MEDIX, God. 27 Br. 149  •  Pregledni članak  •  Alergologija i klinička imunologija HR ENG

Kronični rinosinusitisChronic rhinosinusitis

Livije Kalogjera, Tomislav Gregurić

Kronični rinosinusitis (KRS) upalna je bolest sluznice nosa i paranazalnih šupljina, koja se definira prema prisutnosti kombinacije barem dvaju simptoma KRS-a od kojih jedan mora biti nosna začepljenost ili nosna/postnazalna sekrecija, dok su preostala dva simptoma: bol/pritisak u licu, ili gubitak/smanjenje osjeta mirisa. Prilikom endoskopije nosa (barem 1 znak) i/ili na CT-u paranazalnih sinusa moraju biti prisutni i objektivni znakovi upale. Kronični rinosinusitis pojavljuje se u dvama kliničkim fenotipovima: KRS bez nosnih polipa i KRS s nosnim polipima. Ta dva fenotipa razlikuju se i prema vodećim simptomima, opsegu CT-promjena, polarizaciji imunosnog odgovora sinonazalne sluznice i odgovoru na steroide. U bolesnika s nosnom polipozom dominira začepljenost i disosmija, opsežniji CT-nalaz te upala tipa 2 u nosnoj sluznici i tkivu polipa u 70 do 80% bolesnika. U KRS-u bolesnika bez nosnih polipa dominira postnazalni slijev i bol u licu, CT-promjene su manje, a dominira upala tipa 1. Steroidi su učinkovitiji u fenotipu s nosnim polipima.

Ključne riječi:
dijagnoza; endoskopija; komorbiditet; kompjutorizirana tomografija; kronični rinosinusitis; predisponirajući čimbenici

Članak u cijelosti pročitajte u tiskanom izdanju MEDIX, God. 27 Br. 149

Chronic rhinosinusitis (CRS) is an inflammatory disorder of the nasal mucosa and paranasal cavities defined by the presence of a combination of at least 2 CRS symptoms, one of which must be nasal congestion or nasal/postnasal secretion, while the other two symptoms are pain/pressure in the face or loss/reduction of sense of smell. Objective signs of inflammation must also be present on nasal endoscopy (at least 1 sign) and/or CT of the paranasal sinuses. CRS appears in 2 clinical phenotypes: with and without nasal polyps. These two phenotypes also differ according to the leading symptoms, CT severity scores, the polarization of the sinonasal mucosal immune response and response to steroid treatment. In patients with nasal polyps, obstruction and dysosmia are dominant symptoms, CT scores are higher and type 2 inflammation in the nasal mucosa and polyp tissue is present in 70 – 80% of patients. In CRS patients without nasal polyps, postnasal drip and facial pain predominate, CT scores are better, and type 1 inflammation dominates. Steroids are more effective in the phenotype with nasal polyps.

Key words:
chronic rhinosinusitis; comorbidity; computerized tomography (CD); diagnosis; endoscopy; predisposing factors