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单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,Acute,and,Chronic,Sinusitis,(Rhinosinusitis),（急慢性鼻窦炎,/,鼻,-,鼻窦炎）,The paranasal sinuses are a group of air containing spaces that surround the nasal cavity(four pairs),Each sinus is named for the bone in which it is located:,Maxillary(one sinus located in each cheek),Ethmoid(approximately 6-12 small sinuses per side,located between the eyes),Frontal(one sinus per side,located in the forehead),Sphenoid(one sinus per side,located behind the ethmoid sinuses,near the middle of the skull),Anatomy,The drainage of the sinuses,Frontal,maxillary,anterior ethmiod,middle meatus,Posterior ethmoid superior meatus,Sphenoid sphenoethmoidal recess,ostiomeatal complex,OMC(,窦口鼻道复合体,),EPOS 2012,CPOS 2012,Rhinology.,2012 Mar;50(1):1-12.,EPOS 2012:European position paper on rhinosinusitis and nasal polyps 2012.A summary for otorhinolaryngologists.,Fokkens WJ,Lund VJ,Mullol J,Bachert C,Alobid I,Baroody F,Cohen N,Cervin A,Douglas R,Gevaerts P,Georgalas C,Goossens H,Harvey R,Hellings P,Hopkins C,Jones N,Joos G,Kalogjera L,Kern B,Kowalski M,Price D,Riechelmann H,Schlosser R,Senior B,Thomas M,Toskala E,Voegels R,Wang DY,Wormald PJ,.,EPOS 2012,Sinusitis/Rhinosinusitis,Rhino-sinusitis,refers to the inflammation of the tissues of the nose(rhino-)and the sinuses.The inflammatory process involving one or more of the paranasal sinuses.,Maxillary sinusitis is the most common type of sinusitis.,Sinusitis is rare in children younger than 1 year because the sinuses are poorly developed before that age.,Classification,Acute Rhinosinusitis(ARS),:lasting less than 12 weeks,Chronic Rhinosinusitis(CRS),:lasting more than 12 weeks,EPOS 2012,D,efinition,Acute rhinosinusitis:,38,),Elevated ESR/CRP,Double sickening(i.e.a deterioration after an initial milder phase of illness).,ARS Classification in EPOS 2012,EPOS 2012,with symptom free intervals if the problem is recurrent,with validation by telephone or interview.,Chronic Rhinosinusitis without nasal polyps(CRSsNP),Chronic Rhinosinusitis with nasal polyps(CRSwNP),CRS Classification in EPOS 2012,Causes and,Pathogenesis,A.,Bacteria:,Sinusitis is caused by a variety of bacteria such as streptococci,staphylococci,pneumococci and Haemophilus.,B.,Viruses:,Influenzae viruses such as the influenza and the parainfluenza virus,C.,Fungi:,less commonly by fungi such as aspergillus.,Sinusitis,Predisposing factors of ARS,Factors associated with ARS,：,Environmental Exposures,Anatomical factors:,In patients with recurrent ARS,anatomical variations including Haller cells and septal deviation,nasal polyps,septal deviation,and choanal obstruction by benign adenoid tissue,or odontogenic sources of infections should be considered.,Allergy,Ciliary impairment:,Ciliary function is diminished during viral and bacterial rhinosinusitis.Exposure to cigarette smoke and allergic inflammation has also been shown to impair ciliary function,although research is required to understand these processes further.,Primary Cilia Dyskinesia(PCD),Smoking,Laryngopharyngeal reflux,Anxiety and depression,Drug resistance,Concomitant Chronic Disease,EPOS 2012,Predisposing factors of CRS,Factors associated with CRS,：,Ciliary impairment,Allergy,Asthma,Aspirin sensitivity:,In patients with aspirin sensitivity,36-96%have CRSwNP.,Immunocompromised state,Genetic factors,Pregnancy and endocrine state,Local host factors:,There is no evidence for a causal correlation,between nasal anatomic variations in general and the incidence of CRS,Biofilms,Environmental factors,Iatrogenic factors,Helicobacter pylori and laryngopharyngeal reflux,“Osteitis”,EPOS 2012,Inflammatory mechanisms of,CRSwNP or CRSsNP,CRS can be typically described as a dysfunctional host-environment interaction at the site of interface,which occurs in the nose and paranasal sinuses,fungal hypothesis,staphylococcal,superantigen hypothesis,immune barrier hypothesis,biofilms,EPOS 2012,Symptoms and Signs of Acute Sinusitis,A,.General Symptoms,Acute Sinusitis,malaise,mild fever,headache,B,.Local Symptoms and signs:,a.,a stuffy or runny nose,b.colored,discharge:,from the nose,c.,Pain or headache:,persistent,dull pain,or swelling around the eyes or around the cheekbones,or sensation of pressure in head,d.,smells bad,Symptoms and Signs,Acute Sinusitis,Maxillary sinusitis,may in the maxillary area of the face,toothache,and frontal headache.,Frontal sinusitis,causes frontal pain and headache.,Ethmoid sinusitis,cause pain behind the eyes and frontal headache.,Sphenoid sinusitis,cause pain in the occipital region.,Rhinogenic headache,Different sinusitis has different headache,Symptoms of chronic sinusitis,Blocked nose(nasal obstruction):,the most prominent symptom,usually a One or more of the following may also occur:,Runny nose,:,the discharge may be green/yellow.,Reduced sense of smell,.,Pain:,over the affected sinus.However,pain is often not a main feature of chronic sinusitis(unlike acute sinusitis).In many case
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