. Prof Livije KalogjeraENT ClinicZagreb .

Dražen Shejbal ENT depCity hospital Pakrac

. Kojić Psychiatry depSiniša Stevanović ENT depCity hospital Virovitica

.

NASAL COMPLIANCE ON PATIENT WITH PTSD

.We are here

PTSD

• Trigger- enviromental event

• Abnormal or disordered reaction to stress

• Amygdala and hyppocampus

BERSERK

“Tight me, my friends, because When I will hear this warrior song, I lost consciousness and I will hurt anyone

AMOK

If you accepted a stress impulse,you are going run to the street and try to kill so many people with your short knife and pedestrians try tostop you with (longer than your knife)wooden pitch fork.( killing animal is strongly forbidden)

MAD DOG WHO WANT S TO DIE

If you a Crow warrior, and you dissappointing in combat You have two possibilities

1. Became a “Mad dog who wants to die” and going in Another combat without Armours, only with howl

2. Became a woman

NOWADAY s

• PTSD expression is very painfull for patients, family and society

• PTSD going to most popular in modern science and entertaiment

Nowaday s we know (two way) pathways

WELL KNOWN

Olfactory n.

Trigeminal

Sympathetic

parasymphatetic

HYPOTHETIC

Cranial nerve zero

Vomeronasal

Nose shape

HYPOTHESIS

• PTSD aggravate sympotms of CRS

• Similar like chronic fatigue syndroma

METHODS

• 15 patinets with CRS• 15 patients with PTSD/CRS• either obstruction or hypersecretion/postnasal

drip, • + hyposmia or facial pressure/headache

longer than 3 months, confirmed either by endoscopy and/or CT score Lund-Mackay greater than 5.

METHODS

• Medical outcome survey short form SF-36

• Sinonasal outcome test 22 SNOT 22

• VAS

44

46

48

50

52

54

56

58

60

SNOT 22

CRS

PTSD/CRS

-50

-40

-30

-20

-10

0

10

20

PTSP/CRSGROUP

.12!

Nasalsymptoms

EmotionalSleepfatigue

-20

-10

0

10

20

30

40

50

CRS GROUP

EmotionalSleepfatigue

Nasalsymptoms

.12!

5849

5 most important items CRS PTSD/CRS

3. Runny nose 13. difficulty falling asleep 4. Nasal obstruction 14. wake up at night

0

10

20

30

40

50

60

70

SF 36

CRS

PTSD/CRS

0

10

20

30

40

50

60

70

80

90

CRS PTSD/CRS

Physicalfunction

Limit.Physicalhealth

Limit.Emo.Probl.

Energyfatigue

EmoWellbeing

SocialFunc.

pain General health

64 32

0

10

20

30

40

50

60

¸VAS SCORE

CRS

PTSD/CRS

39 56

0

10

20

30

40

50

60

70

80

CRS PTSD/CRS

Nasal crusts Vomiting Diarrhea

01020304050607080

Hea

dac

he

Nas

alo

bst

ruct

ion

Ru

nn

y n

ose

Dis

char

ge

Fee

lin

g o

ffu

lln

ess

CRS

PTSP/CRS

VAS

VAS

0

10

20

30

40

50

60

70

Facial pain Tooth pain Generalhealth

Tiredness

CRS

PTSP/CRS

Discussion PTSD/CRS vrs. CRS

• Basic research• Questionarre• education

• Advanced• interview

Discussion

• Basic reserch vrs. Advanced

• Quoestionarre vrs. Interview

• Education between group?

• Serching for benefit between group

• PTSD-drugs- nasal congestion