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 PASSAGES BREATHING WARMING FILTERING HUMIDIFYING OLFACTION (SENSE OF SMELL) RESISTANCE SINUSES LIGHTEN 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 INHIBITORS ANTIBIOTICS (TOPICAL/SYSTEMIC) USUALLY START TREATMENT EMPIRICALLY---TREAT AT LEAST 1 WEEK PAST THE RESOLUTION OF SYMPTOMS (OFTEN 20 DAYS) SINUNEB—IRRIGATIONS CHRONIC---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 TERM MOST MUCOSAL PROBLEMS ARE REVERSIBLE SINUS 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