Presentation on theme: "Gary Kroukamp. Definition: >3 months of symptoms of sinusitis."— Presentation transcript:
Definition: >3 months of symptoms of sinusitis
Case Study: 55 yo man 3 episodes of acute sinusitis since last winter Treated with antibiotics Resolution of acute sx continues to have pressure “sinus” headache, nasal congestion, poor smell, and intermittent rhinorrhea.
Chronic Rhinosinusitis? l History Duration Allergic Symptoms? Smoker? l Presenting symptoms l Examination
The Dairy and Wheat Myth! Milk mucous sensation Inhaled vs Ingested allergen
Common Presenting Symptoms l nasal obstruction94% l postnasal drip 92% l facial pain & headache90% l rhinorrhoea61% S hyposmia / anosmia
Physical examination: l Purulent rhinorrhoea l Polyps l Complications?
Future Research The magic bullet! Anti-inflammatory biological Anti-interleukin
Referral Failure of treatment Complications
“Sinus headache” Headache is complicated Multifactorial! Sinus headache/pain does NOT mean sinusitis MUST have proper evaluation
FESS – Functional Endoscopic Sinus Surgery Patient selection crucial! – Don’t operate for headache! Abnormal CT Restore sinus function Improve ventilation and drainage Open the ostium Remove the obstructed honeycomb (ethmoids) Clear obstruction
FESS – Surgical Aims Restore sinus function Improve ventilation and drainage Open the ostium Remove the obstructed honeycomb (ethmoids) Clear obstruction
Evidence/Validation? Impact of Functional Endoscopic Sinus Surgery on Symptoms and Quality of Life in Chronic Rhinosinusitis † Michael Damm MD, Gero Quante MD, Markus Jungehuelsing MD, Eberhard Stennert MD – Laryngoscope Jan 2009 † Recalcitrant Rhinosinusitis, the diagnosis and treatment and evaluation of results – Rhinology 2010 EPOS -