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Chapter-38 Refractory Chronic Rhinosinusitis

BOOK TITLE: Sataloff’s Comprehensive Textbook of Otolaryngology: Head & Neck Surgery (Rhinology/Allergy and Immunology) -Volume 2

Author
1. Chandra Rakesh
2. Zirkle Whitney
ISBN
9789351524564
DOI
10.5005/jp/books/12714_39
Edition
1/e
Publishing Year
2016
Pages
20
Author Affiliations
1. G.S.V.M. Medical College, Kanpur, U.P., India, Vanderbilt University, Nashville, Tennessee, USA
2. Chicago, Illinois, USA
Chapter keywords
chronic immunosuppression, epigenetic variation, cutaneous lesions, granulomatous disorders, nasopharyngeal processes, polysaccharide antigens, antipneumococcal antibody, biofilm formation, histologic changes, pathogenic organisms, mucosal-sparing techniques, etiologic factor, maxillary antrostomies, biologic surfactants, endoscopic techniques, therapeutic concentrations, antifungal therapy

Abstract

This chapter discusses refractory chronic rhinosinusitis, where chronic inflammatory processes appear critical to the development and persistence of disease and are believed to occur primarily at the sinonasal mucosal level. Allergic rhinitis may also mimic or exacerbate chronic rhinosinusitis (CRS) symptoms and can sometimes be difficult to discern from CRS especially with perennial allergies. Biofilms are highly organized structures encasing bacteria in an extracellular matrix that provides physical protection in addition to observed phenotypic and genotypic changes promoting bacterial survival. Sinus surgery often does not directly address mucosal inflammation, which may be the reason for persistence or recurrence of symptoms in patients with recalcitrant disease. The current accepted medical management of CRS includes a combination of courses of topical steroids, saline irrigations, courses of antibiotics as well as nasal decongestants and oral steroids. Topical steroid sprays have become a standard first-line therapy in the treatment of CRS.

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