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Chronische Rhinosinusitis mit Septumperforation

Differenzialdiagnostische Überlegungen

Chronic rhinosinusitis with septal perforation

Differential diagnostic considerations

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Zusammenfassung

Nasenseptumperforationen im Rahmen einer chronischen Rhinosinusitis mit oder ohne Schmerzen im Bereich des Nasenskeletts, denen kein Trauma oder ein operativer Eingriff vorausging, rücken einen M. Wegener in den Mittelpunkt differenzialdiagnostischer Überlegungen. Dabei helfen sowohl eine Schleimhautbiopsie als auch die Untersuchung der ANCA in der Differenzialdiagnostik häufig nicht weiter. Dem Hals-Nasen-Ohren-Arzt kommt in dieser Situation eine entscheidende Rolle zu, in Zusammenarbeit mit einem internistischen Rheumatologen eine Therapie mit Sulfatrimethoprim, ggf. auch mit Immunsuppressiva, zu initiieren, um den Befund zu stabilisieren und möglichst eine Systemausbreitung zu verhindern.

Abstract

Chronic rhinosinusitis together with nasal septal perforation with or without pain of the nasal skeleton and without previous trauma or surgery point toward the possible diagnosis of Wegener’s granulomatosis. However, nasal biopsy and serologic testing remain inconclusive in many patients. The otolaryngologist’s role in this situation is to initiate, in close cooperation with a rheumatologist, therapy with sulfatrimethoprim, as well as with immunosuppressants if necessary. This helps stabilize the symptomatology and may prevent progressive systemic disease.

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Authors and Affiliations

  1. HNO-Klinik und Poliklinik der Johannes-Gutenberg-Universität Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland

    W. Mann & P. Bumb

  2. Innere Medizin IV (Rheumatologie, klin. Immunologie, Nephrologie), HSK Wilhelm-Fresenius-Klinik, Wiesbaden, Deutschland

    E. Märker-Hermann

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  1. W. Mann
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  2. P. Bumb
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  3. E. Märker-Hermann
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Correspondence to W. Mann.

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Mann, W., Bumb, P. & Märker-Hermann, E. Chronische Rhinosinusitis mit Septumperforation. HNO 56, 1129–1134 (2008). https://doi.org/10.1007/s00106-008-1699-9

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  • DOI: https://doi.org/10.1007/s00106-008-1699-9

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