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Chronic Rhinosinusitis

Current concepts and future trends in the Management of Chronic Rhinosinusitis.

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Chronic Rhinosinusitis

  1. 1. CRS Dr. Prahlada N.B Tame YETI with NETI! Yeti Tamer ! Prahlada N.B
  2. 2. CRS - Definition
  3. 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. 4. University of Pennsylvania Smell Identification Test (UPSIT) Richard L Doty Et. al.
  5. 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. 6. Management Strategy
  7. 7. Systemic Steroids: Poetker et al
  8. 8. Antibiotic therapy
  9. 9. CRS & Asthma • UNIFIED AIRWAY • Same pathophysiology • ASTHMA - CRS • CRSwNP - 60% • CRS Treatment - Severity of Asthma • Asthma: -ve Predictor for ESS in CRSwNP
  10. 10. CRSwNP Saline Irrigation Topical Corticosteroids Oral Corticosteroids Oral Antibiotics/C & S/ Doxycycline Montelukast
  11. 11. Saline Irrigation Topical Steroids Oral Antibiotics – C & S - Macrolides CRSsNP
  12. 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. 13. FESS
  14. 14. Diet Immune modulation Anti-allergy MucolyticsIndigenous Off-label Nasal irrigaitons Vit, Mineral etc., Emerging Strategies Managing Microflora Herbal Immune enhancers Homeopathy Chinese!
  15. 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. 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. 17. FACEMAX 2 23, 24, 25 JUNE 2017
  18. 18. Thank you

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