Académique Documents
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Nama : Dr. Cita Herawati Murjantyo, Sp THT-KL Tempat/tgl lahir : Yogyakarta, 15 Maret Pekerjaan/jabatan :
Staf Medik Fungsional RS Kanker Dharmais Bagian THT RSI Bintaro
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Osteomeatal Complex
physiologic organ
Same pathology
mechanism
Same analogy &
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Rhinosinusitis Definition
AAO definitionDefined as an inflammation of the nose and sinuses
Rhinosinusitis
Include nasal airway
inflammation (Rhinitis)
Rhinosinusitis Symptoms
A rhinosinusitis task force in 1997 "major" criteria
facial pain nasal obstruction Hyposmia purulence on examination fever Headache Fatigue dental pain cough
"minor" criteria
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Viral infections
Most common predisposing factors for
Prevention
Hand washing
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Definition
Up to 4 weeks of purulent nasal drainage (anterior, posterior, or both) accompanied by nasal obstruction, facial pain-pressure-fullness, or both: Purulent nasal discharge is cloudy or colored, in contrast to the clear secretions that typically accompany viral upper respiratory infection, and may be reported by the patient or observed on physical examination Nasal obstruction may be reported by the patient as nasal obstruction, congestion, blockage, or stuffiness, or may be diagnosed by physical examination Facial pain-pressure-fullness may involve the anterior face, periorbital region, or manifest with headache that is localized or diffuse Acute rhinosinusitis that is caused by, or is presumed to be caused by, viral infection. A clinician should diagnose VRS when: a. symptoms or signs of acute rhinosinusitis are present less than 10 days and the symptoms are not worsening Acute rhinosinusitis that is caused by, or is presumed to be caused by, bacterial infection. A clinician should diagnose ABRS when: a. symptoms or signs of acute rhinosinusitis are present 10 days or more beyond the onset of upper respiratory symptoms, or b. symptoms or signs of acute rhinosinusitis worsen within 10 days after an initial improvement (double worsening)
(Adapted from ref 1)
1.
Rosenfeld RM, Andes D, Bhattacharyya N et al. Clinical practice guideline : Adult sinusitis. Otolaryngology Head & Neck Surgery; 2007; 137:S1-S31.
Classification by
Duration of
Symptoms
symptoms
ACUTE lasting up to 4 weeks, with total resolution of SUBACUTE persisting more than 4 weeks, but less than 12
weeks, with total resolution of symptoms
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2007
Symptoms
10
15
12 Minggu
Acute Rhinosinusitis
Subacute Rhinosinusitis
Chronic Rhinosinusitis
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2007
Hari
10
15
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chronic headache and facial pressure, plus stopped up nose; has had innumerable courses of antibiotics and 3 sinus operations by 2 different physicians
Enviromental factors
Microorganisms
Local
Anatomic obstruction Gastroesophageal reflux
viral illness (children in daycare) Pollutants cigarette smoke Medications Rhinitis medicamentosa
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Attenuate Inflammation
Steroids Immunotherapy Antileukotrienes Macrolides Who knows what else?
CRS
Antibiotics in CRS
Should be based on culture results Endoscopic directed culture of purulent
secretions from the nasal vestibule or middle meatus correlate well with maxillary tap results S. aureus, Anaerobes & Gram negative Pseudomona Aeruginosa
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Antibiotics
First-line
amoxicillin-clavulanate amoxicillin cephalosporin second-or third-generation
Second-line
For adults The respiratory quinolones
ciprofloxin, levofloxacin, gatifloxacin, and moxifloxacin
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Augmentin in ABRS
TM
- Reliable efficacy
Several guidelines include amoxicillin- clavulanate as a firstline/second-line treatment option (France, Germany, USA, Spain, UK, Belgium, Netherlands, Finland, Canada) 8
7. 8.
Poole MD, Portugal LG. Treatment of rhinosinusitis in the outpatient setting. Am J Med 2005;118 (7A):45S50S. Klossek JM, Federspil P. Update on treatment guidelines for acute bacterial sinusitis. Int J Clin Pract 2005; 59 (2): 230238
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Conclusion
CRS is multifactorial
predisposing factors
Therapeutic options
Prevent & treat etiology Reduce inflammatory response
Surgery
Exhaustion of medical option Certainty of diagnosis
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Thank you
9 April 2011
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