Air conditioning
Keseimbangan kepala
Menjaga suhu
Resonansi
Batas2 :
Anterior : permk fasial sinus maksila
Pterigomaksila
Medial : dinding lateral hidung
Superior : dasar orbita
Anatomi klinik
Vaskularisasi :
a. maksila interna
a. sphenopalatina
a. palatina mayor
meatus superior
Sinus Ethmoid
Batas batasnya
Lateral : Lamina papirasea ( mata)
Superior : Lamina kribosa
Posterior : Sinus sphenoid
Sinus Sphenoid
Letak : di dalam os sphenoid
Batas batas :
Superior : fosa cerebri media
Inferior : atap nasofaring
Lateral : sinus cavernosus &
a. carotis interna
Posterior : Pons / fosa cerebri
posterior
Komplek ostiomeatal
Angka absen
Lama sakit
Biaya pengobatan
PATOGENESIS
Dengan C.T. :
- Struktur sinus
- Kompleks ostiomeatal
Sinusitis disertai kelainan
kompleks ostiomeatal
Sinus sehat : bakteri aerob dan
anaerob dlm sinus
PATOGENESIS
SIKLUS SINUSITIS
Faktor predisposisi
Sekret kental
Sekret terbendung
Perubahan met. gas mukosa
Virus :
Corona virus, Rhinovrus, Influenza A, RSV
Bakteria aerob:
Streptokokus pnemoni,
H influenzae,
Moraxella catarhalis,
Streptokokus pyogenes,
Staphylokokus aureus
Bakteri anaerob
Diagnosis Sinusitis
Anamnesis
Sering dianggap pilek biasa yg tak
kunjung hilang
Ingus kental, sepanjang hari
Foetor ex nasi
Pemeriksaan fisik
Mayor Minor
Rhinorhe purulen demam
Drainase post nasal nyeri kepala dan sinus
Batuk foetor
Sinusitis : 2 mayor
1 mayor + 2 / lebih minor
Task Forse AAOA dan ARS ( 1997)
Gejala mayor :
Sakit pada muka ( pipi, dahi,
hidung)
Buntu hidung Gejala minor :
Ingus purulen Batuk, demam ( yang akut )
Gangguan penciuman Nyeri kepala
pem hidung : ingus purulen Nyeri geraham
Halitosis
SINUSITIS ? Tenggorok berlendir
Sinusitis Akut
Antibiotika spektrum luas
Dosis cukup, 10-21 hari
Mukolitik
PENGOBATAN
Sinusitis Kronik
- Antibiotika sesuai hasil kultur
- Dekongestan hidung
- Mukolitik minimal 10-14 hari
tak terkontrol ?
Allergic salute
EPIDEMIOLOGY
1. INTERMITTENT
Less than 4 days a week, or
Less than 4 weeks
2. PERSISTENT
More than 4 days a week, and
More than 4 weeks
SEVERITY OF THE DISEASE
allergen Y Y
Newly formed mediators
PLA2 AA + PAF
C.O 5 L.O
H1-R
Nociceptive Nerves Vascular wall
CNS Endothelium
Itch. (Vascular Permeability)
Systemic Reflexes
Sneeze Vasodilatation
Allergic Salute
Parasympathic Reflexes
Serous/Mucous Secretion
Glandular Exocytosis
Diagram of DIAGNOSTIC PROCEDURES
(1)
patients with AR symptoms
( history of illness + physical exam.)
(+) (-)
eosinophil on
AR with AR without nasal cytology
complications / complication
concomitant dis
(+) (-)
NARES
allergic non allergic
Rhinitis ? rhinitis
Diagnostic Procedures (2)
1. Anamnesis
Chief complain :
1. Itching nose
2. Sneezing : morning >>
3. Serous nasal secretion
4. Nasal obstruction at night
Diagnostic Procedures (3)
1. Anamnesis
The symptoms was environment related
History of other allergic manifestation of
patients and other allergic familial
manifestations
Duration of illness, severity of the disease
and the respond of the previous treatment
Diagnostic Procedures
2. Physical examination
Should be performed with appropriate
lighting and use of nasal speculum
normal oedema
Diagnostic Procedures (5)
2. Physical examination
Including :
1. Nasal passage ways
2. Nasal mucosa
3. Turbinates
4. Secretion
5. Septum
6. Polyps ?
7. Sinusitis ?
Diagnostic Procedures (6)
3. Nasal cytology
Large number of eosinophils may aid to
differentiate AR & NARES from other
Rhinitis
No consensus to routinely performed for
evaluation of rhinitis
Diagnostic Procedures (7)
4. Total serum Ig E
Neither very sensitive nor very specific
35 50 % AR Normal Ig E levels
Poor correlation with symptom and skin
testing result
Diagnostic Procedures (8)
Ease
Rapid performance
Low cost
( Prick test )
Allergy skin prick testing
OME
U R T infection
Allergic
Rhinitis Nasal
polyp
Bronkhial
Sinusitis
asthma
Comorbidity AR and Sinusitis
NARES
Atrophic Rhinitis
Idiopatic
Management of AR
Objectives :
relieving symptoms for improving QOL
to avoid triggering factor
to avoid / to treat complication
to change the natural history
Allergen elimination
EDUCATION
Explain what is allergic rhinitis / reaction
Explain the meaning of pos. allergic skin test
Confirm whether there is correlation between
allergen contact & rhinitis attack
Explain how to do allergen avoidance
Encourage to avoid the allergens
Globally important allergens
mites sources
mites pets : dogs
weed cockroaches
pollen
Pharmacological treatment
1. ANTIHISTAMINE
First line
Consider new antihistamine since :
Long acting more practical
No sedating normal daily activity
No / less cardiac effect
Broad spectrum effects
Except :
Patient doesnt mind sedation effect
It is not available
Can not be afforded
Classic antihistamine can be considered
2. NASAL DECONGESTANT
Indicated in patient with prominent nasal
obstruction complaint
As addition / combination with A H
Note :
Patients should be well informed how to use
Symptoms relieve is not directly achieved
Non-pharmacological therapy
Allergen avoidance measure
Non-pharmacological therapy
Allergen avoidance measure
Environment control
If inadequate
control If resistent
If resistent
Nasal blockage
Rhinorrhea
Antihistamine and
Oral / nasal Nasal ipratropium
decongestant bromide
Or
Short course oral
steroid If persistent
If inadequate control
Consider
Immunotherapy
Further examination &
consider immunotherapy
Or
Surgical turbinate reduction