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UPDATE MANAGEMENGANGGUAN HIDUNG &SINUS PARANASALDR. SARI WULAN DWI SUTANEGARA, SPTHT-KL(K),FICS
Fungsi hidungJalan napasPengatur kondisi udaraPenyaring dan pelindungIndra penghiduResonansi suaraProses bicaraRefleks nasal
PREVALENCE OF THE UPPERAIRWAY DISEASESCommon,especially inchildrenCommoncold/Viral rhinitis2:Up to 7-10/yr (children)Up to 2-5/yr 16%Snoring/sleep apnea12-26%1. Abrishamiet al. (2010)2.EPOS (2007)3. ARIA 1997Nasal polyps20.5-4.3%
PREFACE : CLINICAL DEFINITION Rhinosinusitis is defined as inflammation of the nose and the paranasal sinuses resultingin: 2 SYMPTOMS Blockage/congestion Discharge anterior/postnasal drip Loss of smell Facial pain/pressure cough (ped)EAACI. Rhinol Suppl. 2005;18:1.Fokkens et al. Allergy. 2005;60:583.
RHINOSINUSITIS: CLINICAL DEFINITION Rhinosinusitis is defined as inflammation of the nose and the paranasal sinuses resultingin: 2 SYMPTOMS Blockage/congestion Discharge anterior/postnasal drip Loss of smell Facial pain/pressure cough (ped)EAACI. Rhinol Suppl. 2005;18:1.Fokkens et al. Allergy. 2005;60:583.AND eitherENDOSCOPIC SIGNS of Polyps or Mucopurulent discharge from middlemeatus or Edema/mucosal obstruction primarily inmiddle meatusORCT CHANGES Mucosal changes within ostiomeatalcomplex and/or sinuses
Faktor predisposisi Obstruksi mekanik: deviasi septum, hipertrofikonka, tumor, benda asing, obstruksi kompleksostiomeatal, polip nasi, hipertrofi adenoid Rinitis alergika: edema mukosa dan sekret yangbanyak merupakan media yang baik untuktumbuhnya bakteri Polusi lingkungan: dapat terjadi perubahanmukosa dan kerusakan silia
ACUTE RHINOSINUSITIS: DEFINITIONSudden onset of 2 or more of the major symptoms( 12mgg)Facial s of smellAnteriordischarge/postnasal dripFokkens et al. EP3OS Guidelines. Rhinol Suppl. 2005;18:1.
RHINOSINUSITIS: CLINICAL DEFINITIONDuration Acute/intermittent 12 weeks Complete resolutionof symptoms Persistent/chronic 12 weeks No complete resolutionof symptomsEAACI. Rhinol Suppl. 2005;18:1.Fokkens et al. Allergy. 2005;60:583.
RHINOSINUSITIS:INTENSITY OF SYMPTOMS AND SIGNS Acute rhinosinusitis Adults Chronic rhinosinusitis Children Recurrent acute rhinosinusitisIntensity of symptomsand signs Acute exacerbations of chronicrhinosinusitisAcute rhinosinusitisChronic rhinosinusitisRecurrent acute rhinosinusitisAcute exacerbationof chronic rhinosinusitis12Weeks
ACUTE RHINOSINUSITIS CONTINUUMSpectrum of acute rhinosinusitis based on clinicalcriteriaIncreasing symptom severityMildrhinosinusitisModerate to severe acuterhinosinusitis Allergic Viral Bacterial is
BACTERIAL INFECTION IN ACUTE RHINOSINUSITIS Antibiotics for acute rhinosinusitis are a common prescription in primary care Acute bacterial rhinosinusitis is usually a secondary infection resulting fromsinus obstruction following acute viral URI Streptococcus pneumoniaeMost common pathogens Haemophilus influenzae Acute bacterial and viral rhinosinusitis are difficult to differentiate on clinicalgroundsURI upper respiratory infection.Hickner et al. Ann Intern Med. 2001;134:498.
Diagnosis penyebab obstruksi nasi:1. Rinitis akut7.Fraktur hidung2. Rhinitis kronis allergika8.Valvular kolaps9.Atresia koana10.Korpus alienum11.Massa pd hidung &nasofaring3. Sinusitis paranasalis4. Deviasi septi5. Rinitis vasomotor6. Hematoma septi/absessepti
ACUTE RHINOSINUSITIS BACTERIAL INFECTION? Estimated 1 billion viral URIs occur each year in US Only 0.2%-2% of viral URIs are estimated to be complicated by bacterialrhinosinusitis 40% of acute bacterial infections resolve spontaneously 85%-98% of patients with acute rhinosinusitis are needlessly prescribedan antibiotic by their primary care physiciansURI upper respiratory infection.Fokkens et al. EP3OS Guidelines. Rhinol Suppl. 2005;18:1.Meltzer et al. J Allergy Clin Immunol. 2004;114(suppl):155.
SNOT-22 menilai kualitas hidup penderita rinosinusitis. modifikasi dari Rhinosinusitis Outcome Measure (RSOM) dan SNOT-20. 4 kategori utama : gejala hidung, gejala telinga dan wajah, kualitas tidur perubahan psikologis
VAS / VISUAL ANALOGUE SCALERingan : 0-3Sedang : 3-7Berat : 7-10EPOS. Rhinology, Supplement 20, 2007; www.rhinologyjournal.com;www.eaaci.net
OBJECTIVES OF MEDICAL TREATMENT OFACUTE RHINOSINUSITISMultifacetedtreatment regimen Eliminate infection Reduce inflammation Improve symptoms
ACUTE RHINOSINUSITIS TREATMENT Acute rhinosinusitis is usually a self-limiting disease Treatment can be symptomatic in mild disease Antibiotics should be reserved only for persistent moderate to severedisease Early treatment of inflammation allows sinus drainage and helps to preventbacterial infection Antibiotic prescriptions should be based on local resistance patterns Local corticosteroids are an effective therapyEAACI. Rhinol Suppl. 2005;18:1.Fokkens et al. Allergy. 2005;60:583.
TREATMENT OPTIONS FOR ACUTERHINOSINUSITISAgentPrimary ActionAntibioticsEliminate (bacterial) infectionSaline lavageRemove secretions, promote nasal mucosalhealingOral and topicaldecongestantsReduce congestion and improve drainageMucolyticsThin mucus secretions, reduce mucus stasis,and promote clearingAntihistaminesDecrease production of mucus and diminishrhinorrheaIntranasal corticosteroidsReduce inflammation and improve associatedsymptomsEAACI. Rhinol Suppl. 2005;18:1.Fokkens et al. Allergy. 2005;60:583.
EUROPEAN GUIDELINES FOR MANAGEMENTOF ACUTE/INTERMITTENT RHINOSINUSITIS Recommendations for GPs Mild symptoms: symptomatic relief, analgesics Moderate/severe symptoms: additional topical steroids Recommendations for ENT specialists Mild symptoms: symptomatic relief, analgesics Moderate/severe symptoms Antibiotic therapy according to national recommendationsTopical steroids /- decongestion of the middle meatus /- microbiology culture/resistance pattern Persistent moderate disease: second course of antibiotics Persistent severe disease: hospitalization, microbiology culture, changeantibiotic and route of administration, CT scanEAACI. Rhinol Suppl. 2005;18:1.Fokkens et al. Allergy. 2005;60:583.
LEVEL OF EVIDENCE AND GRADE OFRECOMMENDATION FOR TREATMENT OFACUTE/INTERMITTENT RHINOSINUSITISLevel ofEvidenceRecommendationRelevanceAntibioticIaAYes: after 5 daysor in severecasesTopical steroidIbBYesTopical steroid antibioticIbAYesTherapyIa: Evidence from meta-analysis of randomized,EAACI. Rhinol Suppl. 2005;18:1.controlledFokkenset al.trials.Allergy. 2005;60:583.Ib: Evidence from at least 1 randomized, controlled trial.A: Consistent level 1 studies.B: Consistent level 2 or 3 studies or extrapolationsfrom level 1 studies.
EPOS, 2020 Rhinology. 2020 Suppl. 29: 1-464.
SKEMA PENATALAKSANAAN RINOSINUSITIS AKUT PADA DEWASAUNTUK PELAYANAN KESEHATAN PRIMEREPOS, 2020 Rhinology. 2020 Suppl. 29: 1-464.
ACUTE RHINOSINUSITIS IN ADULT & CHILDRENMANAGEMENT SCHEME FOR ENT SPECIALISTRefferal from GP & paediatricianModerate symptomNo improvement 14 daystreatmentsevere symptomNo improvement 48 hourstreatmentReconsider diagnosisNasal endoscopyConsider imagingConsider cultureConsider hospitalizationNasal endoscopyCultureImaginghospitalisationNasal endoscopyCultureImagingNasal corticosteroidOral AntibiotikaNasal corticosteroidConsider Iv AntibiotikaConsider oral steroidConsider surgeryIv antibiotikaAnd/or surgerycomplication
TAKE HOME PAGERS mrp inflamasi pada mukosa hidung & sinus paranasalPenyebabnya : multifaktorOnset : akut kronis, terkontrol / tak terkontrolTujuan penanganan : menghilangkan inflamasi / infeksi,mencegah komplikasi & meningkatkan QoL penderitaSemoga bermanfaat
SUKSMA
Obstruksi mekanik: deviasi septum, hipertrofi konka, tumor, benda asing, obstruksi kompleks ostiomeatal, polip nasi, hipertrofi adenoid Rinitis alergika: edema mukosa dan sekret yang banyak merupakan media yang baik untuk tumbuhnya bakteri Polusi lingk
