Chronic Rhinosinusitis Terjemahan

(1)

Amrita Journal of Medicine

Vol. 8, No: 1Vol. 8, No: 1

Jan - Jun 2012. Page 1 - 44 Jan - Jun 2012. Page 1 - 44

review article

Rinosinusitis Kronis – Ikhtisar

N.V ee!thi", #.K. $enon", K. $a%hu&ita"

Abstrak

Rinosinusitis kronis '(R)* a%alah kon%isi u&u&

Rinosinusitis kronis '(R)* a%alah kon%isi u&u& %engan i&!likasi sosial +ang signiikan karena &en+eakan hilangn+a a& %engan i&!likasi sosial +ang signiikan karena &en+eakan hilangn+a a& kera. Patoisiologiskera. Patoisiologis u&u& untuk ha&!ir se&ua entuk

u&u& untuk ha&!ir se&ua entuk (R) a%alah !era%angan, +ang !engoatann+a terse%ia luas. Na&un, ti%ak se&ua (R) a%alah !era%angan, +ang !engoatann+a terse%ia luas. Na&un, ti%ak se&ua !asien se&uh atau!asien se&uh atau %a!at &engon

%a!at &engontrol geala &ereka trol geala &ereka ahkahkan an %eng%engan an &ana&anae&en &e%is e&en &e%is +ang &aksi&al+ang &aksi&al. . alaala& & kasus terseukasus terseut, t, %ian%ianurkaurkan n untuk e%ah sinusuntuk e%ah sinus en%osko!i ungsional '/))*. $o%alitas &anae&en, &eski!un erariasi,

en%osko!i ungsional '/))*. $o%alitas &anae&en, &eski!un erariasi, %a!at er&anaat !a%a !asien +ang %a!at er&anaat !a%a !asien +ang !atuh terha%a! !engoatan.!atuh terha%a! !engoatan. agai&ana!un, a%a ariailitas +ang signiikan %an kurangn+a stan%arisasi

agai&ana!un, a%a ariailitas +ang signiikan %an kurangn+a stan%arisasi !e%o&an sehuungan %engan &o%alitas %i atas. !e%o&an sehuungan %engan &o%alitas %i atas. 3rtikel ini &enoa3rtikel ini &enoa untuk &e&erikan !e&aa ga&aran tentang &eto%ologi inestigasi %an !engoatan &asalah 565 terseut

untuk &e&erikan !e&aa ga&aran tentang &eto%ologi inestigasi %an !engoatan &asalah 565 terseut..

Kata kunci:

Kata kunci: Rinitis kronis, sinusitis, (5 san Rinitis kronis, sinusitis, (5 san )inus Paranasal)inus Paranasal ,, e%ah e%ah

Pendahuluan

Rin

Rinosiosinusnusitiitis s krokronis nis '(R'(R)* )* a%aa%alahlah s

saallaah h ssaattu u !!eenn++aakkiit t oottoorrh hii--no

nolalar+r+ngngoolologigi  +an+ang g !a!allining g seseririnngg %it

%ite&ue&ui i %al%ala& a& !ra!raktektek k sehsehariari-ha-hari.ri. en

engan gan konkon%is%isi i &e%&e%is is +an+ang g ukuku!u! u&

u&uu&, &, %i %i &&anana a %%iaiagngnososis is %a%ann !ro

!rognognosis sis tertergangantuntung g !a%!a%a a gegealaala,, ta

tan%n%a-a-tatan%n%a, a, !e!eninilalaiaian n klklininis is %a%ann ealu

ealuasi ra%iologiasi ra%iologi. . 6al ini 6al ini sering ti%aksering ti%ak &u%ah, an+ak !eneliti telah erusaha &u%ah, an+ak !eneliti telah erusaha unt

untuk uk &en&engkagkarakrakterterisaisasi si konkon%is%isi i iniini %i

%i%a%asasarkrkan an !a!a%a %a eerragagai ai aaktoktor.r. eera!a %i antaran+a a%alah seagai eera!a %i antaran+a a%alah seagai e

eririkutkut: : skskor or gegeaalala, , skskor or (o(o&!&!uteute%% 5

5oo&o&ogrgra!a!h+h+, , te&ute&uan an enen%o%osksko!o!i,i, te&ua

te&uan n e%ah, hasil Keu%a+aae%ah, hasil Keu%a+aan n %an%an hasil 6isto!atologi

hasil 6isto!atologi..

(R) a%alah sekelo&!ok gangguan (R) a%alah sekelo&!ok gangguan karak

karakteristiteristik k eru!eru!a a !era%a!era%angan ngan !a%a!a%a &ukos

&ukosa a hi%unhi%ung g %an sinus %an sinus !aran!aranasalasal %e

%engngan an %u%urarasi si &i&inini&a&al l 12 12 &i&ingnggugu ertur

erturut-turutut-turut. . )elai)elain n itu, itu, osteitosteitis is tulangtulang %a

%a!a!at t &e&en%n%asasarari i gagangngguguan an inini.i. e

eeerara!a !a akaktotor, r, aaik ik inintritrinsnsik ik %a%ann ekstri

ekstrinsik nsik &e&e&e&erikan rikan kontrikontriusi usi !a%a!a%a !enge&angan %ari (R)

!enge&angan %ari (R)..

Pen%ekatan &anae&en untuk

&en+aikan !asien %engan (R) a%alah &en+aikan !asien %engan (R) a%alah seara ertaha! logis %engan tuuan seara ertaha! logis %engan tuuan &e&aksi&alkan &anae&en &e%is %an &e&aksi&alkan &anae&en &e%is %an &

&eerree%%aakkaan n ggeeaallaa. . ee%%aah h ssiinnuuss en%osko!i ungsional '/))* sekarang en%osko!i ungsional '/))* sekarang %iteri&a seara luas %ala& !engaturan %iteri&a seara luas %ala& !engaturan kegagalan &anae&en &e%is

kegagalan &anae&en &e%is..

*Dept. of ENT, AIMS, Koci. *Dept. of ENT, AIMS, Koci.

Meto!e

Ino

Inor&ar&asi si +an+ang g %ig%igunaunakan kan untuntukuk &en

&enuliulis s &ak&akalaalah h ini ini !a%!a%a a %as%asarn+arn+aa telah %iku&!ulkan seagai agian %ari telah %iku&!ulkan seagai agian %ari !asa sarana

!asa sarana %iteri%iteri&a &a oleholeh National National Boa

Board rd of of ExaExamiminatnationion_{. 5}_. _5e_eks_{ks sta}_stan%a_n%ar,_r,

artikel %ari Jurnal %iin%eks %an eragai artikel %ari Jurnal %iin%eks %an eragai su&er %i asis %ata seara elektronik su&er %i asis %ata seara elektronik %enga

%engan n &engg&enggunakan kata-kata unakan kata-kata kunikuni rinosinusitis kronis, !oli!osis hi%ung %an rinosinusitis kronis, !oli!osis hi%ung %an e%ah sinus en%osko!i ungsional +ang e%ah sinus en%osko!i ungsional +ang %igun

%igunakan akan untuk untuk &ela&elakukan kukan !enel!enelitianitian lat

latar ar elelakaakang. ng. PrePreereerensi nsi %i%ierierikankan ke!a%a !enelitian +ang leih aru

ke!a%a !enelitian +ang leih aru..

Insi!ensi

Ri

Rinonosisinunusisititis s krkrononis is '('(R)R)* * a%a%alalahah !en+

!en+akit akit u&u& +ang u&u& +ang &e&!&e&!engarengaruhiuhi leih %ari 70 uta orang seara gloal leih %ari 70 uta orang seara gloal setia! tahun %engan leih %ari 200.000 setia! tahun %engan leih %ari 200.000 orang setia!

orang setia! tahunn+tahunn+a a &e&&e&utuhkanutuhkan tin

tin%ak%akan an e%e%ahah11.. 6al ini 6al ini %ila%ila!orkan!orkan leih

leih an+ak %ian%inan+ak %ian%ingkan arthritis gkan arthritis atauatau hi!er

hi!ertensitensi, , +ang +ang &e&!&e&!engaruengaruhi hi antaraantara 9

9 %a%an n 119 9 %a%ari ri !o!o!u!ulalasi si &e&enunururutt li

liteteraratutur r aararat. t. InIni i a%a%alalah ah &a&asasalalahh u&

u&u& u& +an+ang g &en&enuntuntut ut iaia+a +a tintinggiggi %a

%alala& & hahal l !e!eraraatatan an kekesesehahatantan langsung serta hilangn+a !ro%uktiitas langsung serta hilangn+a !ro%uktiitas..

Defnisi

Rinos

Rinosinusiinusitis tis a%alaa%alah h sekelsekelo&!oko&!ok gangguan %itan%ai %engan !era%angan gangguan %itan%ai %engan !era%angan !a

!a%a %a &u&ukoskosa a hihi%u%ung ng %a%an n sisinunuss !aran

!aranasal. asal. RinosRinosinusiinusitis tis kronis kronis a%alaa%alahh sekelo&!ok gangguan +ang

sekelo&!ok gangguan +ang

%itan%

%itan%ai ai %enga%engan n !era%a!era%angan ngan !a%a!a%a &ukosa hi%ung %an

&ukosa hi%ung %an sinus !aranasasinus !aranasall %urasi &ini&a

%urasi &ini&al l 12 12 &ingg&inggu u erturerturut- ut-turut turut77..

"aktor Etiolo#i

3; /aktor 6ost:

Sistemik Sistemik

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Lokal Lokal

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ki&ia,

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!olusi, asa!, oat-oatan, %ll.

(; =ain-lain:

3s&a,

3s&a, alergi, alergi, !en+akit !en+akit gigi,gigi, !oli!osis, irosis sistik, %an

!oli!osis, irosis sistik, %an )in%ro& %eisiensi i&un )in%ro& %eisiensi i&un77..

$atofisiolo#i

Patologi !enting %ala& (R) ter%iri %ari Patologi !enting %ala& (R) ter%iri %ari %rainase +ang ti%ak &e&a%ai atau %rainase +ang ti%ak &e&a%ai atau %ilokir %ari sinus !aranasal >PN); %ilokir %ari sinus !aranasal >PN); &en+eakan stasis %an < atau ineksi &en+eakan stasis %an < atau ineksi sekun%er . )itus lok a%alah selalu sekun%er . )itus lok a%alah selalu %aerah +ang telah %iga&arkan seagai %aerah +ang telah %iga&arkan seagai ? ostio&eatal ko&!leks ? >@$(; . )iste& ? ostio&eatal ko&!leks ? >@$(; . )iste& anato&i-isiologi nor&al %ari PN) erisi anato&i-isiologi nor&al %ari PN) erisi u%ara, !engeringan sekresi %an len%ir u%ara, !engeringan sekresi %an len%ir &elalui ostia keil ke %aerah +ang relati &elalui ostia keil ke %aerah +ang relati keil %i %in%ing lateral hi%ung A B

keil %i %in%ing lateral hi%ung A B Ca&ar 1 , )alah satu atau

Ca&ar 1 , )alah satu atau leih %arileih %ari aktor etiologi %a!at erkontriusi untuk aktor etiologi %a!at erkontriusi untuk &engganggu aik anato&i atau isiologi &engganggu aik anato&i atau isiologi siste& PN)

siste& PN)

Amrita Journal of Medicine

(2)

(3)

clearance of frontal sinus

&steo'eatal co'ple(

Mucociliar% "lui!_{collecte! in}

clearance of

sinus 'a(illar%

sinus

(ilia %rain sinuses + !ro!elling &uus toar% natural ostia '&uoilist+ learane*

"i#. ): Sce'atic representation of ostio'eatal co'ple( an! nor'al 'ucociliar% clearance

+ a host o ators. $ost o these hae een

&entione% in the earlier list. @ne or &an+ o the&

an ontriute to %isru!t either the anato&+ or the

!h+siolog+ o the PN) s+ste&.

ecent fin!in#s

Rhinologi literature has suggeste% the inole&ent o a signiiant inla&&ator+ o&!onent that has een largel+ attriute% to +tokines an% inla&&ator+ ells &e%iate% + the a%a!tie i&&une s+ste& 4. Reent !a!ers hae i&!liate% sta!h+looal su!er antigens, aterial ioil&s, an% ungal oloniDation as ke+ ele-&ents in (R).

+linical features, stan!ar!ie!

In 3ugust 1EEF, the 3&erian 3a%e&+ o @tolar+n-golog+–6ea% an% Nek )urger+ '33@6N)* onene% a &ulti%isi!linar+ Rhinosinusitis 5ask /ore 'R)5/* to onront %iiult issues relate% to %eining, staging, an% researh o rhinosinusitis. 5he resulting artile G3%ult Rhinosinusitis eine%,H e&erge% in 1EE an% as en%orse% + the 33@-6N), the 3&erian 3a%e&+ o @tolar+ngologi 3llerg+ '33@3*, an% the 3&erian Rhinologi )oiet+ '3R)*F.

5he artile G3%ult Rhinosinusitis eine%H harater-iDes rhinosinusitis into  se!arate linial ategories: aute, su aute, hroni, reurrent aute an% aute eaeration o (R). 3ute rhinosinusitis is a linial on%ition lasting less than 4 eeks su aute

rhinosi-nusitis, &ore than 4 eeks ut less than 12 eeks.

3s earlier state%, the R)5/ urther %eine% hroni

rhinosi-nusitis as lasting &ore than 12 eeks



5he &aor an% &inor s+&!to&s an% signs

suggeste% + R)5/ are gien in 5ale 1.

TA-E )

"actors

associate!

wit

!ia#nosis

of

rinosinusitis

/

0e1uires two 'a2or factors or

one 'a2or an! two 'inor factors3

Ma2or factors

Minor factors

/a4ial !ain<!ressure 'this

alone %oes not 4onstitute

6ea%ahe

a suggestie histor+ or

rhinosinusitis in the

a-sene o another &aor

nasal s+&!to& or sign*

Nasal ostrution<

/eer 'all non-aute*

lokage

Nasal %isharge<

6alitosis

!urulene<

isoloure% !ostnasal

/atigue

%rainage

6+!os&ia< anos&ia

ental !ain

Purulene in nasal ait+

(ough

on ea&ination

/eer 'in aute sinusitis

ar !ain<!ressure<

alone %oes not 4onstitute

ullness

a strongl+ suggesti1e

his-tor+ or rhinosinusitis in

the asene o another

&aor nasal s+&!to& or

sign*

Measures or diagnosing CRS or

adult clinical care

4istor%:

uration o %isease is Lualiie% + ontinuous

s+&!-to&s or M 12 onseutie eeks or M 12

eeks o !h+sial in%ings

+linical e(a'ination:

@ne o these signs o inla&&ation &ust e

!resent an% i%entiie% in assoiation ith ongoing

s+&!to&s onsistent ith (R)

a;

isoloure% nasal %rainage arising ro& the na-sal !assages, nasal !ol+!s, or !o l+!oi% selling

(4)

(5)

either

+

rhinoso!+

in

the

%eongeste% nose or + nasal en%oso!+.

A/igure 2B

"i#. 5: Nasal en!oscopic appearance of pol%p in te ri#t 'i!!le 'eatus

b;

@e%e&a or er+the&a o the &i%%le &eatus or

eth&oi% ulla

as

i%entiie% + nasal

en%oso!+.

c;

CeneraliDe% or loaliDe% er+the&a, e%e&a, or granulation tissue. I it %oes not inole the &i%-%le &eatus or eth&oi% ulla, ra%iologi i&aging is reLuire% to onir& a %iagnosis '@ther hroni rhinologi on%itions suh as allergi rhinitis an hae suh in%ings, an% thereore the+ &a+ not e assoiate% ith rhinosinusitis. It is reo&&en%e% that a %iagnosis o rhinosinusitis reLuires ra%iologi onir&ation un%er these iru&stanes*8.

Investi#ations:

I&aging &o%alities or onir&ing the %iagnosis:

i;

Plain

sinus

ra%iogra!h(al%ellOs

an%

aterOs ies reealing:

a;

$uous &e&rane thikening o M  &&

b;

(o&!lete o!aiiation o one or &ore

sinuses

"i#. /: +oronal stu!% of +o'pute! to'o#rap% of para6 nasal sinus sowin# opacification an! !iffuse 'ucosal tickenin# of 'a(illar% an! et'oi! sinuses, ri#t 7 left

(hroni Rhinosinusitis – 3n @erie

c;

3n air-lui% leel - &ore !re%itie o aute

rhinosinusitis, ut &a+ also e seen in

hroni rhinosinusitis

'3 !lain sinus -ra+ ithout the eLuioal signs liste% in a, , or  is not onsi%ere% %iagnosti. 3si%e ro& an air-lui% leel, !lain sinus ra%io-gra!hs hae lo sensitiit+ an% s!eiiit+*

ii;

(o&!ute% 5o&ogra!h+ '(5* san%e&onstrat-ing isolate% or %iuse &uosal thikensan%e&onstrat-ing, one hanges an% air-lui% leel. A/igure 7B 5his is the Qgol% stan%ar%O inestigation or (R).

iii;

$agneti Resonane I&aging '$RI* is not reo&-&en%e% as an alternatie to (5 or routine %iagnosis o (R) eause o its eessiel+ high sensitiit+ an% lak o s!eiiit+7.

&ter investi#ations:

3 nu&er o other tests that &a+ e i&!ortant to in%ii%ual stu%ies an% !rotools inlu%e the olloing:

;

3llerg+ testing: 5here is goo% ei%ene that

the ini%ene o (R) is inrease% in the

allergi !atient. 5hereore allerg+ testing +

)kin !rik test or )!eii Ig or R3)5 &a+

e &easure% in &an+ stu%ies.

;

Vali%ate% outo&es instru&ents to &easure

the Lualit+ o lie an% !atient !ere!tion o

%is-ailit+.

;

Rhino&ano&etr+ an% aousti rhino&etr+

to oetiel+ &easure nasal !aten+ an%

resist-ane

;

$uoiliar+ learane testing inlu%ing

sa-harine &etho%s or ra%ioisoto!es

;

@lator+

ealuations

ith

ali%ate%

threshol% an% su!rathreshol% testing

;

Nasal +tolog+

;

irete% laorator+ ealuation to %etet

un-%erl+ing assoiate% s+ste&i %isease suh

as &easure&ent o seru& eosino!hilia, Ig

leels, an% geneti testing.

Nasal En!oscop%:

$ost o&&onl+ use% en%oso!es are 4.0&&, 70 %egree rigi% so!e an%<or 0 %egree so!e. In a%ults ith narro nasal !assages or in hil%ren, a 2.&&, 70 %egree rigi% en%oso!e or a leile naso!har+ngo-so!e &a+ e etter tolerate%. 70 an% 4 %egree naso!har+ngo-so!es !roi%e %iret line o sight an% angle% isualiDation.

3n organiDe% nasal en%oso!+ in 7 !asses is

the usual &etho% a%o!te%.

5he irst !ass is along the loor o the nose. Inerior &eatus, ustahian tue oriies, 5orus tuarius, a%-enoi% !a% an% entire naso!har+n an e isualiDe%. )eretions originating ro& the @$( ill t+!iall+ %rain elo the ustahian tue o riie, hile

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F

Amrita Journal of Medicine

/or the seon% !ass, the en%oso!e is reinserte% eteen the &i%%le an% inerior turinates, an% a%-ane% in a !osterior %iretion. 5he inerior !ortion o the &i%%le turinate, &i%%le &eatus, the ontanelles an% aessor+ ostia are ea&ine%. )!henoeth&oi%al reess, su!erior turinate an% natural s!henoi% os &a+ also e isualiDe%.

5hir% !ass ie is + lateral rotation o the en%o-so!e eneath the !osterior as!et o &i%%le turinate to gain aess to the %ee!er areas o the &i%%le &eatus, ulla eth&oi%alis, hiatus se&ilunaris an% inun%iular entrane. 3s the so!e is ith%ran, urther eellent ie o the

uninate !roess is otaine%.

@ne %iagnose%, atte&!ts to urther %eine the

seer-it+ o (R) inlu%e &etho%s to assess !atient

s+&!to&s. 6ere again, arious stu%+ grou!s hae

o&e u! ith %ierent ealuation s +ste&s.

Rhinosinusitis 5ask /ore $aor an% $inor

s+&!to& riteria

E

20 ite& )inonasal @uto&e 5est 10

')N@520* (hroni )inusitis )ure+

E

'())*

Rhinosinusitis )+&!to& Inentor+ 'R)I*10 Visual

3nalogue )ore 'V3)* uestionnaire11

An appro(i'ate al#orit' in a +S case coul!

be as follows:

iagnosti Nasal n%oso!+ 'N*

Nor&al Positie

/in%ings /in%ings

3llergi4 is4harge Pol+!s

3nti-allergi (ulture S Protool treat&ent (onsi%er

treat&ent _{sensiti1it+ -} _{'In4lu%ing oral} _{(5 PN)}

%ire4te% steroi%s* anti&i4roials

ole an! relevance of +T $NS stu!%



5o onir& the %iagnosis o rhinosinusitis



5o assess the seerit+ o ases rerator+ to

&e%ial thera!+ !rior to surger+



5o !roi%e the anato&i !reision nee%e% to

gui%e en%oso!i sinus surger+



5o assess res!onse to surgial interention A/igure

4 a, B

=un%-$aka+ staging s+ste&, !ro!ose% in 1EE7,

is onsi%ere% as the &ost i%el+ ae!te% staging

Sinus s%ste'

i#t

eft

$aillar+

0,1an% 2

3nterior eth&oi%al

0,1an% 2

Posterior eth&oi%al

0,1an% 2

)!henoi%al

0,1an% 2

/rontal

0,1an%

2 0,1an%

2 @stio&eatal o&!le

0, an% 2

5otal !oints or eah si%e

0-12

)oring: /or all sinus s+ste&s, ee!t the

ostio&eatal o&!le:

0 - no anor&alities, 1- !artial o!aiiation,

2-total o!aiiation

/or the ostio&eatal o&!le: 0 - not olu%e%, 2 - olu%e% 5reat&ent &o%alities $e%ial thera!+12.

•

3solute &e%iations

3llergen or irritant aoi%ane, 7-eeks ourse o

ulture-%irete% or roa% s!etru& antiiotis an%

8-eeks ourse o to!ial nasal steroi% s!ra+

•

)u!!ortie 5reat&ent

)+ste&i %eongestants, 3ntihista&ines an%

ta!ering s+ste&i ortiosteroi%s

ole an! relevance of en!oscopic sinus sur#er% In those !atients ho hae aile% &e%ial &anage-&ent, untional en%oso!i sinus surger+ '/))* has een %e&onstrate% an% is generall+ ae!te% to !ro-i%e i&!roe% relie o s+&!to&s an% etter Lualit+ o lie. 3lthough there is so&e ontroers+ as to the est or &ost a!!ro!riate surgial tehniLue or treat-ing !atients ith (R) ith !ol+!osis '(R)P* &ost surgeons ill reo&&en% that these !atients un%ergo !ol+!eto&+, o&!lete eth&oi%eto&+, an% &i%%le &eatal antrosto&+, ith or ithout rontal sinusoto&+ or s!henoi%oto&+.

)urgial anato&+

@ all the !aranasal sinuses, the eth&oi% sinus is the &ost o&!le an% is a!tl+ reerre% to as a la+rinth. 5he eth&oi%s attain a%ult siDe + the telth +ear. 6oeer, hen inetion s!rea%s ro& the ostio&eatal area to inole the &aillar+ an% rontal sinuses, it is the s+&!to&s an% the roentgenogra!hi hanges in these latter sinuses that !re%o&inate. 5hus the surgeon &a+ atte&!t to orret the seon%ar+ !athologi hanges hile oerlooking the un%erl+ing !role& in the osti-o&eatal o&!le.

5he intro%ution o /untional n%oso!i )inus )urger+ + $esserklinger an%  igan% ra%iall+ hange% the a+ @tolar+ngologists treat sinusitis14. 5he !ur!ose o untional en%oso!i sinus surger+ is to re-estalish entilation an% &uoiliar+ learane o the sinuses. 5his is ahiee% + re&oing %isease ro& ke+ areas o the anterior eth&oi% an% &i%%le &eatus. $i%%le

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

Amrita Journal of Medicine

(hroni Rhinosinusitis – 3n @erie

turinate is !resere% an% s!henoeth&oi%eto&+ is %one. 5he tehniLue allos or eellent isualiDation, hilst ausing &ini&al lee%ing an% lo &ori%it+1.

In 1E8 $esserklinger intro%ue% the one!t o untional en%oso!i sinus surger+ ase% on en%o-so!i oseration an% %ou&entation o anato&+ an% !atholog+ in the &i%%le &eatal area an% sinus &uo-iliar+ learane in nor&al an% %isease% &uosa1F. In 1E80 )ta&&erger !ulishe% a series o !a!ers on /)).

5he !rini!le o the tehniLue is li&ite% resetion o

inla&&ator+ tissue or anato&i %eets that interere

ith nor&al &uoiliar+ learane an% result in

loal-iDe% !ersistent inla&&ation.

Routinel+ arrie% out ste!s in /)) or (R) <o

Pol+!s oul% inlu%e:

8ncinecto'%: re&oal o the o&&a-sha!e% !iee o one at the anterior e%ge o the &i%%le &eatus

Infun!ibuloto'%: entering the narro s!ae ust

anterior to the eth&oi% air ells

Et'oi!ecto'%: eentration o the %isease%

anterior, &i%%le an% !osterior eth&oi% air ells

Spenoi!oto'%: o!ening into the s!henoi% sinus to lear %isease ithin an% i%ening the natural ostiu&

Mi!!e 'eatal antrosto'%: i%ening the natural os-tiu& o the &aillar+ antru& an% learing %isease ithin

"rontal recess an! sinus clearance: areul i%entii-ation an% learane o the rontal sinus ostiu& area to ensure %rainage o the sinus into the nose

{

/igure  a, B

a*

Pre-o!eratie * Post-o!eratie

en%o-so!i ie

so!i ie o the

o sino-nasal

sa&e ase,

!ol+!osis

2 &onths later

ecent a!vances

5he role o arious inla&&ator+ &e%iators (7,

(2, I/N-r, 5C/-, I=-1, $$P in the !athogenesis o

(R) an% there+ the role or targete% thera!+ is

gaining attention

1.

Ra&anathan et al %e&onstrate I=-22R1 &RN3 an% !rotein e!ression on nasal e!ithelial ells. /ailure o &e%ial an% surgial thera!+ in (R)NP is assoiate% ith signiiantl+ %erease% e!ression o I=-22R118.

)tu%ies hae shon the role o ioil& %etetion in harateriDation o (R). a=ight< onoal san-ning

tehniLues or ioil& %etetion on the sinus &uosal

s!ei&ens o (R) !atients

1E.

/or etter un%erstan%ing o the anato&+ o !aranasal sinuses, 5ols%or et al %e&onstrate% a irtual realit+ si&ulator or en%onasal sinus surger+ ase% on a olu&e &o%el. 5his is a ull+ o!erational si&ulator or sinus surger+

ase% on stan%ar% P( har%are20.

alloon sinu!last+ is a ne surgial tehniLue to

&anage (R), eing %one as an oie !roe%ure at

&an+ (entres.

Conclusions

3n i&!roe% un%erstan%ing o the un%erl+ing

%is-ease !roess has le% to an eolution in the treat&ent

o (R).

etaile% reor%ing o the linial s+&!to&s an% !h+sial in%ings, olloe% + %iagnosti nasal en%os-o!+ ' N* an% (5 san o PN) !la+ a ruial role in the %iagnosis, !rognosis an% ollo-u! o (R) !atients.

$e%ial thera!+ has egun to shit ro& antiiotis an% %eongestants to a o&ination o to!ial steroi%s, s+ste&i steroi%s, %eongestants, antihista&ines an% antiiotis. )urgial treat&ent o (R), still a ruial o&!onent o the oerall treat&ent !lan, has shite% ro& ra%ial to a &ore onseratie, +et o&!lete a!-!roah. 3lthough i&!ortant, surger+ alone %oes not lea% to a long

ter& %isease ree state.

3 o&!rehensie &anage&ent !lan inor!orating oth &e%ial an% surgial are re&ains the &ost likel+ a+ to !roi%e long ter& %isease ontrol or (R). 5he e-at o&ination ontinues to e %eate%. Neertheless, use o long ter& to!ial steroi%s an% regular ollo-u! o all !atients see& to e the est o!tion till %ate.

eferences

1;

$uruga!!an Ra&anathan, Jr, $ rnst . )!annhake, Ph 3n%re P. =ane, $. (hroni Rhinosinusitis ith Nasal Pol+!s is 3ssoiate% ith erease% !ression o $uosal Interleukin 22 Ree!tor. =ar+ngoso!e @toer 20011:187E-42

2;

6o!kins et al.: )urger+ 3u%it or Nasal Pol+!osis an% (R). =ar+ngoso!e 200E:11E:24E–F

3;

enninger et al 3%ult (hroni rhino sinusitis: einitions, %iagnosis, e!i%e&iolog+, an% !atho!h+siolog+. @tolar+ngol 6ea% Nek )urg 2007 12E):)1-)72.

4;

$eltDer @, 6a&ilos =, an% 6a%le+ J3, et al. Rhinosinusitis: estalishing %einitions or linial researh an% !atient are. @tolar+ngol 6ea% Nek )urg 2004 171')u!!l F*: )1–F2.

5;

(r+er J, )hi!or I, Perlo JR, Pal&er JN. i%ene o aterial ioil&s in hu&an hroni sinusitis. @R= J @torhinolar+ngol Relat )!e 2004 FF:1–8.

6;

Re!ort o the Rhinosinusitis 5ask /ore (o&&ittee $eeting. 3lean%ria, Virginia, 3ugust 1, 1EEF. @tolar+ngol 6ea% Nek )urg 1EE 11'7 Pt 2*:)1-F8.

(10)

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8

Amrita Journal of Medicine

8;

3.K. eaiah < @tolar+ngol (lin N 3& 7 '2004* 247–2.

9;

ra%el+ 5, Kountakis ). (orrelation eteen o&!ute% to&ogra!h+ sores an% s+&!to&ati i&!roe&ent ater n%oso!i sinus surger+. =ar+ngoso!e 200:11'7*: 4FF-E

10;

asu ), Ceorgalas (, Ku&ar N, esai ). (orrelation e-teen s+&!to&s an% ra%iologial in%ings in !atients ith (hroni Rhinosinusitis: an ealuation stu%+ using the )ino nasal 3ssess&ent uestionnaire an% =un%-$aka+ gra%ing s+ste&. ur 3rh @torhinolar+ngeolog+. 200: 2F2 'E*: 1-4

11;

Neil hattahar++a (linial an% s+&!to& riteria or the aurate %iagnosis (hroni Rhinosinusitis. =ar+ngoso!e 200F 11F no !art2,su!!le&ent no.110

12;

$etson R, Cliklih R. )tankieiD J3. t al. (o&!arison o sinus staging s+ste&s. @tolar+ngol 6ea% Nek )urg 1EE11:72-E

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5i&oth+ =, )&ith. @etie testing an% Lualit+ o lie ealu-ation in an%i%ates ith (hroni Rhinosinusitis 3& J Rhinol 20071'F*:71-F

14;

Protor / 5he nose, !aranasal sinuses an% !har+n, in alters  'e%*: =eis- alters !ratie o surger+. oston, =ittle ron an% o1E82:1-7

15;

Rau Polaara&, 3nan% K. eiah, @sa&u )akai, )tanle+ $. )ha!sha+, 3nato&i ariants an% !earls-/untional en%oso!-i sinus surger+ @tolar+ngol (lin N 3&7'2004*:221-42

16;

)ta&&erger 6, $iheal 6ake, /untional en%oso!i sinus surger+:1-17

17;

$esserklinger .n%oso!+ o the nose. alti&ore: #ran an% )harDenerg 1E8.

18;

ahert etal.I&!ortant researh Luestions in allerg+ an% relate% %iseases: (hroni Rhinosinusitis-3 galen stu%+3llerg+200EF4:20-77

19;

3n%re /ore&an, ee!ti )inghal, 3lkis J. Psaltis, Peter-John or&al%.5argete% I&aging $o%alit+ )eletion or ate-rial ioil&s in (hroni Rhinosinusitis =ar+ngoso!e 2010 120:42-71

20;

oris 5ols%or, Virtual Realit+: 3 Ne Paranasal )inus )ur-ger+ )i&ulator =ar+ngoso!e 2010 120:420-

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