Chronic Rhino Sinusitis With Suspect Ion Nasal Polyps New

8/6/2019 Chronic Rhino Sinusitis With Suspect Ion Nasal Polyps New

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CASE REPORT

BY :

ENDRO TANOYO YANUAR ADI KURNIAFUAD ANSHORI INDERA NOOR A.

YOHANES AGUNG P. ABDUL SYUKUR


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PATIENT IDENTITY

Name : Mr. H

Age : 60 years old

Sex : Male

Adress : Bayan, Purworejo

Occupation : Farmer Last studied : SD


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ANAMNESIS

Chief complaint : obstructed right and leftnostril

Present Ilnessess: Since 1 year before, thispatient complains obstructed right and leftnose.

Obstructed nose is felt continually. Patientcomplained of frequent runny nose(+),

yellow-green nasal mucus, the nose smells(+),especially on waking up. Patient frequentexperienced colds when exposed to dust(+),sneezing(+), itching of the nose(+). Pain is felt

on the nose, on the right cheek and left(+).


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Patient also complained of frequent cough (+), feels a

lot of mucus in the throat (+), and often swallow

mucus. Patient has no complaints on the ear (-) &

sore throat (-), fever (-) and a history of tooth

extraction (-).

History of treatment: patients always to seek health

care if the patient has complaints like this, and

experienced temporary improvement.


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Past Illnesses :

Denied history of trauma

History of dust allergy (+) History of asthma denied

History of itching in the skin denied

Denied a history of hypertension and diabetes

mellitus

History denied bleeding nose


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Family History :

No family history of similar illness

Dust allergy history denied History of asthma denied

History of itching in the skin denied

Denied a history of hypertension and diabetes

mellitus


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RESUME ANAMNESIS

Nasal obstruction (+) on the right & left nose

Rhinorrhea (+)

Pain on nose and around cheek (+) Sneezing (+)

Itching on the nose (+)

Smell from the nose (+) Dust allergic (+)

Cough (+)


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PEMERIKSAAN FISIK

Status Generalis :

KU : Good, CM, adequate nutrition

VS : BP : 130/90 mmHgP : 88/mnt

RR : 24/mnt

T : 36,7 C


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Ear

Ear Examination: Auricle Normal

CAE laceration(-), Cerumen(+)N,Oedema(-)

Tymphanic Membrane redness(-),

Normal

Kanan Kiri


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Nose

Mass (+)

mucopurulen

Discharge (+)

Posterior Rhinoscopy : no Examination

Kanan Kiri


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Throat

Throat Examination:

Mucosal layer normal, redness(-), Ulcer(-), Tonsils normal


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DIAGNOSIS

Chronic Rhinosinusitis with Bilateral nasal

polyp


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Treatment

Ceftriaxone

Metronidazole

Dolak 3 x 30mg

Metilprednisolone

Aldisa 2 x 1

Natrium diklofenac


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PLAN

Ro SPN

Allergic test

Pro op Sinus : Polipectomy Anthrotomy

Medial, Ethmoidectomy

PROGNOSIS

Dubia ad bonam


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Anatomy


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Paranasal Sinus Drainage


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Vascularization and Innervation


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Nasal Polyp


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DEFINITION

Nasal polyps is the mass of benign / sessile stemmedfrom the nose-clear pale yellow, single or multiple,and stemmed from the mucoperiosteal tissue or

mucoperichondrial and filled with edematous stromaand inflammatory cells (Bailey, 2004)

Histologically, polyps are edematous nasal mucosatissue (Brown, 1997)

Nasal polyps that prolapse is part stemmed from themucosa of the nose / paranasal sinuses, and is not aneoplasm (Bhargava, 2002)


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Mass intracelluler fluid accumuluation

swell :

Vascular tissue

Polysacharide deposite

Sodium Absorption

ion Cl -


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Nasal Polyp characterized by chronic

eosinophils inflammation:eosinophil + mast cell+neutrophil

cytokine & other mediators

sodium Uptake

polyp water retention


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Etiologi (Scott Brown,1997)

Bernoulli phenomen

Polysacharide change

Vasomotor imbalance Infection

Allergy


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Nasal obstructionpmain complaint

Rhinorea, Sneezing

Hyposmia/anosmia

Post nasal drip Headache

Epistaxis

Clinical Symptoms

(Scott Brown,1997)


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Clinical Signs

Outer Nose : broad face, froglike

Anterior Rhinoscopy : polypsappear smooth, pale colors likepearl, shiny, not painful to thetouch(Bhargava, 2002)


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DiagnosisDiagnosis

Major factor Facial pain / pressure

Nasal obstruction /blockage

Nasal discharge /purulence / discoloredpostnasal drainage

Hyposmia / anosmia

Purulence in nasal cavityon examination

Fever ( acute rhinosinusitisonly)

Minor factor Headache

Fever (all nonacute )

Halitosis Fatigue

Dental pain

Cough

Ear pain / pressure /

fullness


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DIAGNOSIS

GEJALA KLINIS :

1) Nasal congestion

2) Sneezing

3) Discharge4) Expansion of the nose

5) anosmia

6) Snoring / breathing through the mouth

7) Dizziness, epiphora, PND rarely8) Talk impaired

(Bhargava, 2002)


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PATHOGENESIS

Ostium

Occlusion

Inflammation of

thelamina propria

Changes ofthe mucosal

gas

metabolism

Inhibition of

ventilation &

drainage

Stagnation of

secretion

Change in the

composition & pH

ofsecretion

Ciliary &

epithelial

damage

Change ofthe

host milieu.

Bacterial become

path

oge

nic

Increased

mucosalthickness


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Radiology Examination(Scott Brown 1997)

Ro SPN

Head CT scan


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Therapy

conservative

- corticosteroid

- Antihistamin

- Antibiotic polipoid with suspected sinusitis

- Decongestan

Operation- Polypectomy

- Sinuscopy- Caldwell-Luc

- Ethmoidectomy


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Thank You


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POLIP NASI

Suatu pertumbuhan edematus dari mukosa saluran napas bagian

atas dapat tumbuh dari semua bagian mukosa kavum nasi dari sinus

ethmoidalis, cenderung multipel (Ballantyne, 1979)

Etiologi

ada 2 tipe1. Simpel : gambaran oedem dan hipertropi sub mukosa stroma

jaringan fibrosa dengan cairan serosa pada interseluler.

Permukaan ditutupi epitel kolumner bersiliap epitel

transisional dan skuamosaa. allergik : Sensitivitas inkomplet terhadap alergen mutipel,

eosinofilia + plasma sel ada jumlah besar

b. vasomotor: serupa dengan alergi, tidak ditemukan gejala

alergi


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c. Infeksi : bakteri atau virus

- akut : influensa, single, lembek, sedikit hemoragi

- kronik non spesifik : multipel

- kronik spesifik : mudah pecah, strawbery

d. Mixed infeksi alergi : infeksi sekunder pada alergi

vasomotor

2. Neoplastik

a. Benigna : neurofibroma, fibroma, glioma dsb

b. Maligna : carsinomatous, sarkomatous, sakit, timbulpendarahan, fragil


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Teori Pembentukan Polip

1. Teori Alergi

Alergi & polip hidungppersamaan histologis

terutama edema & eosinofilia dalam darah & sekret

hidung2. Teori Infeksi

Inflamasi kronisp infeksi kuman

3. Teori Obstruksi Mekanik

Obstruksi mekanikp deviasi septum, hiperplasi &

hipertrofi konka inferior atau mediap teori fenomena

Bernoullipperan penting pembentukan polip.


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4. Teori Gangguan Saraf

struktur polip tidak ada serabut-serabut sarafsensoris, vasomotor dan sekreto-motoris

5. Teori Supurasi Sinus

polip hidung timbul akibat supurasi sinus

6. Teori Pembuluh Darah & Limfepolip timbul karena perubahan pembyuluh darah

dalam mukosa hidung, serta infeksi yang berulang

akan menyebabkan periflebitis & perilimfangitis


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Proses pembentukan polip diduga melalui 2 tahap yaitu :

1. Tahap awal terjadi pertumbuhan mukosa berupa edem

dan infiltrasi sel-sel radang seperti eosinofil dan

neutrofil, yang disebabkan oleh alergi, infeksi,gangguan vasomotor & kombinasinnya

2. Tahap kedua mukosa yang udem tersebut akan

menonjol ke kavum nasi karena pengaruh mekanisdari lingkungannya yaitu tekanan negatif.


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Faktor penyebab Faktor pendukung

(aspirin intolerance, infeksi, cystic fibrosis) (Ig E dependent reaction)

Nerve damage Degranulasi mast sel

Denervasi vasomotor Pelepasan histamin

Kenaikan permeabilitas vaskuler

Oedema

Polip

Gambar 1. Etiopatogenesis Polip nasi (Mygind N, 1981)


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Pembentukan Menurut Histologi

1.P

olip EdematusMasa putih mengkilap, jernih, seperti buah anggur

paling sering ditemukan. Mikroskopis tampak sedikit jaringan

fibrous longgar terdapat pada ruangan yang penuh cairan edern

2. Polip Fibrous

Masa putih keruh kurang mengkilap

Mikroskopis jar. Fibrous lebih banyak daripada cairan edemnya.

3. Polip Vaskuler

Masa kemerahan

Mikroskopis jaringan dominan adanya jar. vaskuler disertai

gambaran edema perivaskuler.

Becker. Wet at. 1994pMassa bertangkai atau tak bertungkai

pada mukosa nasal atau sinus disebabkan oleh inflamasi.


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Nasal Polyposis

Pathophysiology: The pathogenesis of nasal

polyposis is unknown. Polyp development has

been linked to chronic inflammation,

autonomic nervous system dysfunction, and

genetic predisposition. Most theories consider

polyps to be the ultimate manifestation of

chronic inflammation; therefore, conditionsleading to chronic inflammation in the nasal

cavity can lead to nasal polyps.


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Most studies suggest that polyps are

associated more strongly with nonallergic

disease than with allergic disease.

Statistically, nasal polyps are more common

in patients with nonallergic asthma (13%)

than with allergic asthma (5%), and only

0.5% of 3000 atopic individuals have nasalpolyps.

Chronic Rhino Sinusitis With Suspect Ion Nasal Polyps New

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