Chronic Rhinosinusitis

1. CRS Dr. Prahlada N.B Tame YETI with NETI! Yeti Tamer ! Prahlada N.B

2. CRS - Deﬁnition

3. Classiﬁcation • CRSsNP • Fibrosis • High interferon-Gamma • High tumor Growth factor -B • High T-reg activity • TH1 Polarization • CRSwNP • Tissue Edema • High tissue Eosinophilia • High IgE • High IL-5 & IL13 • Low T-reg activity • TH2 Polarization

4. University of Pennsylvania Smell Identiﬁcation Test (UPSIT) Richard L Doty Et. al.

5. DNE - Lund-Kennedy Endoscopy Score 0 1 2 Polyp Asbent Only in MM Beyond MM Edema Absent Mild Severe Discharge Absent Clear thin discharge Purulent Scarring Absent Mild Severe Crusting Asbent Mild Severe Kennedy & Lund: Endoscopic grading - Quantiﬁcation for staging sinusitis

6. Management Strategy

7. Systemic Steroids: Poetker et al

8. Antibiotic therapy

9. CRS & Asthma • UNIFIED AIRWAY • Same pathophysiology • ASTHMA - CRS • CRSwNP - 60% • CRS Treatment - Severity of Asthma • Asthma: -ve Predictor for ESS in CRSwNP

10. CRSwNP Saline Irrigation Topical Corticosteroids Oral Corticosteroids Oral Antibiotics/C & S/ Doxycycline Montelukast

11. Saline Irrigation Topical Steroids Oral Antibiotics – C & S - Macrolides CRSsNP

12. Direct FESS Impending IC/IO Compli- cations Fungal Balls AFS Odonto- genic CRS Mucocoeles Anatomical Variants Polyps (Grade 2/3) Systemic Steroid Dependency

13. FESS

14. Diet Immune modulation Anti-allergy MucolyticsIndigenous Off-label Nasal irrigaitons Vit, Mineral etc., Emerging Strategies Managing Microﬂora Herbal Immune enhancers Homeopathy Chinese!

15. Off-the label! - Budesonide - 0.5 mg - Dexa. Ophth. Drops 0.1% - Prednisolone Ophth. Drops 1% - Cipro/Dexa Otic Drops 0.3/0.1% + - 250 ml Normal Saline

16. Vit D • Augment innate & adaptive immune responses. • Reduces ﬁbroblast proliferation in polyps • Increases sensitivity to Corticosteroids • Deﬁciency: • Severe CRSwNP & AFRS • Severe Bone Erosion • Vit D Supplements.

17. FACEMAX 2 23, 24, 25 JUNE 2017

18. Thank you