Professional Documents
Culture Documents
Accurate Investigations in Rhinology..?: - Problems: AR, Polyps, Rhinosinusitis
Accurate Investigations in Rhinology..?: - Problems: AR, Polyps, Rhinosinusitis
Accurate Investigations in Rhinology..?: - Problems: AR, Polyps, Rhinosinusitis
WISC 2012: WAO International Scientific Conference, Hyderabad. India 1 WAO-2012, Hyderabad 2
– nasal perforations, ulceration or collapse – Nasal polyps: widened dorsum of the nose
– sero-sanguineous discharge • Covering skin of the nose: color changes, edema, scars
– severe crusting within the nasal cavity • The surrounding structures: forehead, eyes, cheeks & upper lip
– recurrent infection
• Palpation:
– periorbital cellulitis (refer urgently)
• Nasal obstruction
– severe sleep problems
WAO-2012, Hyderabad 10 WAO-2012, Hyderabad 12
1
12/9/2012
• Good evaluation of the septum, the whole nasal cavity & the • Nasal polyps: presence and severity can be scored by validated systems with a
good reproducibility.
nasopharynx .
• Correlation between size of polyps and the subjective symptom ..!
• Area of the middle meatus: clinical importance in rhinosinusitis.
Allergic and inflamed mucosa, secretions or swelling in the middle meatus,
WAO-2012, Hyderabad 15 and possible presence of nasal polyps are evaluated 16
Diaphanoscopy
• Inspection, palpation and anterior rhinoscopy
• Transillumination of human tissue or a cavity with a light
– easy and rapid ways
source to evaluate the opacity of the hollow sinus.
– corner stone of every physical examination.
• Maxillary sinus:
– Light source in the mouth of the patient, watched in a darkened room. • Persistent nasal symptom: complete and thorough
– Sinus is accessible (vacant): light shines through sinus and pupil. examination using nasal endoscopy.
• The frontal sinus:
• Rigid endoscopy : more patient friendly and better
– light source is placed at the bottom of the frontal sinus.
image
• Useful only in case of a unilateral acute maxillary or frontal
sinusitis of an adult patient, who did not yet undergo sinus
surgery WAO-2012, Hyderabad 17 WAO-2012, Hyderabad 18
2
12/9/2012
• SPT:
– Unanimously considered the gold standard
3
12/9/2012
• Culture sensitivity:
– Swab from Nose or Sinus…?
• Acoustic rhinometry
WAO-2012, Hyderabad 27 WAO-2012, Hyderabad 29
• Ciliary beat frequency measurement – Anti- nuclear antibodies, extractable nuclear antibodies (anti-Ro
& anti La: Sjogren’s syndrome- QLIPS)
• The definite proof epithelial cell cultures & Ciliogenesis in
– pregnancy test or tests for drugs of addiction on urine.
vitro
– Beta-2 transferrin, Glucostix test strips
4
12/9/2012
Imaging in Rhinology
Radiological Evaluation
• X-ray
•A CT scan
• USG –mandatory before sinus
• CT: MDCT, MSCT surgery
– Caution in Children..! –during surgery
•MRI
– Timing..
–helpful for the diagnosis of
• MRI fungal disease and tumor or if
• CT + MRI: intracranial extension of
disease is suspected.
– Complimentary..!
WAO-2012, Hyderabad 34
Summary
5
12/9/2012
References
• Scadding et al. Diagnostic tools in Rhinology EAACI
position paper. Clinical and Translational Allergy
2011, 1:2.
• Google images for Pictures
WAO-2012, Hyderabad 38