Nazal Kavite ve Paranazal Sinüslerin Değerlendirilmesi
Özet
Nazal kavite ve paranazal sinüslerin değerlendirilmesi anamnez ile başlar ve fizik muayene ile devam eder. En sık karşılaşılan nazal semptom burun tıkanıklığı olup; bunun süresi, başlangıcı, ek semptomlar ve tıknıklığın etiyolojisi detaylıca sorgulanmalıdır. Fizik muayenede anterior rinoskopi ve dekonjestan tatbiki sonrası değerlendirme yapılırken, Bachmann ve Cottle testleri subjektif değerlendirmede kullanılır. Poliklinik şartlarında nazal endoskopi alt, orta ve üst meatuslar ile diğer anatomik yapıların tam olarak incelenmesinde tartışılmaz bir yere sahiptir. İleri mukozal ve sinüs patolojileri ile tümör invazyonlarının değerlendirilmesinde BT ve MR gibi görüntüleme yöntemlerinden yararlanılır. Mukosiliyer klirensin in-vivo değerlendirilmesinde en sık sakkarin testi kullanılırken, nükleer ve partikül testleri de mevcuttur. In-vitro yöntemler arasında siliyer aktivite frekansı, ELISA, mukoza biyopsisi, TEM ve konfokal lazer tarama mikroskobu (CLSM) yer alır. Fonksiyonel değerlendirmelerde rinomanometri, rinorezistometri, akustik rinometri ve 24 saatlik uzun süreli rinoflowmetri gibi hava akımı ile nazal direnç ve hacmi ölçen objektif yöntemler kullanılır. Ayrıca arjininden sentezlenen nazal nitrik oksit ölçümü, polipli kronik rinosinüzit takibinde, primer siliyer diskinezi ve kistik fibrozis taramasında yardımcı bir yöntem olarak önem taşımaktadır.
The evaluation of the nasal cavity and paranasal sinuses begins with a detailed medical history and is followed by a physical examination. Nasal obstruction is the most common symptom, and its duration, onset, and associated findings must be carefully investigated. Physical examination involves anterior rhinoscopy performed before and after decongestant application, utilizing subjective tools like Bachmann and Cottle tests to evaluate the nasal isthmus. Nasal endoscopy plays an indispensable role in outpatient clinics for a comprehensive examination of the meatuses, olfactory cleft, and sphenoethmoidal recess. Advanced imaging modalities, such as CT and MRI, are utilized to evaluate mucosal status, sinus pathologies, and neoplastic invasions. For in-vivo assessment of mucociliary clearance, the saccharin test is most commonly preferred, alongside nuclear and particle tests. In-vitro techniques include the measurement of ciliary beat frequency, ELISA, mucosal biopsy, transmission electron microscopy (TEM), and confocal scanning laser microscopy (CSLM). Objective functional assessments of nasal airflow, resistance, and volume are conducted via rhinomanometry, rhinoresistometry, acoustic rhinometry, and 24-hour long-term rhinoflowmetry. Additionally, measurement of nasal expiratory nitric oxide serves as a valuable tool for monitoring treatment response in chronic rhinosinusitis with polyps and screening for primary ciliary dyskinesia and cystic fibrosis.
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