• Chris de Souza
  • Rosemarie A. de Souza


■ Inflammation causes changes in the nasal and sinus mucosa.

■ Edema occurs and this is followed by a transudate. The effect of edema is that it causes obstruction of the ostia of the sinuses, thereby causing impairment in the drainage of secretions.

■ The quality of the mucus changes.

■ Inflammation causes the cilia to become paralyzed. This may be temporary or sustained, depending upon the severity of damage.

■ The outcome of all these changes is that mucus collects within the sinuses and stasis occurs.

■ Initially, the secretions are sterile. They can soon get contaminated with bacteria by nose-blowing, which forces the bacteria into the sinuses from the nasal cavity.

■ This results in an acute bacterial infection within the sinuses.

■ This can resolve either spontaneously or with the aid of medication. If it does not resolve it can result in chronic disease.

■ The criteria for the diagnosis of acute (presumed bacterial) rhinosinusitis include having symptoms that persist for 10 days up to a maximum of 24 days.

■ Fever should be present. Symptoms for diagnosis should include anterior and/or posterior nasal discharge, nasal obstruction, and facial pain.

■ Objective documentation should include a nasal airway examination for purulent discharge and radiographic evidence of acute rhinosinusitis.

■ Both nasal endoscopy and CT are objective measures that can increase the accuracy of the chronic rhinosinusitis (CRS) diagnosis.

■ Nasal endoscopic observation of pus, polyps or other disease can help confirm a diagnosis of CRS.

■ For areas that cannot be observed with nasal endoscopy, CT can be useful in helping to diagnose disease.

■ The use of combining symptoms, findings on nasal endoscopy, and the findings on CT scans can reliably and accurately diagnose and treat CRS.

■ Newer instruments and powered tools are now available making mucosal preservation possible.

■ Areas in the healing sinus cavity that demonstrate polypoid mucosa are most likely the areas that will demonstrate persistent inflammation. This is likely due to an osteitis reaction.

■ Aggressive postoperative debridement of devitalized bone in these areas will result in improved epithelialization of the sinus cavity. Simultaneously, equally aggressive management of infection and inflammation is needed.

■ Long-term antibiotics and long-term application of topical steroids are appropriate for the management of these conditions.

■ Literature is accumulating in support of the use of topical steroids, which are given preoperatively as well as postoperatively.

■ Details of endoscopic sinus surgery are provided elsewhere in this textbook.

■ It has been found that a definite relationship exists among allergy, bronchial asthma, and RS.

■ The allergic component must be treated appropriately if the management of RS is to be successful.

■ Similarly, successful sinus surgery results in a better ability to control bronchial asthma.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2009

Authors and Affiliations

  • Chris de Souza
    • 1
    • 2
    • 3
  • Rosemarie A. de Souza
    • 4
  1. 1.State University of New YorkBrooklynUSA
  2. 2.Health Sciences CenterLouisiana State UniversityShreveportUSA
  3. 3.The Tata Memorial Hospital, Lilavati Hospital, Holy Family HospitalMumbaiIndia
  4. 4.Department of Internal MedicineSion Hospital and LTMG Medical CollegeMumbaiIndia

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