CRSDr. Prahlada N.B

Tame YETI with NETI!

Yeti Tamer ! Prahlada N.B

CRS - Definition

Classification

• CRSsNP

• Fibrosis

• High interferon-Gamma

• High tumor Growth factor -B

• High T-reg activity

• TH1 Polarization

• CRSwNP

• Tissue Edema

• High tissue Eosinophilia

• High IgE

• High IL-5 & IL13

• Low T-reg activity

• TH2 Polarization

University of Pennsylvania Smell Identification Test (UPSIT)

Richard L Doty Et. al.

DNE - Lund-Kennedy Endoscopy Score

0 1 2

Polyp Asbent Only in MM Beyond MM

Edema Absent Mild Severe

Discharge Absent Clear thin discharge Purulent

Scarring Absent Mild Severe

Crusting Asbent Mild Severe

Kennedy & Lund: Endoscopic grading - Quantification for staging sinusitis

Management Strategy

Systemic Steroids: Poetker et al

Antibiotic therapy

CRS & Asthma• UNIFIED AIRWAY

• Same pathophysiology

• ASTHMA - CRS

• CRSwNP - 60%

• CRS Treatment - Severity of Asthma

• Asthma: -ve Predictor for ESS in CRSwNP

CRSwNP

SalineIrrigation

TopicalCorticosteroids

OralCorticosteroids

OralAntibiotics/C &S/Doxycycline

Montelukast

SalineIrrigation

TopicalSteroids

OralAntibiotics– C&S- Macrolides

CRSsNP

DirectFESS

ImpendingIC/IOCompli-cations

FungalBalls

AFS

Odonto-genicCRS

Mucocoeles

AnatomicalVariants

Polyps(Grade2/3)

SystemicSteroid

Dependency

FESS

Diet

Immunemodulation

Anti-allergy

MucolyticsIndigenous

Off-labelNasal

irrigaitons

Vit, Mineraletc.,

Emerging Strategies

Managing Microflora Herbal Immune enhancers

Homeopathy Chinese!

Off-the label!- Budesonide - 0.5 mg - Dexa. Ophth. Drops 0.1% - Prednisolone Ophth. Drops 1% - Cipro/Dexa Otic Drops 0.3/0.1%

+

- 250 ml Normal Saline

Vit D• Augment innate & adaptive immune

responses.

• Reduces fibroblast proliferation in polyps

• Increases sensitivity to Corticosteroids

• Deficiency:

• Severe CRSwNP & AFRS

• Severe Bone Erosion

• Vit D Supplements.

FACEMAX 2

23, 24, 25 JUNE 2017

Thank you