differences in culturing
techniques, prior use of abx
Fungi
Mucolytic treatment
1 double blinded study
2400 mg of guaifenesin or placebo in HIV+ with chronic
sinusitis
improvement in congestion and thick secretions
Saline irrigation
may help mucociliary clearance
mild vasoconstrictor of nasal blood flow