Ngày tải lên :
19/02/2014, 08:20
... nolLaryngolSupp2004May;193:3‐5.
10.KoyA,CoonsSJ.Self‐reportedchronicconditions
and EQ‐5Dindexscoresin the USadultpopulation.CurrMed
ResOpin2006Oct;22(10):2065‐71.
11.RayNF,BaraniukJN,ThamerM,RinehartCS,GergenPJ,KalinerM,JosephsS,PungYH.Healthcareexpenditures
for sinusitisin1996:ContributionsofAsthma,Rhinitis and otherAirwayDisorders.JAllergy
ClinImmunol1999
Mar;103(3Pt1):408‐14.
12.FacerGW,KernEB.Sinusitis:currentconcepts and management.In:BaileyBJ,editor.Head and NeckSurgery–
Otolaryngology.Philadelphia,PA:JBLippincott,1993.
13.ReulerJB,LucasLM,KumarKL.Sinusitis.Areview for generalists.WestJMed1995;163:40–48.
14.StammbergerH.
FunctionalEndoscopicSinusSurgery.Philadelphia,PA:BCDecker,1991.
36
LABORATORYEXAMINATION
Severallaboratorytestsmaybeconsideredin the workupofpatientswithrefractorychronicorrecurrent
acutesinusitis.Theseincludecompletebloodcount(CBC)withdifferential, and serumimmunoglobulintests,.Also,
sweatchloridetestingmaybeperformedtoruleoutcysticfibrosis,especiallyinchildrenwithnasalpolyps
or
chronicorrecurrentsinusitis.
RADIOLOGY
WhenanX‐raymustbedone, the imagingprocedureofchoiceis the computerizedtomography(CT)scan,
whichisrecommendedprimarilyinevaluating the extent and severityofdiseaseinchronicsinusitis and in
complicatedsinusitis(Fıgs.5–6).SinusCTscans and
MRIscanshavealloweddoctorstodirectlyvisualize the
pathologywithin the sinuses and depictnormal and abnormalanatomy.Thesetoolsareanimmenseimprovement
overplainfilmsinusdepiction and cangivereliablereproducibleinformation.(14‐24)
The CTscanisnow the goldstandard and hasreplaced
plainX‐raysas the imagingstudyofchoiceinchronic
sinusitis.CTscans,especially the coronalimages,areusefulinimaging the underlyingsinusanatomyindetail. The
combinationofnasalendoscopy and CTscansin the evaluationofchronicsinusdiseaseallows for precisediagnosis
and treatment.
CTscan
isaninvaluabletoolin the evaluationof the sinuses.Oneof the primarystrengthsofsinusCT
imagingisimprovedcontrastresolution:thatistosay, the abilitytodepictbone/air and bone/softtissueinterfaces.
AnotherprimarystrengthofCTscansisimprovedspatialresolution:thatis, the ability
todepictverysmall
structures. The surgeon and the radiologist,workingtogether,hopetoobtainnumerousspecificpiecesof
informationfromCTscansofpatientswithsinusdisease.Thisinformationincludes the statusof the bonywalls, the
natureofmaterialwithin the sinuses, and the statusof the adjacentnormal
structuressuchas the eye,brain, and
midface. The statusof the bonywallsof the sinusesisimportantbothinbenignsinusdisease and alsoinsinus
tumors.Ittakesnewer‐generationscannersonlyminutestoprovidehigh‐resolutionimagesoftissueslabsthatare
26
fewdayspriortotravel.Medicalcareshouldbeavailableat the patient’sdestinationincasesinusitisor ...
9
The sinusescommunicatewith the nasalcavityvianarrowopeningscalledostia.(11)Ostiadrainintospaces
within the nosecalledmeatiwhichareborderedbyverticallyorientedbonesknownasturbinates. The tearduct
(naso‐lacrimalduct)drainsinto the inferiormeatus(whichisborderedby the inferior
turbinatebone).Thisisone
reasonwhyournosedripswhenwecry. The maxillary,frontal, and ethmoidsinusesdraininto the middlemeatus,
whichisborderedby the middleturbinatebone(FIGURE2).Someof the ethmoidsinusesalsodraininto the
superiormeatus,whichisaspacedefined
bysuperiorturbinatebone.While the maxillary,frontal, and sphenoid
sinusesaresolitary,well‐definedcompartments, the ethmoidsinusis–inactuality–acollectionofseveralsmall
sinuses,structuredlikeabeehive.Itis for thisreasonthat the ethmoidsinuseshavevarieddrainagepatterns. The
sphenoidsinusdrains
into the spheno‐ethmoidalrecess,locatedbetween the superiorturbinatebone and the nasal
septum.(3,11,12)
Air and mucusenter and exit the sinusthrough the sinusostia. The functionsof the nose and sinusesinclude
olfaction(senseofsmell),respiration, and defense.(3,11,12)
The nose and sinusesproducemucustokeep the
nasal and upperrespiratorypassagewaysmoist, and haveaneffectonvocalresonance.Among the important
physiologicalrolesof the sinusesare the humidification and warmingofinspiredair, and the removalofparticulate
matterfromthisair.Humidification and warmingof
inspiredairareaccomplishedby the waterysecretionsof the
serousglands,whichcanproduceupto1–2litersofsecretionsperday.
24
FACIALPAIN AND HEADACHE
... )was for children12years
oryounger.(5‐7)Aprimarydiagnosisofacuteorchronicsinusitisaccounted for 58.7%ofallexpenditures($3.5
billion).(5‐7)Itisestimatedthat2.2billiondollarsisspentyearly
onprescription and nonprescriptionmedication.
(5‐7)About12%eachof the costs for asthma and chronicotitismedia and eustachiantubedisorderswere
45
Allergic and Non‐AllergicSinusitis for the PrimaryCarePhysician:
Pathophysiology,Evaluation and Treatment
CHAPTER4
ALLERGY AND SINUSDISEASE
INTRODUCTION
Accordingto the AmericanAcademyofAllergy,Asthma, and Immunology(AAAAI),over50million
Americanssufferfromsomeformofallergiesthatgreatlyimpactstheirqualityoflifeaswellashealthcarecoststhat
areestimatedatapproximately20billiondollarsayear.(
1)Allergicrhinitisaloneisestimatedtoaffect20to30
millionAmericanseachyear and accounts for anestimated3%ofallmedicalofficevisits and ranksas the second
mostcommonreasonpatientsseekprofessionalhealthcare.(1)Inmanygeographicareasof the UnitedStates,
allergies play
asignificantroleascontributoryfactorsofsinusdiseaseaswellassecondarycauseofsinusinfections.
Itisofgreatvalueto the practitionertounderstand the underlyingimmunologicfactors,availablediagnostictests
and treatments.(2‐8)
Itisespeciallyvaluable for the practitionertobewellversedin
allergybecausemanypatientsareconfused
about the differencebetweensinusitis...