Gå direkt till huvudinnehållet

Kronisk rinosinuit

Senast uppdaterad: Senast reviderad:


Definition:
Symtom och tecken på inflammation i en eller flera av de paranasala bihålorna och i nässlemhinnan med varaktighet över 12 veckor.
Förekomst:
Vanligast bland yngre och medelålders personer.
Symtom:
Vanliga symtom är varig snuva, smärta/tryck i ansiktet och nedsatt luktsinne.
Kliniska fynd:
Pus i en eller bägge näskaviteterna, speciellt lokaliserat till mellersta näsgången, eventuellt näspolyper vid kronisk rinosinuit med polypos. 
Diagnostik:
Rhinoskopi som påvisar typiska kliniska fynd. DT är vid oklarheter om diagnosen, när medicinsk behandling har misslyckats, när det uppstår komplikationer och vid misstänkt malignitet.
Behandling:
Nässköljning med koksaltlösning, intranasala kortikosteroider och i vissa fall antibiotika används vid behandlingen. Eventuell astma behandlas. I vissa fall kan kirurgi vara av värde.
  1. Fokkens WJ, Lund VJ, Hopkins C, et al. European Position Paper on Rhinosinusitis and Nasal Polyps 2020. Rhinology. 2020;58(Suppl S29):1‐464. PMID:32077450. PubMed  
  2. Hastan D, Fokkens WJ, Bachert C, et al. Chronic rhinosinusitis in Europe--an underestimated disease. A GA²LEN study. Allergy 2011; 66(9): 1216-23. pmid:21605125 PubMed  
  3. Bhattacharyya N. Incremental health care utilization and expenditures for chronic rhinosinusitis in the United Stats. Ann Otol Rhinol Laryngol 2011; 120(7): 423-7. pmid:21859049 PubMed  
  4. Larsen K, Tos M. The estimated incidence of symptomatic nasal polyps. Acta Otolaryngol. 2002;122:179–182. PMID:11936910. PubMed  
  5. Lusk R. Chronic rhinosinusitis: contrasts between children and adult patients. Clin Allergy Immunol 2007; 20: 287. PubMed  
  6. Hamilos DL. Chronic rhinosinusitis patterns of illness. Clin Allergy Immunol 2007; 20: 1. PubMed  
  7. Läkemedelsverket. Läkemedel vid rinosinuit – behandlingsrekommendation. 2020-06-25 (Hämtad 2020-06-25). www.lakemedelsverket.se  
  8. Berrettini S, Carabelli A, Sellari-Franceschini S, et al. Perennial allergic rhinitis and chronic sinusitis: correlation with rhinologic risk factors. Allergy 1999; 54: 242. PubMed  
  9. Tammemagi CM, Davis RM, S Benninger M, Holm AL, Krajenta R. Secondhand smoke as a potential cause of chronic rhinosinusitis: a case-control study. Arch Otolaryngol Head Neck Surg 2010; 136: 327-34. PubMed  
  10. Orlandi RR, Kingdom TT, Hwang PH, et al. International Consensus Statement on Allergy and Rhinology: Rhinosinusitis. Int Forum Allergy Rhinol 2016; 6 suppl 1: S22-209. pmid:26889651 PubMed  
  11. Schreiber CP, Hutchinson S, Webster CJ, Ames M, Richardson MS, Powers C. Prevalence of migraine in patients with a history of self-reported or physician-diagnosed "sinus" headache. Arch Intern Med 2004; 164: 1769-72. PubMed  
  12. Hamilos DL. Clinical manifestations, pathophysiology, and diagnosis of chronic rhinosinusitis. UpToDate, last updated June 13, 2011. UpToDate  
  13. Jani AL, Hamilos DL. Current thinking on the relationship between rhinosinusitis and asthma. J Asthma 2005; 42: 1. PubMed  
  14. Makowska J, Lewandowska-Polak A, Kowalski ML, et al. Hypersensitivity to Aspirin and other NSAIDs: Diagnostic Approach in Patients with Chronic Rhinosinusitis. Curr Allergy Asthma Rep. 2015 Aug;15(8):47. PubMed  
  15. Meltzer EO, Hamilos DL, Hadley JA, et al. Rhinosinusitis: establishing definitions for clinical research and patient care. J Allergy Clin Immunol 2004; 114 (6 Suppl): 155.
  16. The Royal College of Radiologists. Making the best use of a Department of Clinical Radiology. Guidelines for doctors. Fourth edition. London: The Royal College of Radiologists, 1998
  17. Wuister AM, Goto NA, Oostveen EJ, et al. Nasal endoscopy is recommended for diagnosing adults with chronic rhinosinusitis. Otolaryngol Head Neck Surg. 2014 Mar;150(3):359-64. doi: 10.1177/0194599813514510. DOI  
  18. Head K, Chong LY, Piromchai P, et al. Systemic and topical antibiotics for chronic rhinosinusitis. Cochrane Database Syst Rev 2016; 26;4: CD011994. pmid:27113482 PubMed  
  19. Wei CC, Adappa ND, Cohen NA. Use of topical nasal therapies in the management of chronic rhinosinusitis. Laryngoscope. 2013 Oct;123(10):2347-59. PMID: 23553558. PubMed  
  20. Darrell R, Guthmann R. Which treatments are safe and effective for chronic sinusitis?. J Family Practice 2016; 11: 829-31. www.researchgate.net  
  21. Chong LY, Head K, Hopkins C, et al. Saline irrigation for chronic rhinosinusitis. Cochrane Database Syst Rev 2016; 26;4: CD011995. pmid:27115216 PubMed  
  22. Scadding GK, Durham SR, Mirakian R, et al, British Society for Allergy and Clinical Immunology. BSACI guidelines for the management of rhinosinusitis and nasal polyposis. Clin Exp Allergy 2008; 38: 260. PubMed  
  23. Lund VJ, Black JH, SzabóLZ, Schrewelius C, Akerlund A. Efficacy and tolerability of budesonide aqueous nasal spray in chronic rhinosinusitis patients. Rhinology 2004; 42: 57. PubMed  
  24. Rudmik L, Soler ZM, et al. Medical Therapies for Adult Chronic Sinusitis: A Systematic Review. JAMA. 2015 Sep 1;314(9):926-39. PubMed  
  25. Aanæs K, Alanin MC, Arndal E et al.. Kronisk bihulebetændelse og type 2-sygdom. Ugeskr Læger 2022; 184: V05210446. ugeskriftet.dk  
  26. Chong LY, Piromchai P, Sharp S, et al. Biologics for chronic rhinosinusitis. Cochrane Database Syst Rev. 2021;3(3):CD013513. Published 2021 Mar 12. DOI:10.1002/14651858.CD013513.pub3. DOI  
  27. Rix I, Håkansson K, Larsen CG, et al. Management of chronic rhinosinusitis with nasal polyps and coexisting asthma: A systematic review. Am J Rhinol Allergy 2015; May-Jun;29(3): 193-201. pmid:25975250 PubMed  
  28. Mafee MF. Imaging of paranasal sinuses and rhinosinusitis. Clin Allergy Immunol 2007; 20: 185. PubMed  
  • Morgan Andersson, docent och överläkare, Öron-, näs- och halskliniken, Skånes universitetssjukhus
  • Remy Waardenburg, specialist i allmänmedicin, Vårdcentralen Hökarängen