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

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

2. CRS - Definition

5. 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

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

10. 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

11. Management
Strategy

16. Systemic Steroids: Poetker et al

18. Antibiotic therapy

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

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

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

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

23. FESS

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

26. 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

28. 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.

31. FACEMAX 2
23, 24, 25 JUNE 2017

32. Thank you