RHINOSINUSITIS

&
NASAL POLYPOSIS

 Rhinosinusitis
common complication
AR
40 % chronic sinusitis
alergy
Adult children
Inflamatory mucous membrane
USA
incidence 18%
Socioeconomic problem

Pathophysiology of Rhinosinusitis

Symptoms Rhinosinusitis
Major symptoms
Facial pain/pressure
Facial congestion/fullness
Nasal
obstruction/blockage
Nasal discharge/
purulence/post nasal drip
Hyposmia/anosmia
fever

Minor symptoms
Headache
Fever
Halitosis
Fatique
Dental pain
Cough
Earpain/pressure/fullness

RHINOSINUSITIS
Diagnosis :
Medical history
Physical examaination
Purulent secretion
Patencyt of sinus out flow tract
Edema

X-ray

RHINOSINUSITIS
Medical management
Non sedating antihistamine
Decongestan
Intranasal steroid
Antibiotics (severe)

Surgycal

NASAL POLYPOSIS
Polyps
smooth, grade like structure arise
from inflamed mucosa lining pranasal sinuses .
Allergy ??

Eosinophilia
IL 5
Eotaxin
rantes

Intranasal Corticosteroid
Untreated nasal polyps
Relapse prevention
Post operative

POLYPOSIS
Smooth, grape like
Skin test
allergen

not identify all possible

Local production Ig E
Prevalence polyposis in allergic rhinitis

PATHOPSHYSIOLOGY
TNF a
epithelial
cell

Anti TNF a

IL 1
epithelial
cell

VCAM-1
EPITHELIAL CELL

Injury to air way epithelial

cells by allergen, virus or
trauma
Anti IL 1

Anti VCAM 1

Regeneration of airway epithelium

1.Basal cell hyperplasia
2.Squamous cell hyperplasia
3.Goblet cell hyperplasia

EOSINOPHIL >>
Migration through blood
vessel wall

Anti VLA 1

Release of
eosinophil granule
protein

Alteration of Na & Cl
flux

EDEMA

Detective CFTR
migration

POLYPOSIS
Diagnosis :
History
Physical examination (RA/Endoscopy)
Laboratory
X ray/ CT scan

POLYPOSIS
History
Nasal congestion
Hyposmia/ anosmia
Sneezing
Rhinorrhea

POLYPOSIS
Physical examination
Multiple/ dingle
Smooth
Grade-like
Gelatinous
Common arise from ethmoid/ ostial region

POLYPOSIS
Laboratory
Skin testing
Histamine / Ig E
X ray/ CT scan

polyps fluids

POLYPOSIS
STAGING
Grade 1 : polyps do not prolaps middle
turbinate (endoscopy)
Grade 2 : polyps extend bellow middle
turbinate (rhinoscopy anterior)
Grade 3 : polyps massive

POLYPOSIS
Guideline for the management
Primary goal : relief patient symptoms
Secondary goal :
Infections <
Improvement chest symptoms
Prevention of mucocele/ reccurence polyposis

POLYPOSIS
TREATMENT

Essential intranasal
corticosteroid or 4-6
weeks

Consider antibiotics
aspirin
desentsitization

Continue intranasal
corticosteroids

Systemic
corticosteroids

response

No response

CT Scan and surgery

PENATALAKSANAAN
KELUHAN
CURIGA KEGANASAN
Permukaan berbenjol dan
mudah berdarah

Masa polip
hidung

Stad. 2&3
Terapi bedah

Stad. 1&2
Terapi medik

Persiapan
1.HDST
2.CT Scan

Terapi medik :
1.Steroid topikal dan atau
2. Polipektomi medikamentosa (HDST=high dose short term oral corticosteroids
dengan cara : -. Deksametasone 12 mg(3 hari) 8 mg(3 hr)4 mg(3hr)
-metylprednisolon 64 mg10 mg(10 hr)
Prednison 1mg/kgBB (10 hr)

Terapi bedah :
-polipektomi
-.Etmoidektomi
-.BSE

Tidak ada perbaikan

perbaikan

Tindak lanjut dgn steroid topikal

Polip rekuren :
-.cari faktor alergi
-.kaustik/kauterisasi/ekstraksi polip kecil
-.steroid topikal
-.operasi ulang
-.steroid oral (HDST) tidak lebih dari 3-4x/tahun

Perbaikan-hilang

STADIUM
1.Polip dalam MM (NE)
2.Polip keluar dari MM
3.Polip memenuhi rongga hidung

SEMBUH