SLEEP%20APNEA----WHAT

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RHINOSINUSITIS

• DANIEL W. TODD, M.D.
• MIDWEST ENT

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FORM AND FUNCTION

• FORM (ANATOMY)

• FUNCTION (PHYSIOLOGY)

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ANATOMY (FORM)

• EXTERNAL NOSE (NASAL PYRAMID)
• NASAL CAVITY (SEPTUM TURBINATES)
• PARANASAL SINUSES
• NASOPHARYNX

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ANATOMY
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PHYSIOLOGY (FUNCTION)

• NASAL PASSAGES
• BREATHING
• WARMING
• FILTERING
• HUMIDIFYING
• OLFACTION (SENSE OF SMELL)
• RESISTANCE

• SINUSES
• LIGHTEN THE SKULL
• MUCOUS PRODUCTION
• HUMIDIFICATION
• PROTECT FROM FALCIAL TRAUMA
• PROTECT NASAL BAROTRAUMA
• VOCAL RESONANCE
• ENHANCE OLFACTION

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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

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Rhinosinusitis

• A GROUP OF DISORDERS CHARACTERIZED BY
  INFLAMMATION OF THE MUCOSA OF THE NOSE AND
  PARANASAL SINUSES
• THERE IS NO CRITERIA BASED ON ETILOGY

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RHINOSINUSITIS

• REALLY AN IMFLAMMATORY DISORDER
• NEED TO STOP THINKING OF IT AS SOLEY AN INFECTION

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RHINOSINUSITIS---HOW DO YOU GET IT

• INFLAMMATION---BLOCKING OF THE OSTIADIMINISHED
  PH---MUCOCILIARY DYSFUNCTION----STAGNATION OF
  SECRECTIONS---OVERGROWTH OF BACTERIA OR FUNGUS

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RHINOSINUSITIS

• INFLAMMATION CAUSED BY VIRUS, ALLERGEN,
  IRRITANT, BACTERIA, FUNGUS
• OMC AREA OF RELATIVELY TIGHT ANATOMY

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RHINOSINUSITIS

• 60-90 OF SURGICAL PTS HAVE SIGNIFICANT ALLERGIES
  ON SKIN TESTING
• THE MUCOSAL SPECIMENS ON ALL SURGICAL PTS
  DEMONSTRATE ALLERGIC INFLAMMATION

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SUPERANTIGEN HYPOTHESIS

• HIGH MOLECULAR WEIGHT PYROGENIC PROTEINS
• ELICIT EXTREMELY POTENT STIMULATORY EFFECT ON
  T-LYMPHOCYTES

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SUPERANTIGENS

• BACTERIA (staph aureus, pseudomas, H influenza)
• FUNGI (Molds, Candida, Bipolaris, Alternaria,
  Aspergillosis)
• Allergens (Conventional and Bacterial antigens)
• Irritants

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SUMMARY

• RHINOSINUSITIS IS AN INFLAMMATORY DISORDER OF THE
  NASAL PASSAGES AND PARANASAL SINUSES
• ITS ETIOLGY CAN BE EITHER INFECTIOUS (VIRAL,
  BACTERIAL, FUNGAL OR PARASITIC) OR NON-INFECTIOUS
  (ALLERGY, IRRITANT)
• MAY HAVE ANATOMIC PREDISPOSITIONS

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RHINOSINUSITIS

• HOW DO YOU DIAGNOSE IT?
• HOW DO YOU TREAT IT?

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DIAGNOSIS

• HISTORY
• PHYSICAL
• ENDOSCOPY
• CT SCAN

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DIAGNOSIS

• MAJOR FACTORS
• FACIAL PAIN/PRESSURE
• NAO
• DISCHARGE
• HYPOSMIA
• PURULENCE
• FEVER

• MINOR FACTORS
• HEADACHE
• FEVER
• HALITOSIS
• FATIGUE
• DENTAL PAIN
• COUGH
• AURAL PAIN/FULLNESS

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MAXIMAL MEDICAL THERAPY

• SALINE (SPRAY/IRRIGATIONS)HYPERTONIC?
• DECONGESTANTS (TOPICAL/SYSTEMIC)
• MUCOLYTICS
• STEROIDS (TOPICAL/SYSTEMIC)
• ANTIHISTAMINES (TOPICAL/SYSTEMIC)
• REFLUX THERAPY?

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MAXIMAL MEDICAL

• LEUKOTRIENE INHIBITORS
• ANTIBIOTICS (TOPICAL/SYSTEMIC)
• USUALLY START TREATMENT EMPIRICALLY---TREAT AT
  LEAST 1 WEEK PAST THE RESOLUTION OF SYMPTOMS
  (OFTEN 20 DAYS)
• SINUNEBIRRIGATIONS
• CHRONIC---LOW DOSE CHRONIC BIAXIN

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ALLERGY

• THE NOSE IS THE TARGET ORGAN FOR AEROALLERGENS,
  IRRITANTS, AND DEBRIS.
• TOPICAL THERAPIES AND NASAL RINSES ARE PARAMOUNT.

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ALLERGY

• ALLERGY TESTING AND TREATMENT IS NEVER A BAD IDEA
  PRIOR TO SURGERY
• IDT IS THE MOST SENSITIVE AND SPECIFIC METHOD OF
  ALLERGY TESTING

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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

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SINUS SURGERY

• WE DO IT BETTER---UTILILIZE LASERS, ENDOSCOPES,
  TV MONITORS, MICRODEBIDERS, COMPUTER GUIDANCE
  SYSTEMS----STILL A DRAINAGE PROCEDURE

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FUNCTIONAL
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IMAGE GUIDED
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LASER AND POWERED
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MINIMALLY INVASIVE
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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

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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

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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

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