Zusammenfassung
Ein Rezidiv oder eine Persistenz einer chronischen Sinusitis nach Nasennebenhöhlenoperation
kann bedingt sein durch die Operationstechnik bei der primären Operation, die postoperative
Narbenbildung, die Persistenz der Ursache (entzündliches Geschehen bzw. pathophysiologisch
relevante Faktoren) oder umschriebene Lokalfaktoren. Die Therapie ist individuell
festzulegen und verlangt eine präzise Analyse des klinischen Problems, eine Endoskopie
und ggf. eine CT-Untersuchung. Abhängig von deren Ergebnis erfolgt eine medikamentöse
und/oder operative Therapie. Die einzelnen Vorgehensweisen und Möglichkeiten werden
ausführlich diskutiert.
Persistant Chronic Rhinosinusitis after Endonasal Sinus Surgery
Reasons for recurrent or persistent chronic rhinosinusitis could be the operation
technique of the primary surgery, postoperative scarring, persistent inflammation
or pathophysiologic agent or local factors. The management should be individualized
and demands precise analysis of the clinical problem of the patient, nasal endoscopy
and CT examination. Dependent on the results conservative or surgical therapy is mandatory.
Medical and operative approaches are discussed in detail.
Schlüsselwörter
Rezidiv · chronische Rhinosinusitis · endoskopische Nebenhöhlenchirurgie · Polyposis
nasi · Revisionschirurgie
Key words
Recurrence · chronic rhinosinusitis · nasal polyps · endoscopic sinus surgery · revision
surgery
Literatur
1
Alobid I, Benitez P, Bernal-Sprekelsen M, Roca J, Alonso J, Picado C, Mullol J.
Nasal polyposis and its impact on quality of life: comparison between the effects
of medical and surgical treatments.
Allergy.
2005;
60
452-458
2
Amrol D, Murray J J.
Alternative medical treatment strategies for chronic hyperplastic eosinophilic sinusitis.
Curr Opin Otolaryngol Head Neck Surg.
2005;
13
55-59
3
Bachert C. et al .
Leitlinie der DGAI zur allergischen Rhinokonjunktivitis.
Allergologie.
2003;
26
147-162
4
Bachert C, Gevaert P, van Cauwenberge P.
Staphylococcus aureus superantigens and airway disease.
Curr Allergy Asthma Rep.
2002;
2
252-258
5
Bachert C, Hörmann K, Mösges R, Rasp G, Riechelmann H, Müller R, Luckhaupt H, Stuck B A,
Rudack C.
An update on the diagnosis and treatment of sinusitis and nasal polyposis.
Allergy.
2003;
58
176-191
6
Bachert C, van Zele T, Gevaert P, de Schrijver L, van Cauwenberge P.
Superantigens and nasal polyps.
Curr Allergy Asthma Rep.
2003;
3
523-531
7
Bachert C.
Pharmakologische Therapie der Polyposis nasi.
Allergologie.
2004;
27
484-494
8
Berges-Gimeno M P, Simon R A, Stevenson D D.
Long-term treatment with aspirin desensitization in asthmatic patients with aspirin-exacerbated
respiratory disease.
J Allergy Clin Immunol.
2003;
111
180-186
9
Beule A G, Weber R K, Kaftan H, Hosemann W.
Übersicht: Art und Wirkung geläufiger Nasentamponaden.
Laryngorhinootol.
2004;
83
534-551
10
Braun H, Stammberger H, Buzina W, Freudenschuss K, Lackner A, Beham A.
Häufigkeit und Nachweis von Pilzen und eosinophilen Granulozyten bei chronischer Rhinosinusitis.
Laryngorhinootologie.
2003;
82
330-340
11
Davis G E.
Psychiatric distress amplifies symptoms after surgery for chronic sinusitis.
Otolaryngol Head Neck Surg.
2005;
132
189-196
12
DelGaudio J M.
Direct nasopharyngeal reflux of gastric acid is a contributing factor in refractory
chronic rhinosinusitis.
Laryngoscope.
2005;
115
946-957
13
Dijkstra M D, Ebbens F A, Poublon R M, Fokkens W J.
Fluticasone propionate aqueous nasal spray does not influence the recurrence rate
of chronic rhinosinusitis and nasal polyps 1 year after functional endoscopic sinus
surgery.
Clin Exp Allergy.
2004;
34
1395-1400
14
Fokkens W.
European position paper on rhinosinusitis and nasal polyps.
Rhinology.
2005;
Suppl
1-87
15
Gosepath J, Schaefer D, Amedee R G, Mann W J.
Individual monitoring of aspirin desensitization.
Arch Otolaryngol Head Neck Surg.
2001;
127
316-321
16
Gotfried M H.
Macrolides for the treatment of chronic sinusitis, asthma, and COPD.
Chest.
2004;
125
52S-61S
17
Heppt W, Brendelberger J.
Montelukast in patients with aspirinintolerance and recurrent nasal polyposis - a
prospective randomized placebo controlled study (Publikation in Vorbereitung).
18
Hosemann W, Schwab N, Praetner L, Breme K, Beule A, Kaftan H.
Erweiterte Ergebnisanalyse der endonasalen Nasennebenhöhlenchirurgie.
Laryngorhinootologie.
2003;
82
341-346
19
Hosemann W.
Nasal surgery: evidence of efficacy. Nasal surgery for chronic rhinosinusitis.
Rhinology.
2004;
42
246-248
20
Hosemann W.
Postoperative Rezidivprophylaxe bei chronischer Pansinusitis und Polyposis nasi.
HNO.
2003;
51
279-283
21 Hosemann W G, Weber R K, Keerl R E, Lund V J. Minimally invasive endonasal sinus
surgery. Stuttgart New York; Thieme 2000
22
Keerl R, Weber R, Draf W, Kind M, Saha A.
Periorbital Paraffingranuloma following Paranasal Sinus Surgery.
Am J Otolaryngol.
1996;
17
264-268
23
Kennedy D W, Senior B A, Gannon F H, Montone K T, Hwang P, Lanza D C.
Histology and histomorphometry of ethmoid bone in chronic rhinosinusitis.
Laryngoscope.
1998;
108
502-507
24
Kennedy D W.
Prognostic factors, outcomes and staging in ethmoid sinus surgery.
Laryngoscope.
1992;
102 (Suppl)
1-18
25
Kirtsreesakul V, Naclerio R M.
Role of allergy in rhinosinusitis.
Curr Opin Allergy Clin Immunol.
2004;
4
17-23
26
Lavigne F, Cameron L, Renzi P M, Planet J F, Christodoulopoulos P, Lamkioued B, Hamid Q.
Intrasinus administration of topical budesonide to allergic patients with chronic
rhinosinusitis following surgery.
Laryngoscope.
2002;
112
858-864
27
Levasseur-Acker G M, Molimard M, Regnard J, Naline E, Freche C, Lockhart A.
Effect of furosemide on prostaglandin synthesis by human nasal and bronchial epithelial
cells in culture.
Am J Respir Cell Mol Biol.
1994;
10
378-383
28
Lindemann J, Keck T, Rettinger G.
Septal-turbinate-suture in endonasal sinus surgery.
Rhinology.
2002;
40
92-94
29
Metson R B, Gliklich R E.
Clinical outcomes in patients with chronic sinusitis.
Laryngoscope.
2000;
110 (Suppl 94)
24-28
30
Nathan R A, Santilli J, Rockwell W, Galsheim J.
Effectiveness of immunotherapy for recurring sinusitis associated with allergic rhinitis
as assessed by the Sinusitis Outcomes Questionnaire.
Ann Allergy Asthma Immunol.
2004;
92
668-672
31
Nishioka G J, Cook P R, Dais W E, McKinsey J P.
Immunotherapy in patients undergoing functional endoscopic sinus surgery.
Otolaryngol Head Neck Surg.
1994;
110
406-412
32
Nucera E, Schiavino D, Milani A, Del Ninno M, Misuraca C, Buonomo A.
Effects of lysine-acetylsalicylate (LAS) treatment in nasal polyposis: two controlled
long term prospective follow up studies.
Thorax.
2000;
Suppl 2
S75-S78
33
Parikh A A, Scadding G K.
Intranasal lysine-aspirin in aspirin-sensitive nasal polyposis: a controlled trial.
Laryngoscope.
2005;
115
1385-1390
34
Parnes S M.
The role of leukotriene inhibitors in patients with paranasal sinus disese.
Curr Opin Otolaryngol Head Neck Surg.
2003;
11
184-191
35
Parsons D S, Stivers F E, Talbot A R.
The missed ostium sequence and the surgical approach to revision functional endoscopic
sinus surgery.
Otolaryngol Clin North Am.
1996;
29
169-183
36
Passali D, Bellussi L, Lauriello M, Ferrara A, Bernstein J M.
Medical therapy fort he prevention of relapsing nasal polyposis: a pilot study on
the use of furosemide by inhalation.
Am J Rhinol.
1996;
10
187-192
37
Passali D, Bernstein J M, Passali F M, Damiani V, Passali G C, Bellussi L.
Treatment of recurrent chronic hyperplastic sinusitis with nasal polyposis.
Arch Otolaryngol Head Neck Surg.
2003;
129
656-659
38
Patriarca G, Nucera E, Di Rienzo V.
Nasal provokation test with lysine acetylsalicylate (LAS) in aspirin-sensitive patients.
Ann Allergy.
1991;
67
60-62
39
Polzehl D, Weschta M, Podbielski A, Riechelmann H, Rimek D.
Fungus culture and PCR in nasal lavage samples of patients with chronic rhinosinusitis.
J Med Microbiol.
2005;
54
31-37
40
Ponikau J U, Sherris D A, Kern E B, Homburger H A, Frigas E, Gaffey T A, Roberts G D.
The diagnosis and incidence of allergic fungal sinusitis.
Mayo Clin Proc.
1999;
74
877-884
41
Ponikau J U, Sherris D A, Kita H, Kern E B.
Intranasal antifungal treatment in 51 patients with chronic rhinosinusitis.
J Allergy Clin Immunol.
2002;
110
862-866
42
Ponikau J U, Sherris D A, Weaver A, Kita H.
Treatment of chronic rhinosinusitis with intranasal amphotericin B: a randomized,
placebo-controlled, double-blind pilot trial.
J Allergy Clin Immunol.
2005;
115
125-131
43
Ragap S, Parik K HA, Darby Y C, Skadding G K.
An open audit of montelukast, an leucotriene receptor antagonist in nasal polyposis
associated with asthma.
Clin exp allergy.
2001;
31
1385-1391
44
Ricchetti A, Landis B N, Maffioli A, Giger R, Zeng C, Lacroix J S.
Effect of antifungal nasal lavage with amphotericin B on nasal polyposis.
J Laryngol Otol.
2002;
116
261-263
45
Richtsmeier W J.
Top 10 reasons for endoscopic maxillary sinus surgery failure.
Laryngoscope.
2001;
111
1952-1956
46
Riechelmann H.
Pilze und Polypen. Fakten und Mythen.
Laryngorhinootologie.
2003;
82
766-768
47
Riechelmann H.
Immunotherapie mit Allergenextrakten bei allergischer Rhinitis.
HNO.
2005;
53
517-520, 522 - 526, 528 - 530
48
Riechelmann H, Deutschle T, Rozsasi A, Keck T, Polzehl D, Burner H.
Nasal biomarker profiles in acute and chronic rhinosinusitis.
Clin Exp Allergy.
2005;
35
1186-1191
49
Sanclement J A, Webster P, Thomas J, Ramadan H H.
Bacterial biofilms in surgical specimens of patients with chronic rhinosinusitis.
Laryngoscope.
2005;
115
578-582
50
Scadding G K.
Medical management of chronic rhinosinusitis.
Immunol Allergy Clin N Am.
2004;
24
103-118
51
Schapowal S.
Phenomenology, pathogenesis, diagnosis and treatment of aspiri-sensitive rhinosinusitis.
Acta Oto-Rhino-Laryngol belg.
1995;
49
235-250
52
Ulualp S O, Stermann B M, Toohill R J.
Antileucotriene therapy for the relief of sinus symptoms in aspirine triad disease.
Ear Nose Throat J.
1999;
78
604-613
53
Walker F D, White P S.
Sinus symptom scores: what is the range in the healthy individuals?.
Clin Otolaryngol.
2000;
25
482-484
54
Watelet J B, Bachert C, Claeys C, van Cauwenberge P.
Matrix metalloproteinases MMP-7, MMP-9 and their tissue inhibitor TIMP-1: expression
in chronic sinusitis vs nasal polyposis.
Allergy.
2004;
59
54-60
55
Weaver E M.
Association between gastroesophageal reflux and sinusitis, otitis media, and laryngeal
malignancy: a systemativ review of the evidence.
Am J Med.
2003;
115
81S-89S
56
Weber R, Draf W, Keerl R, Behm K, Schick B.
Langzeitergebnisse nach endonasaler Stirnhöhlenchirurgie.
HNO.
1996;
44
503-509
57
Weber R, Draf W, Kratzsch B, Hosemann W, Schaefer S D.
Modern concepts in frontal sinus surgery.
Laryngoscope.
2001;
111
137-146
58
Weber R, Draf W.
Endonasale mikro-endoskopische Pansinusoperation bei chronischer Sinusitis. II. Ergebnisse
und Komplikationen.
Otorhinolaryngologia Nova.
1992;
2
63-69
59
Weber R, Hosemann W, Draf W, Keerl R, Schick B, Schinzel S.
Endonasale Stirnhöhlenchirurgie mit Langzeiteinlage eines Platzhalters.
Laryngorhinootologie.
1997;
76
728-734
60
Weber R, Keerl R, Radziwill R, Schick B, Jaspersen D, Dshambazov K, Mlynski G, Draf W.
Videoendoscopic Analysis of Nasal Steroid Distribution.
Rhinology.
1999;
37
69-73
61
Weber R, Kratzsch B.
Endonasale Mediandrainage. Indikationen und chirurgische Technik.
HNO.
2001;
49
1047-1060
62
Weber R.
Kommentar zu Lebensqualität bei Polyposis nasi: konservative und chirurgische Therapie
im Vergleich.
Laryngorhinootol.
2005;
84
789-791
63
Weber R K, Jaspersen D, Keerl R, Eikermann M, Mösges R.
Gaströsophagealer Reflux und chronische Sinusitis.
Laryngorhinootologie.
2004;
83
189-195
64
Weschta M, Rimek D, Formanek M, Polzehl D, Podbielski A, Riechelmann H.
Topical antifungal treatment of chronic rhinosinusitis with nasal polyps: a randomized,
double-blind clinical trial.
J Allergy Clin Immunol.
2004;
113
1122-1128
65
Wong I W, Omari T I, Myers J C, Rees G, Nair S B, Jamieson G G, Wormald P J.
Nasopharyngeal pH monitoring in chronic sinusitis patients using a novel four channel
probe.
Laryngoscope.
2004;
114
1582-1585
66
Zhang N, Gevaert P, van Zele T, Perez-Novo C, Patou J, Holtappels G, van Cauwenberge P,
Bachert C.
An update on the impact of Staphylococcus aureus enterotoxins in chronic sinusitis
with nasal polyposis.
Rhinology.
2005;
43
162-168
1 Die Studie wurde von AstraZeneca gesponsert.
Prof. Dr. Rainer K. Weber
Leiter der Sektion Nasennebenhöhlen- und Schädelbasischirurgie, Traumatologie, HNO-Klinik
(Direktor: Prof. Dr. Werner J. Heppt)
Städtisches Klinikum Karlsruhe · Moltkestraße 90 · 76133 Karlsruhe
eMail: rainer.weber@klinikum-karlsruhe.com