rhinosinusitis review课件.pptVIP

Lund-Mackey CT staging system Treatments Medical antibiotic therapy: should be continued for a minimum of 10 to 14 days; if not improved at 72 hours?change Abx, culture-directed antibiotics oral or topical nasal steroids, decongestants, mucolytics Surgical: if poor response for medical treatment more than 4 weeks FESS (Functional Endoscopic Sinus Surgery) Functional Endoscopic Sinus Surgery 1. For CRS due to polyps or other abnormal structural factors 2. 80 to 90% rate of improvement References Head Neck Surgery - Otolaryngology, 4th Edition Bailey, Byron J.; Johnson, Jonas T.; Newlands, Shawn D Thanks for your attention~ Rhinosinusitis Rhinosinusitis inflammation in the nose and paranasal sinuses Acute: 20 million annually($3.5 billion) Chronic: 30 million annually($4.3 billion) CRS (chronic rhinosinusitis) is more prevalent than asthma, heart disease, diabetes, or headache QOL: worse than COPD, DM, CHF Anatomy of paranasal sinuses Ostiomeatal complex 1.Uncinate process 2.Hiatus semilunaris 3.Infundibulum Ostiomeatal complex structures for the frontal, maxillary, and anterior ethmoid sinuses to drain The nasal and sinus mucosa produces approximately 1 L of mucus per day, which is cleared by mucociliary transport Ostial obstruction ? fluid accumulation and, creating a moist, hypoxemic environment ideal for growth of pathogens Functions of nose and paranasal sinuses Rhinosinusitis Acute: 4 weeks Subacute: 4 ~ 12 weeks Chronic: 12 weeks recurrent acute: 4 episode per year acute exacerbation of CRS: sudden worsening of symptoms in diagnosed CRS Patho-physiology Inflammation Infection Allergy Mechanical variation Deviated nasal septum Concha Bullosa Polyp Narrow ostio-meatal complex(OMC) ~ concha bullosa is a air-filled cavity within a turbinate in the nose. a normal anatomic variant seen in up to half the population. obstruct the opening of an adjacent sinus, possibly leading to recurrent sinusitis back Acute rhinosinusitis a