Diagnosis
and Management Of Chronic Rhino Sinusitis |
DR. KHURSHID ALAM
FRCS ORL (UK)
|
Introduction
Sinusitis is a common health problem around
the world. 15 – 20% of patient presenting
to ENT OPD in Pakistan suffer from rhinosinusitis.
It contributes to a significant amount
of health care expenditure due to the
direct costs arising from physician visiting
and antibiotics, as well as indirect costs
related to missed days at work and a general
loss of productivity due to decrease in
life quality of those affected
Pakistan unfortunately most of the cost
is endured by the patients themselves.
Therefore better understanding of the
pathogenesis and etiology of chronic rhinosinusitis
is essential in order to develop effective
therapies. 1/5th of patients with chronic
sinusitis also have nasal polyposis
.
Patients
who have been symptomatic for 3 weeks
or less are considered to have acute disease
while symptoms more than 6 weeks are referred
to as having chronic diseas
.
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Clinical Presentation |
Major Criteria – Post nasal discharge,
Nasal congestion / blockage, facial pain
or pressure, headache, decreased smelling
sensation and fever for acute rhinosinusitis
Minor
Criteria – halitosis (bad smell
from mouth), fever, weakness, dental pain,
ear fullness and pain, cough and in children
irritability
If more than 2 of major criteria or one
major and 2 minor criteria are found in
the history and examination over 6 –
12 week interval the presence of chronic
sinusitis is very likely
|
Management |
|
O endoscope is used
to look into the nose for any pathology.
It is impossible to examine the nose completely
without the endoscope. Floor of the nose,
turbinates, middle meatus and postnasal
space is seen. If any pathology seen it
should be noted
|
Investigation
No investigation is required unless medical
treatment is completed for two months.
Only if medial treatment fails then CT
scan of sinuses is required.
scan of sinuses should be done under special
settings by the radiology department.
We call it as a FESS protocol CT scan
of sinuses
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Medical Treatment |
It
depends on the findings of the endoscope
and associated symptoms. |
|
If
nasal polyps are seen then they should
be treated with a 10 day duration dose
of oral steroids. In addition nasal steroids
are given for the duration of 2 months |
|
| If
muco-pus is seen then antibiotic is added
for 7 – 10 days in addition to the
above regime.
If no muco-pus then the treatment is oral
steroid and nasal steroids.
Patient is requested to review in 2 months.
If the patient is still symptomatic then
CT Scan of sinuses with FESS protocol
is requested
CT Scan is the only investigation of choice
where the exact extent of pathology can
be seen Various anatomical abnormalities
are also noted.
.
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