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Gary Kroukamp. Definition: >3 months of symptoms of sinusitis.

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Presentation on theme: "Gary Kroukamp. Definition: >3 months of symptoms of sinusitis."— Presentation transcript:

1 Gary Kroukamp

2 Definition: >3 months of symptoms of sinusitis

3

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? l History  Duration  Allergic Symptoms?  Smoker? l Presenting symptoms l Examination

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

7 Common Presenting Symptoms l nasal obstruction94% l postnasal drip 92% l facial pain & headache90% l rhinorrhoea61% S hyposmia / anosmia

8 Physical examination: l Purulent rhinorrhoea l Polyps l 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: l asthma l cystic fibrosis l ciliary dysmotility l immuno-compromised: l chemotherapy l transplant l 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 l sufficient duration Oral Steroids Nasal Steroids Saline Anti –leucotrienes (Singulair) – not shown to be effective

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

21 Steroids? Oral short course I L-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  Anti-interleukin

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 -


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