RHINOSINUSITIS

FELIX HARTANTO030.10.104RHINOSINUSITISRadang mukosa hidung dan sinus paranasalis

Rhinogen DentogenObstruksi Ostium Rhinosinusitis akutPenumpukan SekresiStagnasiTransudasiCairan MukoidGangguan fungsi ciliaVasodilatasiGangguan fs kel mukosaO23This diagram summarizes Dr. Kerns concept of how bacterial sinusitis develops3. The initiating event is obstruction of the sinus ostium. As a consequence, hypoxia develops with vascular dilation, a reduction in ciliary function, and mucous gland dysfunction. With these changes, sinus secretions accumulate, bacteria are introduced and an infection develops.Klasifikasi berdasarkan timbulnya gejalaAKUT kurang dari 4 mingguSUBAKUT lebih dari 4 minggu kurang dari 12 minggu (3 bulan)KRONIK 12 minggu (3 bulan) atau lebih AKUT REKURREN 4 kali atau lebih per tahun dan sembuh diantara seranganDiagnosis of Acute Rhinosinusitis:2 major atau 1 major & 2 minor symptomsMajorAnterior or posterior purulent drainage Nasal obstructionFacial pain or pressure or congestionHyposmia or anosmiaFever (acute)MinorHead acheEar pain/pressureHalitosisdental painFatigueCough

Kronik rhinosinusitis

Gejala tidak khas

Penderita mengeluh nyeri kepala, buntu hidung wajah tertekan, pernah mendapatkan antibiotika dan pernah operasi

CT Scan gold standart

Tindakan operasi FESSPenatalaksanaan KRSKRSInfeksiAllergiIL-5, IL-4IL-8, IF-GM-CSFAnatomicTerapi Etiologi:Allergen avoidance Antibiotik BedahMenurunkan Peradangan:SteroidImmunotherapyAntileukotriensMacrolides

7Slide 73Possible Strategies for Treating CRS (chronic rhinosinusitis)ReferenceAdapted by Bradley Marple from Benninger M, Ferguson B, Hadley J, Hamilos D, Jacobs M, Kennedy D, Lanza D, Marple B, Osguthorpe J, Stankiewicz J, Anon J, Denneny J, Emanuel I, Levine H. Adult Chronic Rhinosinusitis: Definitions, Diagnosis, Epidemiology, and Pathophysiology. Otolaryngol Head Neck Surg 2003;129(suppl 3):S1-32.AntibiotikFirst-lineamoxicillin-clavulanate cephalosporin second-or third-generation

Second-lineDewasaThe respiratory quinolonesciprofloxacin, levofloxacin, gatifloxacin, and moxifloxacinSinus ventilasi dan drainaseNasal hydrationSaline sprayHumidificationDecongestantMucolytik