1. Define
1.1. Symptoms >12wks
1.1.1. 2 or more PODS
1.1.1.1. facial Pain
1.1.1.2. nasal Obstruction
1.1.1.3. Discharge (anterior or posterior)
1.1.1.4. Smell: Hypo or anosmia
1.2. Exam findings
1.2.1. Site
1.2.1.1. Middale meatues
1.2.1.1.1. Kissing appearance
1.2.1.1.2. Pale mucosa
1.2.1.1.3. Cubblestoneing
1.2.1.1.4. Vascular congestion
1.2.1.2. Ethoid region
1.2.2. Signs
1.2.2.1. Purulent discharge
1.2.2.2. Edema
1.2.2.3. Polyps
1.3. Radiographic evidance
2. Inflammation not an infection
3. Work-up (for underlying Ax).
3.1. Immune
3.1.1. including HIV
3.2. Reps
3.2.1. CF
3.2.2. PCD
3.3. Allergy
3.3.1. SPT sIgE
3.4. Sinus culture +puncture
3.4.1. usually colonization of anaerobes
4. Rx.
4.1. Abx for acute on chronic exacerbation
4.2. Steroid
4.2.1. Intranasal
4.2.2. Short oral
4.3. Surgery
4.3.1. functional endoscopic sinus surgery
4.3.1.1. Indications
4.3.1.1.1. complications
4.3.1.1.2. Failure of Rx.
4.4. Anti-fungal
4.4.1. for dissaminated fungal infections
4.4.1.1. Diabetes
4.4.1.2. immunodeficiencyt
5. Forms
5.1. CRS w/ nasal polyps
5.1.1. Characteristis sympotms hypo/anosmia
5.1.2. 1/3 of pts. w/ CRS
5.1.3. eosniophillia
5.1.4. Ethmoid sinus #1
5.1.5. Risk factor for
5.1.5.1. Asthma
5.1.5.2. AERD
5.1.5.3. Allergic Fungal Rhinosinusitis
5.1.5.4. Malignancy
5.1.5.5. CSS
5.1.5.6. CF/PCD
5.1.6. A/W
5.1.6.1. Dust mite sensitization
5.1.6.2. Local staphylococaus aureus enterotoxins (superAg) with IgE production and Th2 skewing
5.1.7. Better outcome
5.1.8. Rx
5.2. CRS w/o nasal polyps
5.2.1. Characterized with facial pain
5.2.2. Staph aureus (biofilm formation)
5.2.3. Worse outcome
5.2.4. Rx
5.2.4.1. Intransal steroid
5.2.4.2. Saline rinse