Post on 03-Apr-2018
7/28/2019 Maju Jurnal
1/31
Silvia Hari Prastiwi FKUPN
Badzli Achmad FKUPN
Feliks FKUKRIDA
Pembimbing : dr.Khairan I, Sp.THT.KL
7/28/2019 Maju Jurnal
2/31
Rhinosinusitis is the inflammation of the nasalpassages and sinus cavities. It is usuallycaused by allergies or an infection. It causes a
combination of symptoms of rhinitis andsinusitis, including :
American Academy of Allergy Asthma and Immunology. Rhinosinusitis: What is Chronic
Rhinosinusitis?. Accessed: January 5, 2010 fromhttp://www.aaaai.org/patients/publicedmat/sinusitis/whatischronicsinusitis.stm
7/28/2019 Maju Jurnal
3/31
Runny nose
Post nasal drip Congestion
Facial pain or discomfort
Toothaches
Feeling of fullness around the nose, under theeyes and forehead
Decreased sense of smell
American Academy of Allergy Asthma and Immunology. Rhinosinusitis: What is Chronic
Rhinosinusitis?. Accessed: January 5, 2010 fromhttp://www.aaaai.org/patients/publicedmat/sinusitis/whatischronicsinusitis.stm
7/28/2019 Maju Jurnal
4/31
Classification
acute rhiniosinusitis
subacute rhinosinusitis
chronic rhinosinusitis
American Academy of Allergy Asthma and Immunology. Rhinosinusitis: What isChronic Rhinosinusitis?. Accessed: January 5, 2010 fromhttp://www.aaaai.org/patients/publicedmat/sinusitis/whatischronicsinusitis.stm
7/28/2019 Maju Jurnal
5/31
Treatment for rhinosinusitis varies, and is
usually based on the duration and severity of
symptoms.
such as over-the-counter pain relievers (like
acetaminophen or ibuprofen), decongestants
(like pseudoephedrine), nasal irrigation, or
topical steroids. Allergic rhinosinusitis is oftentreated with antihistamines as well.
7/28/2019 Maju Jurnal
6/31
In the case of chronic rhinosinusitis,sometimes endoscopic sinus surgery isnecessary. Endoscopic sinus surgery has been
proven very successful in treating chronicrhinosinusitis.
American Academy of Allergy Asthma and Immunology. Rhinosinusitis: What is Chronic
Rhinosinusitis?. Accessed: January 5, 2010 fromhttp://www.aaaai.org/patients/publicedmat/sinusitis/whatischronicsinusitis.stm
7/28/2019 Maju Jurnal
7/31
Untreated rhinosinusitis can impair yourquality of life and lead to other conditionssuch as nasal polyps.
American Academy of Allergy Asthma and Immunology. Rhinosinusitis: What is ChronicRhinosinusitis?. Accessed: January 5, 2010 fromhttp://www.aaaai.org/patients/publicedmat/sinusitis/whatischronicsinusitis.stm
7/28/2019 Maju Jurnal
8/31
Chronic Sinusitis in children :
a general overview
RL.Friedman, South Afr J EpidemiolInfect 2011;26(1):13-17
7/28/2019 Maju Jurnal
9/31
Introduction
Rhinosinusitis is a significant and increasing
health problem, resulting
in a large financial burden on society. It ismultifactorial in origin. With
age, several predisposing factors change
and rhinosinusitis manifestsdifferently.
7/28/2019 Maju Jurnal
10/31
Technical definition
Rhinosinusitis is defined as inflammation of the
nose and paranasal sinuses characterised by twoor more symptoms, one of which should
be either a nasal blockage/obstruction/congestion
, or a nasal discharge (anterior / posterior nasal
drip)
7/28/2019 Maju Jurnal
11/31
Other symptoms include :
facial pain or pressure, a reduction in, or loss
of smell, and either endoscopic signs of polyps
and/or mucopurulent discharge
7/28/2019 Maju Jurnal
12/31
The role of allergy in chronic rhinosinusitis in children
is mentioned here because of the difficulties in
differentiating persistent allergic rhinitis from chronicsinusitis. Allergy is accepted as a cause of chronic
rhinosinusitis, but only as one of several factors.
7/28/2019 Maju Jurnal
13/31
In order to differentiate between the
two symptomatically very similar
clinical entities, the concept of ARIA
(Allergic Rhinitis and its Impact on
Asthma)2 is presented to facilitate
allergic rhinitis diagnosis.
7/28/2019 Maju Jurnal
14/31
7/28/2019 Maju Jurnal
15/31
Clinical definition
The European position paper on rhinosinusitis
and nasal polyps, 2007 :
- Rhinosinusitus (non-otorhinolaryngological)
- Acute rhinosinusitis
- Acute viral rhinosinusitis (common cold)
- Acute non-viral rhinosinusitis- Chronic rhinosinusitis with or without nasal
polyps
7/28/2019 Maju Jurnal
16/31
Anatomy and pathophysiology in
chronic
rhinosinusitis
7/28/2019 Maju Jurnal
17/31
The paranasal sinuses are a complex series offour paired hollow cavities extending through
various small passages into the anterior skull.
1. Maxillary sinuses
2. Ethmoid sinuses
3. Frontal sinuses
4. Sphenoid sinuses
7/28/2019 Maju Jurnal
18/31
Pseudostratified columnar ciliated epithelium
extends from the nose via the ostiomeatal
complexes into these sinuses.
Any obstruction within this ostiomeatal
complex will lead to stasis, stagnation and
inflammation
7/28/2019 Maju Jurnal
19/31
Chronic rhinosinusitis: clinical
7/28/2019 Maju Jurnal
20/31
Chronic rhinosinusitis is a clinical syndrome,
associated with persistent inflammation of the
mucosa of the nose and paranasal sinuses.
Chronic rhinosinusitis includes the polypoid(CRSwNP) and non-polypoidal (CRSsNP) forms.
7/28/2019 Maju Jurnal
21/31
More recently, the aetiology of chronic
rhinosinusitis is regarded as complex,
multifactorial and as a distinct entity. The
concept of chronic mucosal inflammationhas replaced infection to describe chronic
rhinosinusitis.
7/28/2019 Maju Jurnal
22/31
Epidemiology of rhinosinusitis specific
to children
1. The runny nose child
2. On average, 45% of children had signs of
sinusitis.
3. A history of nasal obstruction increased this
incidence to 50%.
4. With clinical mucosal swelling, this rose to
80%, and to 100% in the presence of
purulent secretions
7/28/2019 Maju Jurnal
23/31
5. After a six-to-seven months follow, up to half
had resolved without intervention.
6. A decrease in the prevalence of rhinosinusitis
in older children is apparent.
7/28/2019 Maju Jurnal
24/31
Predisposing factors
Day care, nasal obstruction and passive
smoking
Breastfeeding does not appear to provide
protection
Tonsillitis and otitis media
Mucociliary dysfunction due to cystic fibrosis
(often with nasal ployps), primary ciliary
dyskinesia,humoral immuno deficiencies
7/28/2019 Maju Jurnal
25/31
Incidence
The frequency of sinusitis was difficult to
assess due to poor uniformity in diagnosis.
Children frequently have viral infections withsinonasal symptoms, with bacteria present 10-
20% . Sinusitis is often observed in children
with allergic rhinitis, and 10-25% of children
around the world estimated allergic
rhinitis.
7/28/2019 Maju Jurnal
26/31
Symptoms of CR in children
7/28/2019 Maju Jurnal
27/31
Clinical examination
The Nose
Outside the nose
Microbiology Imaging
7/28/2019 Maju Jurnal
28/31
Management of CR
Chronic rhinosinusitis in the young child does
not have to be treated,as spontaneous
resolution is probable
7/28/2019 Maju Jurnal
29/31
Treatment of CR
Antibiotics
Topical corticosteroids
Nasal douching Gastro-oesophageal reflux therapy
Local nasal decongestan
Surgical treatment
7/28/2019 Maju Jurnal
30/31
7/28/2019 Maju Jurnal
31/31
Conclusion
The disease is multifactorial, and although
therapies are effective in helping the majority
of patients, a significant number result in
incomplete resolution of the disease.