Chronic rhinosinusitis with nasal polyps and type 2 inflammation

Current treatment paradigm in chronic rhinosinusitis with nasal polyps (CRSwNP) recommends nasal steroids and saline nasal rinses for milder cases, and oral corticosteroids and eventual surgery for severe cases. The most common endotype of CRSwNP is type 2 inflammation. As a result of the common inflammatory pathway type 2, CRSwNP is often associated with asthma and/or salicylate sensitivity. Classification of chronic rhinosinusitis into different endotypes leads to more precise treatment strategies. Classification endotypes to type 2 or non-type 2 in the future will probably be further developed for treatment purposes. Biologic therapy focused on the pathophysiology of the underlying inflammatory disease type 2 has led to a significant shift in the treatment options for CRSwNP, primarily for the most severe cases, refractory to standard treatment. Our experience proved biologics effective in patients with CRSwNP to whom biologics were prescribed because of severe asthma

Chronic rhinosinusitis with nasal polyps and type 2 inflammation

Current treatment paradigm in chronic rhinosinusitis with nasal polyps (CRSwNP) recommends nasal steroids and saline nasal rinses for milder cases, and oral corticosteroids and eventual surgery for severe cases. The most common endotype of CRSwNP is type 2 inflammation. As a result of the common inflammatory pathway type 2, CRSwNP is often associated with asthma and/or salicylate sensitivity. Classification of chronic rhinosinusitis into different endotypes leads to more precise treatment strategies. Classification endotypes to type 2 or non-type 2 in the future will probably be further developed for treatment purposes. Biologic therapy focused on the pathophysiology of the underlying inflammatory disease type 2 has led to a significant shift in the treatment options for CRSwNP, primarily for the most severe cases, refractory to standard treatment. Our experience proved biologics effective in patients with CRSwNP to whom biologics were prescribed because of severe asthma

Computer Assisted Endoscopic Sinus and Skull Base Surgery

The surgical anatomy of the paranasal sinuses and the skull base is considered to be one of the most complex anatomies of the human body, with great morphological differences among individuals. The development of technology in endoscopic sinus and skull base surgery can be divided in two directions. On the one hand, they are increasingly developing powered instruments that make surgery easier and faster, but also make it potentially more dangerous. On the other hand, there is improvement in the devices that enhance the security by better visualization and orientation within the operative field. Among them, computer-assisted navigation (CAN) is particularly important. Originally developed for neurosurgery, CAN was rapidly accepted by endoscopic sinus and skull base surgeons. Thus, by 2010, it became available in the USA to almost all otorhinolaryngologists dealing with this branch of surgery. The main reason for using CAN is the reduction of operative risks and complications, especially reduction of major and orbital complications. It should be noted that CAN also serves as a great educational tool for young surgeons, but one should be aware that it cannot replace surgical skills and knowledge. CAN has no absolute contraindications other than the lack of surgical experience and training. Our experiences with CAN, which we have routinely used for over 10 years, are also presented

Odontogeni sinuitis

Pojam odontogeni sinuitis (ODS) odnosi se na upalu maksilarnog sinusa koja je posljedica širenja bliske dentalne maksilarne infekcije ili jatrogene ozljede prilikom dentalnih i drugih postupaka u usnoj šupljini. Prema literaturi, odontogenoj etiologiji se pripisuje najmanje 10% maksilarnih sinuitisa, a u nas se javljaju i opisuju sporadično, što upućuje na to da je dijagnoza ODS-a u Hrvatskoj podcijenjena. Također, unatoč relativno visokoj prevalenciji, ODS je u literaturi dobio znatno manje pozornosti od ostalih oblika sinuitisa, dok se u smjernicama za sinuitis, ODS rijetko i malo spominje. Za ODS tipičan je osjećaj neugodnog mirisa iz zahvaćene strane nosa (zbog različite bakterijske flore, u odnosu na neodontogene sinuitise), a endoskopski se može vidjeti gnojna sekrecija u ostiomeatalnom kompleksu i iz njega. On može biti blokiran i zbog baloniranja medijalne stijenke maksilarnog sinusa. ODS najčešće traži primarno liječenje dentalne patologije, te endoskopski zahvat. Većem prepoznavanju ODS-a pridonio bi i naglašeniji multidisciplinarni pristup, odnosno intenzivnija suradnja dentalne medicine, otorinolaringologije i radiologije

Management Guidelines for Allergic Rhinitis – The Role of Intranasal Corticosteroids

Alergijski rinitis (AR) najčešći je alergijski poremećaj, a njegova je prevalencija u porastu. Prije uporabe smjernica ARIA oko trećine bolesnika s umjereno teškim/teškim simptomima unatoč terapiji imalo je i dalje teške simptome. Smjernice ARIA definiraju AR kao upalnu bolest. Liječenje AR-a pretpostavlja točnu procjenu težine bolesti i bilo kakve povezanosti s astmom. Intranazalni kortikosteroidi (IKS) najučinkovitiji su lijekovi u liječenju AR-a uz minimalan rizik od sistemskih nuspojava. IKS mogu biti prva opcija liječenja svih oblika AR jer djeluju na sve simptome AR-a.Allergic rhinitis (AR) is the most common allergic disorder and its prevalence is still increasing. Before using the ARIA guidelines, about one third of patients with moderately severe / severe symptoms despite therapy had severe symptoms. The ARIA guidelines define AR as an inflammatory disease. Treatment of AR implies accurate assessment of disease severity, and any relationship of AR and asthma should be evaluated. Intranasal corticosteroids (ICS) are the most effective drugs in the treatment of AR with minimal risk of systemic side effects. ICS can be the first treatment option in all forms of AR because they treat all the symptoms of AR

Towards virtualization and optimization of sinus surgery planning and execution

Introduction: The development of technology offers great possibilities for better understanding, design, standardisation, execution and subsequent mechanisation and automatisation of manual work in complex human activities which are yet to be observed, such as in endoscopic sinus surgery (ESS) where deformable, flexible and biological work objects are present in rather small production quantities. Aim: Those possibilities are achievable only by performing the capturing and thorough analysis of the existing ESS manual work process, where movements are further complicated by the variety of instruments/tools used in the different phases of the surgeon’s work. Methods: On the basis of the chosen surgery process, the paper tries to establish an integrated approach that would include experiments for motion capturing and analysis using traditional and modern methods and equipment, such as an optical video camera, predetermined motion time systems, Leap Motion Controller, Perception Neuron 2.0 and Emotiv Epoc+. Moreover, the research intent is to encompass not only physical but also accompanied mental work in the process. Results: The mentioned integrated approach would enable more quality planning and execution of the chosen surgery process and the results expected in the near future could prove valuable initially in the training of new generations of ESS surgeons. Conclusion: The possibility to analyse and measure human body movements including mental energy is always of great importance for work but also for everyday life. Technology development, particularly in biometrics, results in new, more complex tools and higher levels of materialisation that cover and create more and more realities, that are offered for the involvement of human consciousness (eros). This allows the design and standardisation of manual work in human activities which are yet to be observed, especially those of low scale (small production volume, single-unit production), such as ESS surgery

Smjernice za liječenje kroničnog rinosinuitisa s polipima

Kronični rinosinuitis s polipima čini oko 20% slučajeva kroničnog rinosinuitisa. Dijagnoza nosne polipoze prvenstveno je klinička i temelji se na anamnezi i kliničkom pregledu. Endoskopski pregled nosa najvažniji je u dijagnostici, jer se njime utvrđuje status polipa. Kompjuteriziranu tomografiju sinusa inicijalno nije potrebno raditi, osim u slučaju sumnje na komplikacije. Kod bolesnika koji nemaju značajnu nosnu opstrukciju polipima i imaju sačuvan osjet mirisa, preporučuje se u terapiju uvesti ispiranje nosa fiziološkom otopinom i intranazalne kortikosteroide (u obzir dolazi i intranazalna primjena kombinacije kortikosteroida i antihistaminika). Ukoliko je nosna opstrukcija značajna i/ili postoji hiposmija ili anosmija, uz gore navedenu terapiju, u obzir dolazne niske silazne doze oralnih kortikosteroida tijekom dva do tri tjedna do dva puta godišnje. Endoskopska operacija sinusa dolazi u obzir ukoliko bolesnici nisu dobro reagirali na konzervativnu terapiju. Biološka terapija je novija opcija za bolesnike s refraktornom bolešću, naročito ukoliko imaju pridruženu i tešku astmu

Management Guidelines for Allergic Rhinitis – The Role of Intranasal Corticosteroids

Alergijski rinitis (AR) najčešći je alergijski poremećaj, a njegova je prevalencija u porastu. Prije uporabe smjernica ARIA oko trećine bolesnika s umjereno teškim/teškim simptomima unatoč terapiji imalo je i dalje teške simptome. Smjernice ARIA definiraju AR kao upalnu bolest. Liječenje AR-a pretpostavlja točnu procjenu težine bolesti i bilo kakve povezanosti s astmom. Intranazalni kortikosteroidi (IKS) najučinkovitiji su lijekovi u liječenju AR-a uz minimalan rizik od sistemskih nuspojava. IKS mogu biti prva opcija liječenja svih oblika AR jer djeluju na sve simptome AR-a.Allergic rhinitis (AR) is the most common allergic disorder and its prevalence is still increasing. Before using the ARIA guidelines, about one third of patients with moderately severe / severe symptoms despite therapy had severe symptoms. The ARIA guidelines define AR as an inflammatory disease. Treatment of AR implies accurate assessment of disease severity, and any relationship of AR and asthma should be evaluated. Intranasal corticosteroids (ICS) are the most effective drugs in the treatment of AR with minimal risk of systemic side effects. ICS can be the first treatment option in all forms of AR because they treat all the symptoms of AR

Towards virtualization and optimization of sinus surgery planning and execution

Introduction: The development of technology offers great possibilities for better understanding, design, standardisation, execution and subsequent mechanisation and automatisation of manual work in complex human activities which are yet to be observed, such as in endoscopic sinus surgery (ESS) where deformable, flexible and biological work objects are present in rather small production quantities. Aim: Those possibilities are achievable only by performing the capturing and thorough analysis of the existing ESS manual work process, where movements are further complicated by the variety of instruments/tools used in the different phases of the surgeon’s work. Methods: On the basis of the chosen surgery process, the paper tries to establish an integrated approach that would include experiments for motion capturing and analysis using traditional and modern methods and equipment, such as an optical video camera, predetermined motion time systems, Leap Motion Controller, Perception Neuron 2.0 and Emotiv Epoc+. Moreover, the research intent is to encompass not only physical but also accompanied mental work in the process. Results: The mentioned integrated approach would enable more quality planning and execution of the chosen surgery process and the results expected in the near future could prove valuable initially in the training of new generations of ESS surgeons. Conclusion: The possibility to analyse and measure human body movements including mental energy is always of great importance for work but also for everyday life. Technology development, particularly in biometrics, results in new, more complex tools and higher levels of materialisation that cover and create more and more realities, that are offered for the involvement of human consciousness (eros). This allows the design and standardisation of manual work in human activities which are yet to be observed, especially those of low scale (small production volume, single-unit production), such as ESS surgery