Refractory chronic rhinosinusitis: Pathophysiology and management of chronic rhinosinusitis persisting after endoscopic sinus surgery

被引:39
作者
Desrosiers, M [1 ]
机构
[1] Hop Hotel Dieu, Montreal, PQ H2W 1T8, Canada
关键词
D O I
10.1007/s11882-004-0027-z
中图分类号
R392 [医学免疫学];
学科分类号
100102 ;
摘要
Refractory chronic rhinosinusitis (RCRS) is defined as persistence of signs and symptoms of chronic rhinosinusitis, despite technically adequate endoscopic sinus surgery. Rather than a simple, prolonged bout of acute sinusitis, it instead appears to be secondary to an interaction of a susceptible host with the outside environment. Inflammatory responses to colonizing bacteria appear to be responsible for a significant portion of the pathophysiology. Reduction of bacterial load and inflammation of the mucosa play an important role in controlling the disease. Novel treatment strategies, with an emphasis on topical therapies, seem to offer optimal management. In this review, current concepts on the pathophysiology and current therapies available for RCRS are outlined. A practical management strategy based on the author's personal experience draws upon these concepts, and is detailed in this review of an unusual topic.
引用
收藏
页码:200 / 207
页数:8
相关论文
共 56 条
[21]   Induction of corticosteroid insensitivity in human PBMCs by microbial superantigens [J].
Hauk, PJ ;
Hamid, QA ;
Chrousos, GP ;
Leung, DYM .
JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY, 2000, 105 (04) :782-787
[22]  
HYO N, 1989, Rhinology (Utrecht), V27, P17
[23]   HUMAN NASAL HOST DEFENSE AND SINUSITIS [J].
KALINER, MA .
JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY, 1992, 90 (03) :424-430
[24]  
Kennedy D W, 1992, Laryngoscope, V102, P1
[25]   The influence of the size of the maxillary sinus ostium on the nasal and sinus nitric oxide levels [J].
Kirihene, RKDRA ;
Rees, G ;
Wormald, PJ .
AMERICAN JOURNAL OF RHINOLOGY, 2002, 16 (05) :261-264
[26]  
Kobayashi T, 1992, Rhinol Suppl, V14, P77
[27]   Salicylic acid attenuates virulence in endovascular infections by targeting global regulatory pathways in Staphylococcus aureus [J].
Kupferwasser, LI ;
Yeaman, MR ;
Nast, CC ;
Kupferwasser, D ;
Xiong, YQ ;
Palma, M ;
Cheung, AL ;
Bayer, AS .
JOURNAL OF CLINICAL INVESTIGATION, 2003, 112 (02) :222-233
[28]   Adult rhinosinusitis defined [J].
Lanza, DC ;
Kennedy, DW .
OTOLARYNGOLOGY-HEAD AND NECK SURGERY, 1997, 117 (03) :S1-S7
[29]   Intrasinus administration of topical budesonide to allergic patients with chronic rhinosinusitis following surgery [J].
Lavigne, F ;
Cameron, L ;
Renzi, PM ;
Planet, JF ;
Christodoulopoulos, P ;
Lamkioued, B ;
Hamid, Q .
LARYNGOSCOPE, 2002, 112 (05) :858-864
[30]   Prognosis and prediction of response to surgery in allergic patients with chronic sinusitis [J].
Lavigne, F ;
Nguyen, CT ;
Cameron, L ;
Hamid, Q ;
Renzi, PM .
JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY, 2000, 105 (04) :746-751