Professional Documents
Culture Documents
Management of Rhinosinusitis: Delfitri Munir
Management of Rhinosinusitis: Delfitri Munir
Management of Rhinosinusitis: Delfitri Munir
RHINOSINUSITIS
Delfitri Munir
Rhinosinusitis
Rhinosinusitis is defined as inflammation of the nose and
the paranasal sinuses resulting in:
And either
≥2 MAJOR SYMPTOMS ENDOSCOPIC SIGNS of
• Polyps or
• Blockage/congestion • Mucopurulent discharge from middle
• Loss of smell meatus or
• Discharge anterior/postnasal drip • Edema/mucosal obstruction
primarily in middle meatus
• Facial pain/pressure
Or
CT CHANGES
• Mucosal changes within ostiomeatal
complex and/or sinuses
0 5 10 15
Days
Acute rhinosinusitis
Intensity of symptoms
Chronic rhinosinusitis
and signs
Acute exacerbation
of chronic rhinosinusitis
12
Weeks
Sinus Cycle Leading to Rhinosinusitis
Secretions thicken, pH
changes
Secretions Mucosal gas metabolism
stagnate changes
Frontal sinuses
Maxillary
sinuses
Retained secretions cause
Mucosal thickening
tissue inflammation
creates further blockage
Bacterial infection develops
in the sinus cavity
Haller cells
Underlying Diseases:
asthma
cystic fibrosis
ciliary dysmotility
immuno-compromised:
chemotherapy
transplant
immuno-deficiency
Other Etiology of Rhinosinusitis
3000
2500
2000
1500
1000
500
0
Fluticasone Mometasone Fluticasone Beclometha- Ciclesonide Budesonide Dexamethasone
furoate furoate propionate sone-17- active
monopropionate principle
25
15
11%
10
5
0.5% 0.5% 0.5%
0
Fluticasone Fluticasone Mometasone Budesonide Flunisolide
furoate propionate furoate
Bryson HM, Faulds D. Drugs 1992;43:760–75.; Daley-Yates PT, Baker RC. Br J Clin Pharmacol 2001;51:103–5.; Daley-Yates PT et al. Eur J Clin Pharmacol 2004;60:265–8.; Allen A et al. Clin Ther 2007;29:1415–20.
Angka Kejadian Epistaksis
Angka kejadian epistaksis pada penelitian 6–12 bulan
Study MF % BDP % TAA % FP % FF % Placebo %
duration
6 bulan1,2 9 8-15 8
(blood in the (9) (2-9) (1-2)
nasal mucosa)
12 bulan3 20 8
3 bulan4,5 17-19 23 17 11
12 bulan6* 11 6
*Durasi pengobatan tidak dispesifikasi, termasuk 513 pasien yang diobati selama ≥ 1 thn
1Van As A et al. J Allergy Clin Immunol 1993;91:1146–54; 2Banov CH et al. Ann Allergy 1994;73:240–6; 3 Rosenblut A et al. Allergy 2007;62:1071–7; 4 Drouin M et al. Ann Allergy
Asthma Immunol 1996; 77: 153 – 160; 5Mandl M, et al. Ann Allergy Asthma Immunol 1997; 79: 370 – 378; 6Baldwin CM and Scott LJ. Drugs 2008;63:1723–39
15
Biopsi Nasal
Baseline dan setelah 12 bulan pengobatan dengan FFNS
Setelah pengobatan 12 bulan, ada pengurangan yang bermakna pada infiltrasi sel
inflamasi sub-epitel dengan FFNS dibandingkan dengan MFNS. Sama seperti MFNS, FFNS
menunjukkan tidak ada tanda atropi mukosa.