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