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RHINOSINUSITIS
DANIEL W. TODD, M.D.
MIDWEST ENT
FORM AND FUNCTION
FORM (ANATOMY) FUNCTION (PHYSIOLOGY)
ANATOMY (FORM)
EXTERNAL NOSE (NASAL PYRAMID)
NASAL CAVITY (SEPTUM & TURBINATES)
PARANASAL SINUSES
NASOPHARYNX
ANATOMY
PHYSIOLOGY (FUNCTION)
NASAL PASSAGESBREATHING
WARMING
FILTERING
HUMIDIFYING
OLFACTION (SENSE OF SMELL)
RESISTANCE
SINUSESLIGHTEN THE SKULL
MUCOUS PRODUCTION
HUMIDIFICATION
PROTECT FROM FALCIAL TRAUMA
PROTECT NASAL BAROTRAUMA
VOCAL RESONANCE
ENHANCE OLFACTION
Rhinosinusitis
Rhinosinusitis is the preferred terminology as you rarely have the sinusitis without the rhinitis.
The term is then further defined by the duration of the inflammation
ACUTE – LESS THAN 4 WEEKS
CHRONIC-MORE THAN 12 WEEKS
Rhinosinusitis
A GROUP OF DISORDERS CHARACTERIZED BY INFLAMMATION OF THE MUCOSA OF THE NOSE AND PARANASAL SINUSES
THERE IS NO CRITERIA BASED ON ETILOGY
RHINOSINUSITIS
REALLY AN IMFLAMMATORY DISORDER
NEED TO STOP THINKING OF IT AS SOLEY AN INFECTION
RHINOSINUSITIS---HOW DO YOU GET IT
INFLAMMATION---BLOCKING OF THE OSTIA—DIMINISHED PH---MUCOCILIARY DYSFUNCTION----STAGNATION OF SECRECTIONS---OVERGROWTH OF BACTERIA OR FUNGUS
RHINOSINUSITIS
INFLAMMATION CAUSED BY: VIRUS, ALLERGEN, IRRITANT, BACTERIA, FUNGUS
OMC: AREA OF RELATIVELY TIGHT ANATOMY
RHINOSINUSITIS
60-90% OF SURGICAL PTS HAVE SIGNIFICANT ALLERGIES ON SKIN TESTING
THE MUCOSAL SPECIMENS ON ALL SURGICAL PTS DEMONSTRATE ALLERGIC INFLAMMATION
SUPERANTIGEN HYPOTHESIS
HIGH MOLECULAR WEIGHT PYROGENIC PROTEINS
ELICIT EXTREMELY POTENT STIMULATORY EFFECT ON T-LYMPHOCYTES
SUPERANTIGENS
BACTERIA (staph aureus, pseudomas, H influenza)
FUNGI (Molds, Candida, Bipolaris, Alternaria, Aspergillosis)
Allergens (Conventional and Bacterial antigens)
Irritants
SUMMARY
RHINOSINUSITIS IS AN INFLAMMATORY DISORDER OF THE NASAL PASSAGES AND PARANASAL SINUSES
IT’S ETIOLGY CAN BE EITHER INFECTIOUS (VIRAL, BACTERIAL, FUNGAL OR PARASITIC) OR NON-INFECTIOUS (ALLERGY, IRRITANT)
MAY HAVE ANATOMIC PREDISPOSITIONS
RHINOSINUSITIS
HOW DO YOU DIAGNOSE IT?
HOW DO YOU TREAT IT?
DIAGNOSIS
HISTORY
PHYSICAL
ENDOSCOPY
CT SCAN
DIAGNOSIS
MAJOR FACTORS
FACIAL PAIN/PRESSURE
NAO
DISCHARGE
HYPOSMIA
PURULENCE
FEVER
MINOR FACTORS
HEADACHE
FEVER
HALITOSIS
FATIGUE
DENTAL PAIN
COUGH
AURAL PAIN/FULLNESS
MAXIMAL MEDICAL THERAPY
SALINE (SPRAY/IRRIGATIONS)—HYPERTONIC?
DECONGESTANTS (TOPICAL/SYSTEMIC)
MUCOLYTICS
STEROIDS (TOPICAL/SYSTEMIC)
ANTIHISTAMINES (TOPICAL/SYSTEMIC)
REFLUX THERAPY?
MAXIMAL MEDICAL
LEUKOTRIENE INHIBITORSANTIBIOTICS (TOPICAL/SYSTEMIC)USUALLY START TREATMENT
EMPIRICALLY---TREAT AT LEAST 1 WEEK PAST THE RESOLUTION OF SYMPTOMS (OFTEN 20 DAYS)
SINUNEB—IRRIGATIONSCHRONIC---LOW DOSE CHRONIC
BIAXIN
ALLERGY
THE NOSE IS THE TARGET ORGAN FOR AEROALLERGENS, IRRITANTS, AND DEBRIS.
TOPICAL THERAPIES AND NASAL RINSES ARE PARAMOUNT.
ALLERGY
ALLERGY TESTING AND TREATMENT IS NEVER A BAD IDEA PRIOR TO SURGERY
IDT IS THE MOST SENSITIVE AND SPECIFIC METHOD OF ALLERGY TESTING
SURGERY
THE CHRONIC INFLAMMATION FROM ALLERGIES AND INFECTIONS CAN LEAD TO ANATOMIC CHANGES SINONASAL INFECTION IS A RELATIVE TERMMOST MUCOSAL PROBLEMS ARE REVERSIBLESINUS SURGERY IS PLAN C
SINUS SURGERY
WE DO IT BETTER---UTILILIZE LASERS, ENDOSCOPES, TV MONITORS, MICRODEBIDERS, COMPUTER GUIDANCE SYSTEMS----STILL A DRAINAGE PROCEDURE
FUNCTIONAL
IMAGE GUIDED
LASER AND POWERED
MINIMALLY INVASIVE
CONCEPTS
THE MOST HIGHLY TRAINED SINUS SURGEON IS A BOARD CERTIFIED OTOLARYNGOLOGIST (IN SINUS SURGERY THE MORE RECENTLY TRAINED THE BETTER)
THERE IS NO SUCH THING AS A SINUS SPECIALIST ALTHOUGH FELLOWSHIPS ARE EMERGING
CONCEPTS
SINUS SURGERY IS ALMOST NEVER AN EMERGENCY
PATIENTS WHO HAVE BEEN LURED IN BY DIRECT ADVERTISING SHOULD BE LESS LIKELY TO REQUIRE URGENT SURGERY THAN THE REFERRED PATIENT
NASAL CYCLE
LARGELY A FUNCTION OF THE INFERIOR TURBINATE
INFERIOR TURBINATE FULL OF VENOUS LAKES----SWELLS AND DECONGESTS
ALTERNATES SIDES---ON THE ORDER OF HOURS---PROBABLY ALLOWS THE NOSE TO CLEAN ITSELF