maju jurnal

7/28/2019 Maju Jurnal

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Silvia Hari Prastiwi FKUPN

Badzli Achmad FKUPN

Feliks FKUKRIDA

Pembimbing : dr.Khairan I, Sp.THT.KL


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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


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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




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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


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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.


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In the case of chronic rhinosinusitis,sometimes endoscopic sinus surgery isnecessary. Endoscopic sinus surgery has been

proven very successful in treating chronicrhinosinusitis.




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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


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Chronic Sinusitis in children :

a general overview

RL.Friedman, South Afr J EpidemiolInfect 2011;26(1):13-17


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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.


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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)


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Other symptoms include :

facial pain or pressure, a reduction in, or loss

of smell, and either endoscopic signs of polyps

and/or mucopurulent discharge


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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.


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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.


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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


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Anatomy and pathophysiology in

chronic

rhinosinusitis


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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


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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


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Chronic rhinosinusitis: clinical


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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.


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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.


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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


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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.


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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


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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.


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Symptoms of CR in children


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Clinical examination

The Nose

Outside the nose

Microbiology Imaging


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Management of CR

Chronic rhinosinusitis in the young child does

not have to be treated,as spontaneous

resolution is probable


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Treatment of CR

Antibiotics

Topical corticosteroids

Nasal douching Gastro-oesophageal reflux therapy

Local nasal decongestan

Surgical treatment


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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.

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