Transcript SLEEP APNEA---

RHINOSINUSITIS
DANIEL W. TODD, M.D.
MIDWEST ENT
FORM AND FUNCTION
FORM (ANATOMY)
FUNCTION
(PHYSIOLOGY)
ANATOMY (FORM)
EXTERNAL NOSE (NASAL PYRAMID)
NASAL CAVITY (SEPTUM &
TURBINATES)
PARANASAL SINUSES
NASOPHARYNX
ANATOMY
PHYSIOLOGY
(FUNCTION)
NASAL PASSAGES
SINUSES
BREATHING
WARMING
FILTERING
HUMIDIFYING
OLFACTION (SENSE OF
SMELL)
RESISTANCE
LIGHTEN THE SKULL
MUCOUS PRODUCTION
HUMIDIFICATION
PROTECT FROM FALCIAL
TRAUMA
PROTECT NASAL
BAROTRAUMA
VOCAL RESONANCE
ENHANCE OLFACTION
Rhinosinusitis
Rhinosinusitis is the preferred
terminology as you rarely have the
sinusitis without the rhinitis.
The term is then further defined by the
duration of the inflammation
ACUTE – LESS THAN 4 WEEKS
CHRONIC-MORE THAN 12 WEEKS
Rhinosinusitis
A GROUP OF DISORDERS
CHARACTERIZED BY
INFLAMMATION OF THE MUCOSA OF
THE NOSE AND PARANASAL
SINUSES
THERE IS NO CRITERIA BASED ON
ETILOGY
RHINOSINUSITIS
REALLY AN IMFLAMMATORY
DISORDER
NEED TO STOP THINKING OF IT AS
SOLEY AN INFECTION
RHINOSINUSITIS---HOW
DO YOU GET IT
INFLAMMATION--BLOCKING OF THE
OSTIA—DIMINISHED
PH---MUCOCILIARY
DYSFUNCTION---STAGNATION OF
SECRECTIONS--OVERGROWTH OF
BACTERIA OR
FUNGUS
RHINOSINUSITIS
INFLAMMATION
CAUSED BY:
VIRUS, ALLERGEN,
IRRITANT,
BACTERIA,
FUNGUS
OMC: AREA OF
RELATIVELY TIGHT
ANATOMY
RHINOSINUSITIS
60-90% OF SURGICAL PTS HAVE
SIGNIFICANT ALLERGIES ON SKIN
TESTING
THE MUCOSAL SPECIMENS ON ALL
SURGICAL PTS DEMONSTRATE
ALLERGIC INFLAMMATION
SUPERANTIGEN
HYPOTHESIS
HIGH MOLECULAR WEIGHT
PYROGENIC PROTEINS
ELICIT EXTREMELY POTENT
STIMULATORY EFFECT ON TLYMPHOCYTES
SUPERANTIGENS
BACTERIA (staph aureus, pseudomas,
H influenza)
FUNGI (Molds, Candida, Bipolaris,
Alternaria, Aspergillosis)
Allergens (Conventional and Bacterial
antigens)
Irritants
SUMMARY
RHINOSINUSITIS IS AN INFLAMMATORY
DISORDER OF THE NASAL PASSAGES
AND PARANASAL SINUSES
IT’S ETIOLGY CAN BE EITHER
INFECTIOUS (VIRAL, BACTERIAL, FUNGAL
OR PARASITIC) OR NON-INFECTIOUS
(ALLERGY, IRRITANT)
MAY HAVE ANATOMIC PREDISPOSITIONS
RHINOSINUSITIS
HOW DO YOU
DIAGNOSE IT?
HOW DO YOU
TREAT IT?
DIAGNOSIS
HISTORY
PHYSICAL
ENDOSCOPY
CT SCAN
DIAGNOSIS
MAJOR FACTORS
FACIAL
PAIN/PRESSURE
NAO
DISCHARGE
HYPOSMIA
PURULENCE
FEVER
MINOR FACTORS
HEADACHE
FEVER
HALITOSIS
FATIGUE
DENTAL PAIN
COUGH
AURAL
PAIN/FULLNESS
MAXIMAL MEDICAL
THERAPY
SALINE (SPRAY/IRRIGATIONS)—
HYPERTONIC?
DECONGESTANTS (TOPICAL/SYSTEMIC)
MUCOLYTICS
STEROIDS (TOPICAL/SYSTEMIC)
ANTIHISTAMINES (TOPICAL/SYSTEMIC)
REFLUX THERAPY?
MAXIMAL MEDICAL
LEUKOTRIENE INHIBITORS
ANTIBIOTICS (TOPICAL/SYSTEMIC)
USUALLY START TREATMENT
EMPIRICALLY---TREAT AT LEAST 1
WEEK PAST THE RESOLUTION OF
SYMPTOMS (OFTEN 20 DAYS)
 SINUNEB—IRRIGATIONS
 CHRONIC---LOW DOSE CHRONIC
BIAXIN

ALLERGY
THE NOSE IS THE TARGET ORGAN
FOR AEROALLERGENS, IRRITANTS,
AND DEBRIS.
TOPICAL THERAPIES AND NASAL
RINSES ARE PARAMOUNT.
ALLERGY
ALLERGY TESTING AND TREATMENT
IS NEVER A BAD IDEA PRIOR TO
SURGERY
IDT IS THE MOST SENSITIVE AND
SPECIFIC METHOD OF ALLERGY
TESTING
SURGERY
THE CHRONIC INFLAMMATION
FROM ALLERGIES AND INFECTIONS
CAN LEAD TO ANATOMIC CHANGES
SINONASAL INFECTION IS A
RELATIVE TERM
MOST MUCOSAL PROBLEMS ARE
REVERSIBLE
SINUS SURGERY IS PLAN C
SINUS SURGERY
WE DO IT BETTER--UTILILIZE LASERS,
ENDOSCOPES, TV
MONITORS,
MICRODEBIDERS,
COMPUTER
GUIDANCE SYSTEMS---STILL A DRAINAGE
PROCEDURE
FUNCTIONAL
IMAGE GUIDED
LASER AND POWERED
MINIMALLY INVASIVE
CONCEPTS
THE MOST HIGHLY TRAINED SINUS
SURGEON IS A BOARD CERTIFIED
OTOLARYNGOLOGIST (IN SINUS
SURGERY THE MORE RECENTLY
TRAINED THE BETTER)
THERE IS NO SUCH THING AS A
SINUS SPECIALIST ALTHOUGH
FELLOWSHIPS ARE EMERGING
CONCEPTS
SINUS SURGERY IS ALMOST NEVER
AN EMERGENCY
PATIENTS WHO HAVE BEEN LURED
IN BY DIRECT ADVERTISING
SHOULD BE LESS LIKELY TO
REQUIRE URGENT SURGERY THAN
THE REFERRED PATIENT
NASAL CYCLE
LARGELY A FUNCTION OF THE INFERIOR
TURBINATE
INFERIOR TURBINATE FULL OF VENOUS
LAKES----SWELLS AND DECONGESTS
ALTERNATES SIDES---ON THE ORDER OF
HOURS---PROBABLY ALLOWS THE NOSE
TO CLEAN ITSELF