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
[41]   Intranasal antifungal treatment in 51 patients with chronic rhinosinusitis [J].
Ponikau, JU ;
Sherris, DA ;
Kita, H ;
Kern, EB .
JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY, 2002, 110 (06) :862-866
[42]   The diagnosis and incidence of allergic fungal sinusitis [J].
Ponikau, JU ;
Sherris, DA ;
Kern, EB ;
Homburger, HA ;
Frigas, E ;
Gaffey, TA ;
Roberts, GD .
MAYO CLINIC PROCEEDINGS, 1999, 74 (09) :877-884
[43]   Direct evidence of bacterial biofilms in otitis media [J].
Post, JC .
LARYNGOSCOPE, 2001, 111 (12) :2083-2094
[44]  
Rains BM, 2003, AM J RHINOL, V17, P1
[45]   EFFICACY OF AEROSOLIZED TOBRAMYCIN IN PATIENTS WITH CYSTIC-FIBROSIS [J].
RAMSEY, BW ;
DORKIN, HL ;
EISENBERG, JD ;
GIBSON, RL ;
HARWOOD, IR ;
KRAVITZ, RM ;
SCHIDLOW, DV ;
WILMOTT, RW ;
ASTLEY, SJ ;
MCBURNIE, MA ;
WENTZ, K ;
SMITH, AL .
NEW ENGLAND JOURNAL OF MEDICINE, 1993, 328 (24) :1740-1746
[46]   Cystic fibrosis [J].
Ratjen, F ;
Döring, G .
LANCET, 2003, 361 (9358) :681-689
[47]   Effect of anti-fungal nasal lavage with amphotericin B on nasal polyposis [J].
Ricchetti, A ;
Landis, BN ;
Maffioli, A ;
Giger, R ;
Zeng, C ;
Lacroix, JS .
JOURNAL OF LARYNGOLOGY AND OTOLOGY, 2002, 116 (04) :261-263
[48]   A component of innate immunity prevents bacterial biofilm development [J].
Singh, PK ;
Parsek, MR ;
Greenberg, EP ;
Welsh, MJ .
NATURE, 2002, 417 (6888) :552-555
[49]   Application of staphylococcal enterotoxin B on normal and atopic skin induces up-regulation of T cells by a superantigen-mediated mechanism [J].
Skov, L ;
Olsen, JV ;
Giorno, R ;
Schlievert, PM ;
Baadsgaard, O ;
Leung, DYM .
JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY, 2000, 105 (04) :820-826
[50]   Cytokine profile of chronic sinusitis in patients with cystic fibrosis [J].
Sobol, SE ;
Christodoulopoulos, P ;
Manoukian, JJ ;
Hauber, HP ;
Frenkiel, S ;
Desrosiers, M ;
Fukakusa, M ;
Schloss, MD ;
Hamid, Q .
ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY, 2002, 128 (11) :1295-1298