fig 1 anatomy. fs frontal sinus; up uncinate process; it inferior turbinate; mt middle turbinate; ms...
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Fig 1
Anatomy
FS frontal sinus; UP uncinate process; IT inferior turbinate; MT middle turbinate; MS maxillary sinus; AE anterior ethmoid; PE posterior ethmoid
FS
UP
IT
MT
MS
AEPE
AE anterior ethmoid; PE posterior ethmoid; SS sphenoid sinus;
AE
PE
SS
Fig 3
Chemokines
Massive polyclonal lymphocyte activation
TB
Cytokines Hyper IgE
Eosinophils ( apoptosis)
Superantigens
Epithelial damage (barrier dysfunction)
IL-5
ECP
Albumin
Eotaxin
Polyclonal IgEchronic microbial
trigger
Fig 4
Diagnosis: Nasal polyposis
Topical GCS bid., aftersymptom control OD for 3 months
Oral GCS (decreasing scheme), topical GCS bid., evtl. antibiotics
Not obstructiv Obstructiv, anosmia, asthma
Symptom control ?
Combination treatment necessarySurgeryLongterm therapy
with topical GCS
Yes No
YesNo
Fig 5
Patient VGC Three month of topical steroid treatment: Before treatment
Right side left side
After treatment: right side left side
Symptoms: Obstructed nasal passage, secretion,impaired sense ofsmell
Symptoms: mild secretion, nasal passage free
Fig 6
Ostium
Occlusion
Inhibition of ventilation and drainage
Stagnation of secretion
Change in the composition and pH of
secretion
Change of the mucosal gas metabolism
Ciliary and epithelial damage
Change of the host milieuBacteria become
pathogenic
Inflammation of the lamina propria
Increased mucosal thickness
Fig 7
Common cold or acute rhinosinusitis?
0 5 10 15
Days
Sym
ptom
s Viral Rhinitis/Common cold
Acute Rhinosinusitis/Increase in symptoms
after 5 daysAcute Rhinosinusitis/
Symptoms exeed 10 days
Fig 8
Acute rhinosinusitis may be diagnosed when a common cold gets more symptomatic after 5 days or persists longer than 10 days. Less then 4 % of the patients have a bacterial form of ARS, most of ARS episodes are viral.
Orbital complication of an acute ethmoiditis in a 9-yearold girl. Subperiostal abscess.
Mit freundlicher Genehmigung von C. Bachert Fig 9