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