Rhinosinusitis (eBook)

Preface 6
Contents 7
Contributors 9
to 1 Etiology and Impact of Rhinosinusitis 12
Definition of Rhinosinusitis 12
Epidemiology of Rhinosinusitis 15
Etiology of Rhinosinusitis 15
Environmental Factors 15
Microbial Pathogens in Rhinosinusitis 15
Allergy 17
Asthma 18
Pollution 19
Anatomic Factors 19
Mucociliary Impairment 19
Anatomic Variations 19
Systemic Disorders and Rhinosinusitis 20
Immunodeficiency 20
Genetic Disorders 21
Laryngopharyngeal Reflux 21
Endocrine State 21
Economic Impact of Rhinosinusitis 22
Quality-of-Life Impact of Rhinosinusitis 23
to 2 Microbiology and Immunology of Rhinosinusitis 27
Microbiology 28
Viral Rhinosinusitis 28
Acute Bacterial Rhinosinusitis 28
Subacute Rhinosinusitis 30
Chronic Rhinosinusitis 30
Recurrent, Acute Rhinosinusitis 31
Acute Exacerbation of Chronic Rhinosinusitis 31
Fungal Rhinosinusitis 32
Immunology 34
Innate Immunity 35
Adaptive Immunity 35
Summary 36
to 3 Diagnosis and Management of Acute Rhinosinusitis 39
Definition 39
Pathophysiology 40
Epidemiology 41
Presenting Symptoms and Signs 41
Fever, Nasal Obstruction, Pain, Headache, Purulent Rhinorrhea 41
Associated Factors 42
Sinonasal Endoscopy 42
Sinonasal Culture 43
Laboratory Data 43
Imaging 44
Ultrasound 44
X-Ray 44
Computed Tomography 44
Diagnosis of Complicated Acute Rhinosinusitis 47
Controversy 47
to 4 Diagnosis of Chronic Rhinosinusitis 50
Defining CRS 50
Rhinitis Versus Rhinosinusitis 51
CRS as a Multifactorial Disease 51
The Sinonasal Symptoms 52
Local Symptoms 52
Regional and Systemic Symptoms 53
Duration of Symptoms 53
CRS with Polyps 53
Current Concepts 54
Presenting Symptoms and Differential Diagnoses 56
Nasal Obstruction/Congestion/Blockage/Stuffiness 56
Clinical Basis 56
Differential Diagnoses for Nasal Obstruction 57
Objective Evaluation of Nasal Obstruction 57
Nasal Discharge and Postnasal Drip 59
Clinical Basis 59
Differential Diagnoses for Nasal Discharge 59
Objective Evaluation 60
Facial Pain, Ache, Headache, and Pressure 60
Clinical Basis 60
Differential Diagnoses for "Sinus" Pain 60
Objective Evaluation of Pain 60
Reduction or Loss (Anosmia) of Smell 61
Clinical Basis 61
Differential Diagnoses for Loss of Smell 61
Objective Evaluation of Smell (Olfaction) 61
Regional Symptoms 61
Cough 61
Clinical Basis 61
Differential Diagnoses for Cough 62
Objective Evaluation of Cough 62
Halitosis 62
Clinical Basis 62
Differential Diagnoses for Halitosis 62
Objective Evaluation of Halitosis 62
Warnings and Pitfalls 63
Other Significant Patient History 64
Medications 64
Past Medical History 64
Social History 64
Family History 64
Primary and Secondary Investigations 65
Endoscopy 65
Anterior Rhinoscopy 67
CT Scan 67
X-Ray 68
Secondary Investigations 69
Diagnostic Schemes 69
Adult CRS 70
Pediatric CRS 70
to 5 Medical Management of Acute Rhinosinusitis 74
Treatment Strategy 74
Antiinflammatory Therapy 75
Decongestant Therapy 76
Antihistamine Therapy 77
Anticholinergic Therapy 77
Mucous Transport Therapies 78
Antimicrobial Therapy 78
Conclusion 81
to 6 Medical Management of Chronic Rhinosinusitis 84
Microbiology and Antibiotic Selection 85
Selection of Routine Antibiotic Therapy 85
Unique Roles of Bacteria in CRS 87
Novel Antibiotic Delivery Methods 88
Role of Fungi and Antifungal Therapy 89
Immunomodulatory Therapies 90
Intranasal Corticosteroids 90
Systemic Steroids 93
Allergy Management 95
Other Immunomodulatory Considerations 96
Aspirin Desensitization 96
Macrolide Therapy 97
Summary and Conclusions 97
to 7 Endoscopic Sinus Surgery 101
The Role of Underlying Pathogenesis in Patient Selection for Surgery 104
The Role of Patient Symptoms in Selection for Surgery 104
The Role of Imaging and Endoscopy in Patient Selection for Surgery 105
Selecting Patients for Surgery 106
Selecting the Surgeon for Your Patients 108
Patient Preparation for Surgical Intervention 108
The Surgical Procedure 109
Postoperative Management 111
Complications of Surgery 112
Summary 113
to 8 Allergy and Rhinosinusitis 115
Epidemiology and Burden of Nasal Allergy 115
Pathophysiology of Allergy 116
Allergic Rhinitis: Overview 119
Diagnosis of Allergic Rhinitis 120
History 120
Physical Examination 121
Allergy Testing 122
Screening Tests 122
Confirmatory Tests 123
The Association of Allergy and Rhinosinusitis 126
Treatment of Allergic Rhinitis in the Patient with Rhinosinusitis 128
Avoidance 128
Pharmacotherapy 129
Antihistamines 130
Decongestants 131
Corticosteroids 132
Leukotriene Modifiers 134
Immunotherapy 134
Framework for Managing Concurrent Allergic Rhinitis and Rhinosinusitis 135
Conclusion 137
to 9 Complementary and Alternative Medicine in Rhinology 140
Herbal Medicines 141
Acupuncture 144
Homeopathy 144
Other Complementary and Alternative Therapies 146
Vitamin C 146
Urtica dioca 146
Nasal Irrigation 146
Humming 147
Phototherapy 147
Conclusions 147
to 10 Radiology: Its Diagnostic Usefulness in Rhinosinusitis 151
Development 151
Anatomy 151
Imaging Sinonasal Disease: The Radiologist's Arsenal 154
Plain Film Radiographs 154
Computed Tomography 154
Magnetic Resonance Imaging 155
Imaging Disease Processes of the Paranasal Sinuses 156
Inflammatory Disease/Rhinosinusitis 156
Congenital Lesions 162
Neoplasms 162
Papillomas 165
Malignant Neoplasms 165
Summary 168
to 11 Systemic Diseases and Chronic Rhinosinusitis 170
Autoimmune Disorders 170
Wegener's Granulomatosis 170
Sarcoidosis 172
Cystic Fibrosis 173
Churg--Strauss Syndrome 174
Relapsing Polychondritis 175
Lupus 176
Infectious Processes 177
Fungal Infections 177
Syphilis 179
Mycobacterium 180
Rhinoscleroma 181
Hematologic-Oncologic Illnesses 182
Neoplasms 182
Hereditary Hemorrhagic Telangiectasia 184
Human Immunodeficiency Virus (HIV) 186
Substance Abuse: Cocaine 187
Conclusion 188
to 12 Reactive Airway Disease and the Management of Samter0s Triad 191
Reactive Airway Disease and the Unified Airway 192
Temporal Association 192
Physiological Relationship 192
Histopathology 193
Therapeutic Association 193
Aspirin-Exacerbated Respiratory Disease (Samter's Triad) 194
Epidemiology 194
Pathophysiology 195
Assessment and Diagnosis 197
Management of Samter's Triad 198
Medical Therapy 198
Aspirin Desensitization 200
Surgical Management 201
Conclusions 204
to 13 Pediatric Perspectives of Rhinosinusitis 208
Embryology And Anatomic Considerations 208
Physiology 209
Definitions 210
Prevalence 210
Differential Diagnosis of Rhinosinusitis 211
Risks of ARS and CRS 211
Diagnostic Tests 212
Diagnosis Bacterial ARS 212
Clinical Examination 213
Imaging Studies 213
Diagnosis of Chronic/Recurrent RS 215
Microbiology 215
Rationale for Treatment of ARS 216
Treatment Strategies 216
Antibiotic Therapy for ARS/Recurrent ARS 216
Antibiotics for CRS/Treatment Failure 218
Surgical Therapy 219
Special Considerations in Managing RS in Children 219
Complications 220
Local Complications 220
Systemic Complications 221
Summary 223
to 14 Spectrum of Fungal Sinusitis 226
Noninvasive Fungal Sinusitis 226
Characteristics of Fungus 226
Fungal Balls 228
Diagnosis 228
Treatment 228
Allergic Fungal Sinusitis 228
Diagnosis 229
Therapy 231
Invasive Fungal Sinusitis 233
Characteristics of Fungus 233
Acute Invasive Fungal Sinusitis 233
Diagnosis 234
Treatment 235
Chronic Invasive Fungal Sinusitis 238
Diagnosis 238
Treatment 238
Conclusion 239
to 15 Complications of Rhinosinusitis 242
Anatomy 242
Orbital Complications 244
Intracranial Complications 247
Bony Complications 249
Conclusion 251
to 16 Adjunctive Surgical Therapies in the Treatment of Rhinosinusitis 253
Anatomy and Physiology 254
Adjunctive Surgical Therapies 254
Preoperative Considerations 254
Surgical Procedures 256
Surgery of the External Nose and Nasal Septum 256
Surgery of the Inferior Turbinate 257
Ultraviolet Phototheraphy 259
Balloon Sinuplasty 260
Office Treatment of Sinonasal Polyps 261
Adenoidectomy 262
Vidian Neurectomy 263
Conclusion 264
Index 267