Presentation is loading. Please wait.

Presentation is loading. Please wait.

Chronic RhinoSinusitis- State of the Art

Similar presentations

Presentation on theme: "Chronic RhinoSinusitis- State of the Art"— Presentation transcript:

1 Chronic RhinoSinusitis- State of the Art
Gary Kroukamp

2 Definition: >3 months of symptoms of sinusitis


4 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.

5 Chronic Rhinosinusitis?
History Duration Allergic Symptoms? Smoker? Presenting symptoms Examination

6 The Dairy and Wheat Myth!
Milk mucous sensation Inhaled vs Ingested allergen

7 Common Presenting Symptoms
nasal obstruction 94% postnasal drip % facial pain & headache 90% rhinorrhoea 61% hyposmia / anosmia

8 Physical examination:
Purulent rhinorrhoea Polyps Complications?

9 Scope Pus Polyps Oedema

10 Pathophysiology: Obstruction of osteomeatal complex
Impaired mucociliary clearance Biofilm Superantigen Inflammatory Cascade

11 Anatomical variants: deviated nasal septum concha bullosa
ethmoid bulla other middle turbinate anomalies Agger nasi cells Haller cells

12 Underlying diseases: asthma cystic fibrosis ciliary dysmotility
immuno-compromised: chemotherapy transplant immuno-deficiency

13 CT scan? Sinusitis or not? Surgical Planning

14 Normal CT

15 Abnormal CT

16 Really Abnormal CT

17 Objectives for treatment:
Improve Symptoms Treat Infection Resume normal sinus physiology Prevent complications

18 Microbiology: Anaerobes Staphylococcus aureus Streptococcus
Haemophilus Influenzae Moraxella catarrhalis

19 Treatment options: Antibiotics Oral Steroids Nasal Steroids Saline
sufficient duration Oral Steroids Nasal Steroids Saline Anti –leucotrienes (Singulair) – not shown to be effective

20 Antibiotics: Controversial- none approved in Canada as indication for CRS If there is pus! Amoxicillin-clavulanic acid - Augmentin Fluoroquinolones - Moxifloxacin Macrolides - Ketek

21 Steroids? Oral short course IL-5 & IL-13
Reduce tissue inflammation, oedema

22 Nasal Steroids Treatment mainstay! Compliance! 3 months! Chronic use…

23 Future Research The magic bullet! Anti-inflammatory biological

24 Referral Failure of treatment Complications

25 “Sinus headache” Headache is complicated Multifactorial!
Sinus headache/pain does NOT mean sinusitis MUST have proper evaluation

26 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

27 FESS – Surgical Aims Restore sinus function
Improve ventilation and drainage Open the ostium Remove the obstructed honeycomb (ethmoids) Clear obstruction

28 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 -

Download ppt "Chronic RhinoSinusitis- State of the Art"

Similar presentations

Ads by Google