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Fig 1 Anatomy. FS frontal sinus; UP uncinate process; IT inferior turbinate; MT middle turbinate; MS maxillary sinus; AE anterior ethmoid; PE posterior.

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Presentation on theme: "Fig 1 Anatomy. FS frontal sinus; UP uncinate process; IT inferior turbinate; MT middle turbinate; MS maxillary sinus; AE anterior ethmoid; PE posterior."— Presentation transcript:

1 Fig 1 Anatomy

2 FS frontal sinus; UP uncinate process; IT inferior turbinate; MT middle turbinate; MS maxillary sinus; AE anterior ethmoid; PE posterior ethmoid FS UP IT MT MS AE PE

3 AE anterior ethmoid; PE posterior ethmoid; SS sphenoid sinus; AE PE SS

4 Fig 3

5 Chemokines Massive polyclonal lymphocyte activation TB Cytokines Hyper IgE Eosinophils ( apoptosis) Superantigens Epithelial damage (barrier dysfunction) IL-5 ECP Albumin Eotaxin Polyclonal IgE chronic microbial trigger Fig 4

6 Diagnosis: Nasal polyposis Topical GCS bid., after symptom control OD for 3 months Oral GCS (decreasing scheme), topical GCS bid., evtl. antibiotics Not obstructivObstructiv, anosmia, asthma Symptom control ? Combination treatment necessary Surgery Longterm therapy with topical GCS Yes No Yes No Fig 5

7 Patient VGC Three month of topical steroid treatment: Before treatment Right sideleft side After treatment: right sideleft side Symptoms: Obstructed nasal passage, secretion, impaired sense of smell Symptoms: mild secretion, nasal passage free Fig 6

8 Ostium Occlusion Inhibition of ventilation and drainage Stagnation of secretion Change in the composition and pH of secretion Change of the mucosal gas metabolism Ciliary and epithelial damage Change of the host milieu Bacteria become pathogenic Inflammation of the lamina propria Increased mucosal thickness Fig 7

9 Common cold or acute rhinosinusitis? 051015 Days Symptoms Viral Rhinitis/ Common cold Acute Rhinosinusitis/ Increase in symptoms after 5 days Acute Rhinosinusitis/ Symptoms exeed 10 days Fig 8 Acute rhinosinusitis may be diagnosed when a common cold gets more symptomatic after 5 days or persists longer than 10 days. Less then 4 % of the patients have a bacterial form of ARS, most of ARS episodes are viral.

10 Orbital complication of an acute ethmoiditis in a 9-year old girl. Subperiostal abscess. Mit freundlicher Genehmigung von C. Bachert Fig 9


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