Kronik Rinosinüzit
Özet
Kronik rinosinüzit (KRS), nazal mukoza ve paranazal sinüslerin enfeksiyöz ve enflamatuar süreçlerle karakterize, semptomların 12 haftadan uzun sürdüğü ve genel popülasyonun %5-12'sini etkileyen önemli bir sağlık sorunudur. EPOS 2020 sınıflandırmasına göre hastalık, primer ve sekonder olarak ele alınmakta; anatomik dağılımına göre lokal veya yaygın, endotip baskınlığına göre ise Tip 2 veya Tip 2 dışı şeklinde kategorize edilmektedir. Hastalığın etiyolojisinde dar ostium gibi anatomik faktörler, mukosiliyer disfonksiyon, sigara kullanımı ve Pseudomonas aeruginosa ile Staphylococcus aureus gibi bakterilerin oluşturduğu dirençli biyofilmler kolaylaştırıcı rol oynamaktadır. Tanı sürecinde burun tıkanıklığı, akıntı, yüz ağrısı ve koku bozuklukları klinik olarak incelenirken, nazal endoskopi ve bilgisayarlı tomografi (BT) tanıyı doğrulamada ve cerrahi öncesi yol haritası belirlemede vazgeçilmezdir. Tedavide yaygın bilateral hastalık için lokal kortikosteroidler ve tuzlu su temel oluştururken, uygun medikal tedaviye yanıt vermeyen durumlarda endoskopik sinüs cerrahisi (ESC) önerilmektedir. Ayrıca, Dupilumab gibi biyolojik ajanlar, cerrahiye uygun olmayan veya tekrarlayan şiddetli Tip 2 hastalarda kortikosteroid ihtiyacını azaltarak yaşam kalitesini artıran modern seçenekler sunmaktadır; ancak cerrahi sonrasında da sürekli medikal takip şarttır.
Chronic rhinosinusitis (CRS) is a significant health issue affecting 5-12% of the general population, characterized by infectious and inflammatory conditions of the nasal mucosa and paranasal sinuses lasting longer than 12 weeks. According to the EPOS 2020 guidelines, CRS is classified into primary and secondary categories, which are further divided into local or diffuse diseases based on anatomical distribution, and Type 2 or non-Type 2 based on endotype dominance. While the exact etiology remains unclear, predisposing factors include anatomical variations leading to obstructed ostia, mucociliary dysfunction, smoking, and persistent biofilms formed by pathogens like Pseudomonas aeruginosa and Staphylococcus aureus. Diagnosis is primarily clinical, based on symptoms such as nasal obstruction, rhinorrhea, facial pressure, and olfactory dysfunction, and is confirmed using nasal endoscopy and computed tomography (CT) scans. Topical corticosteroids and saline nasal sprays form the cornerstone of medical management; however, endoscopic sinus surgery (ESS) is recommended for patients who do not respond to appropriate medical therapy. Recently, biological agents like Dupilumab have emerged as innovative options for severe bilateral polypoid Type 2 CRS, significantly improving patient quality of life and reducing the necessity for systemic corticosteroids, though postoperative medical treatment remains mandatory.
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