Management Sinusitis dan Polip Nasi

Hamsu Kadriyan

RinosinusitisRinosinusitis merupakan inflamasi yang

melibatkan mukosa hidung dan mukosa sinus paranasalis

Faktor predisposisiViral/bakterial ISPAEdema mukosa karena Rinitis AlergiFaktor anatomis hidung dan sinus

Prevalensi Sinusitis Akut

Prevalensi Sinusitis Kronis

National centered for health statistic (USA), 2009

Anatomi Sinus Paranasalis

Patofisiologi Sinusitis Akut

Patogenesis Sinusitis

Spektrum Sinusitis Kronis

Patofisiologi Rinosinusitis Kronis

Klasifikasi RinosinusitisClassification Duration History, examination Special notesAcute Up to four weeks The presence of two

or more Major signs and symptoms; one Major and two or more Minor signs or symptoms; or nasal purulence on examination*

Fever or facial pain/pressure does not constitute a suggestive history in the absence of other nasal signs and symptoms. Consider acute bacterial rhinosinusitis if symptoms worsen after five days, if symptoms persist for 10 days or with symptoms out of proportion to those typically associated with viral infection.

Subacute Four to < 12 weeks Same Complete resolution after effective medical therapy.

Recurrent acute

Four or more episodes per year with each episode of at least seven days' duration; absence of intervening signs and symptoms

Same —

Chronic 12 weeks or more Same Facial pain/pressure does not constitute a suggestive history in the absence of other nasal signs and symptoms.

Gejala Rinitis akut, rinitis alergi dan Sinusitis

Gejala Sinusitis Kronis

Tanda dan gejala sinusitisMajor Minor

Facial pain/pressure/fullness*Nasal obstruction/blockageNasal or postnasal discharge/purulence (by history or physical examination)Hyposmia/anosmiaFever (in acute rhinosinusitis only)†

HeadachesFever (other than acute rhinosinusitis)HalitosisFatigueDental painCoughEar pain/pressure/fullnes

Diagnosis Sinusitis

PenatalaksanaanKendalikan faktor pencetus

Alergi sesuai penatalaksaan alergi Antihistamin : fexofenadin, dll Dekongestan : Pseudoefedrin Steroid topikal : Triamcinolon, dll

Untuk infeksi sinusi, pemilihan antibiotik sesuai diagram

Penatalaksanaan Sinusitis

Polip NasiDefinisi

Massa lunak bertangkai, banyak mengandung cairan

Manifestasi dari sinusitis, rinitis alergi dll

EtiologiAdanya peradangan kronik dan berulangGangguan keseimbangan vasomotorPeningkatan tekanan cairan interstitial dan

edema mukosa hidung

Patogenesis Edema mukosa meatus medius stroma

terisi cairan interseluler mukosa polipoid

Bila berlanjut pembesaran mukosa polipoid ke dalam cavum nasi membentuk tangkai polip

Sumbatan polip infeksi sinusMikroskopis epitel polip sama dg

mukosa hidung hanya submukosanya udem, PD minimal, syaraf (-)

DiagnosisKeluhan

Hidung tersumbat terus menerus, semakin lama semakin berat

Sulit membuang ingus post nasal dripsHiposmia atau anosmiaSuara sengau, sakit kepala

Pemeriksaan Massa putih mengkilap di cavum nasiPerlu pemeriksaan radiologis

KlasifikasiStadium 1 : Polip terbatas pada meatus mediaStadium 2 : Polip sudah tumbuh sampai cavum nasiSatdium 3 : Polip massive, sudah memenuhi cavum nasi

TerapiMedikamentosa

Untuk polip kecil (stadium 1-2) steroid sistemik atau topikal

Bila ada infeksi antibiotikKontrol faktor penyebab

OperasiPolip besar (stadium 2-3) polipektomiMelibatkan sinus paranasalis CWL, antral

window, ethmoidektomi dst