DGI:Rhinosinusitis/Therapie: Difference between revisions

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====Akute Rhinosinusitis====
====Akute Rhinosinusitis====
<span style="font-size:12.0pt;line-height:107%;font-family:&quot;Arial&quot;,sans-serif">[2</span><ref><span style="font-size:11.0pt;line-height:107%;
<span style="font-size:12.0pt;line-height:107%;font-family:&quot;Arial&quot;,sans-serif">[2</span><ref name=":0">Stuck BA, Bachert C, Federspil P, et al. [Rhinosinusitis guidelines of the German Society for Otorhinolaryngology, Head and Neck Surgery]. HNO. 2007;55(10):758-760, 762-764, 766-777. doi:10.1007/s00106-007-1589-6</ref><span style="font-size:12.0pt;line-height:107%;font-family:&quot;Arial&quot;,sans-serif">, 5</span><ref>Sinusitis and antibiotics - PubMed. Accessed July 9, 2021. <nowiki>https://pubmed.ncbi.nlm.nih.gov/22541622/</nowiki></ref><span style="font-size:12.0pt;line-height:107%;font-family:&quot;Arial&quot;,sans-serif">- 8</span><ref>Patel, Z.M. Uncomplicated acute sinusitis and rhinosinusitis in adults: Treatment. 2020; Available from: <nowiki>https://www.uptodate.com/contents/uncomplicated-acute-sinusitis-and-rhinosinusitis-in-adults-treatment</nowiki>.</ref><span style="font-size:12.0pt;line-height:107%;font-family:&quot;Arial&quot;,sans-serif">]</span>
font-family:&quot;Calibri&quot;,sans-serif;mso-ascii-theme-font:minor-latin;mso-fareast-font-family:
Calibri;mso-fareast-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;
mso-bidi-font-family:&quot;Times New Roman&quot;;mso-bidi-theme-font:minor-bidi;
mso-ansi-language:DE;mso-fareast-language:EN-US;mso-bidi-language:AR-SA">Stuck, B.A., et al., ''[Rhinosinusitis guidelines of the German Society for Otorhinolaryngology, Head and Neck Surgery].'' HNO, 2007. '''55'''(10): p. 758-60, 762-4, 766-77.</span></ref><span style="font-size:12.0pt;line-height:107%;font-family:&quot;Arial&quot;,sans-serif">, 5</span><ref>''<span style="font-size:11.0pt;line-height:107%;font-family:&quot;Calibri&quot;,sans-serif;
mso-ascii-theme-font:minor-latin;mso-fareast-font-family:Calibri;mso-fareast-theme-font:
minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:&quot;Times New Roman&quot;;
mso-bidi-theme-font:minor-bidi;mso-ansi-language:DE;mso-fareast-language:EN-US;
mso-bidi-language:AR-SA">Sinusitis and antibiotics.</span>'' <span style="font-size:11.0pt;line-height:107%;font-family:&quot;Calibri&quot;,sans-serif;
mso-ascii-theme-font:minor-latin;mso-fareast-font-family:Calibri;mso-fareast-theme-font:
minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:&quot;Times New Roman&quot;;
mso-bidi-theme-font:minor-bidi;mso-ansi-language:DE;mso-fareast-language:EN-US;
mso-bidi-language:AR-SA">Lancet Infect Dis, 2012. '''12'''(5): p. 355.</span><br /></ref><span style="font-size:12.0pt;line-height:107%;font-family:&quot;Arial&quot;,sans-serif">- 8</span><ref>Patel, Z.M. ''Uncomplicated acute sinusitis and rhinosinusitis in adults: Treatment''. 2020; Available from: https://www.uptodate.com/contents/uncomplicated-acute-sinusitis-and-rhinosinusitis-in-adults-treatment.</ref><span style="font-size:12.0pt;line-height:107%;font-family:&quot;Arial&quot;,sans-serif">]</span>


<span style="font-family:&quot;Arial&quot;,sans-serif">Spontanheilungsraten von > 50% nach 1 Woche, 60-80% nach 2 Wochen, und über > 90% nach 4 Wochen</span>
<span style="font-family:&quot;Arial&quot;,sans-serif">Spontanheilungsraten von > 50% nach 1 Woche, 60-80% nach 2 Wochen, und über > 90% nach 4 Wochen</span>


<span style="font-family:&quot;Arial&quot;,sans-serif">Wenn Patient innerhalb von 7 Tagen erneut vorstellig werden kann, dann bei viraler wie auch bei bakterieller Rhinosinusitis rein symptomatische Therapie.</span>
<span style="font-family:&quot;Arial&quot;,sans-serif">Wenn Patient:innen innerhalb von 7 Tagen erneut vorstellig werden kann, dann bei viraler wie auch bei bakterieller Rhinosinusitis rein symptomatische Therapie.</span>
<br />
<br />


*<span style="font-family:&quot;Arial&quot;,sans-serif">Symptomatische Therapie</span>
*<span style="font-family:&quot;Arial&quot;,sans-serif">Symptomatische Therapie</span>
**<span style="font-family:&quot;Arial&quot;,sans-serif">Kochsalzinhalationen</span>
**<span style="font-family:&quot;Arial&quot;,sans-serif">Kochsalzinhalationen</span>
**<span style="color: black">nasale Anwendung von Salzlösungen z. B. als hochvolumige (≥150 ml), iso- bis leicht hypertone Spülung </span>
**<span style="color: black">Nasale Anwendung von Salzlösungen z. B. als hochvolumige (≥150 ml), iso- bis leicht hypertone Spülung </span>


*<span style="color: black">medikamentöse Therapie</span>
*<span style="color: black">Medikamentöse Therapie</span>
**<span style="font-family:&quot;Arial&quot;,sans-serif">Mukolytische/Sekretolytische Therapie</span>
**<span style="font-family:&quot;Arial&quot;,sans-serif">Mukolytische/Sekretolytische Therapie</span>
**<span style="font-family:&quot;Arial&quot;,sans-serif">Dekongestiva</span>
**<span style="font-family:&quot;Arial&quot;,sans-serif">Dekongestiva</span>
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{| class="wikitable sortable filterable MsoTableGrid" style="margin-left:-.25pt;border-collapse:collapse;mso-table-layout-alt:fixed;" width="605" cellspacing="0" cellpadding="0" border="1"
<br />
{| class="wikitable sortable filterable MsoTableGrid" border="1" cellspacing="0" cellpadding="0" width="605" style="margin-left:-.25pt;border-collapse:collapse;mso-table-layout-alt:fixed;"
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| style="width:63.8pt;" width="85" valign="top" |'''<span style="font-family:&quot;Arial&quot;,sans-serif;mso-fareast-font-family:Arial">Klinische  Situation</span>'''
| style="width:63.8pt;" width="85" valign="top" |'''<span style="font-family:&quot;Arial&quot;,sans-serif;mso-fareast-font-family:Arial">Klinische  Situation</span>'''
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| style="width:63.75pt;" width="85" valign="top" |'''<span style="color: black">Kommentar</span>'''
| style="width:63.75pt;" width="85" valign="top" |'''<span style="color: black">Kommentar</span>'''
|- style="height:27.7ptpx;"
|- style="height:27.7ptpx;"
| rowspan="3" style="width:63.8pt;" width="85" valign="top" |<span style="font-family:&quot;Arial&quot;,sans-serif;mso-fareast-font-family:
| rowspan="2" style="width:63.8pt;" width="85" valign="top" |<span style="font-family:&quot;Arial&quot;,sans-serif;mso-fareast-font-family:
   Arial">Bakterielle Rhinu-sinusitis</span>
   Arial">Bakterielle Rhinu-sinusitis</span>
| rowspan="2" style="width:63.8pt;" width="85" valign="top" |<span style="font-family:&quot;Arial&quot;,sans-serif;mso-fareast-font-family:
| style="width:63.8pt;" width="85" valign="top" |<span style="font-family:&quot;Arial&quot;,sans-serif;mso-fareast-font-family:
   Arial">Therapie der Wahl</span>
   Arial">Therapie der Wahl</span>
| style="width:3.0cm;" width="113" valign="top" |<span style="font-family:&quot;Arial&quot;,sans-serif;mso-fareast-font-family:
| style="width:3.0cm;" width="113" valign="top" |<span style="font-family:&quot;Arial&quot;,sans-serif;mso-fareast-font-family:
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| style="width:53.35pt;" width="71" valign="top" |<span style="font-family:&quot;Arial&quot;,sans-serif;mso-fareast-font-family:
| style="width:53.35pt;" width="71" valign="top" |<span style="font-family:&quot;Arial&quot;,sans-serif;mso-fareast-font-family:
   Arial">-</span>
   Arial">-</span>
| style="width:63.75pt;" width="85" valign="top" |
|- style="height:21.05ptpx;"
| style="width:3.0cm;" width="113" valign="top" |
| style="width:80.7pt;" width="108" valign="top" |
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| style="width:53.35pt;" width="71" valign="top" |
| style="width:63.75pt;" width="85" valign="top" |
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====Chronische Rhinosinusitis====
====Chronische Rhinosinusitis====
[2<ref><span style="font-size:11.0pt;line-height:107%;
[2<ref name=":0" />, 10<ref>Sedaghat AR. Chronic Rhinosinusitis. Am Fam Physician. 2017;96(8):500-506.</ref>]<br />
font-family:&quot;Calibri&quot;,sans-serif;mso-ascii-theme-font:minor-latin;mso-fareast-font-family:
Calibri;mso-fareast-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;
mso-bidi-font-family:&quot;Times New Roman&quot;;mso-bidi-theme-font:minor-bidi;
mso-ansi-language:DE;mso-fareast-language:EN-US;mso-bidi-language:AR-SA">Stuck, B.A., et al., ''[Rhinosinusitis guidelines of the German Society for Otorhinolaryngology, Head and Neck Surgery].'' HNO, 2007. '''55'''(10): p. 758-60, 762-4, 766-77.</span></ref>, 10<ref>Sedaghat, A.R., ''Chronic Rhinosinusitis.'' Am Fam Physician, 2017. '''96'''(8): p. 500-506.</ref>]<br />


*<span style="font-family:&quot;Arial&quot;,sans-serif">Symptomatische Therapie</span>
*<span style="font-family:&quot;Arial&quot;,sans-serif">Symptomatische Therapie</span>
**<span style="font-family:&quot;Arial&quot;,sans-serif">Kochsalzinhalationen</span>
**<span style="font-family:&quot;Arial&quot;,sans-serif">Kochsalzinhalationen</span>
**<span style="color: black">nasale Anwendung von Salzlösungen z. B. als hochvolumige (≥150 ml), iso- bis leicht hypertone Spülung </span>
**<span style="color: black">Nasale Anwendung von Salzlösungen z. B. als hochvolumige (≥150 ml), iso- bis leicht hypertone Spülung </span>


*<span style="color: black">medikamentöse Therapie</span>
*<span style="color: black">Medikamentöse Therapie</span>
**<span style="font-family:&quot;Arial&quot;,sans-serif">Mukolytische/Sekretolytische Therapie</span>
**<span style="font-family:&quot;Arial&quot;,sans-serif">Mukolytische/Sekretolytische Therapie</span>
**<span style="font-family:&quot;Arial&quot;,sans-serif">Dekongestiva</span>
**<span style="font-family:&quot;Arial&quot;,sans-serif">Dekongestiva</span>
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*<span style="font-family:&quot;Arial&quot;,sans-serif; mso-fareast-font-family:&quot;Times New Roman&quot;;mso-fareast-language:DE">Chirurgische Therapie</span>
*<span style="font-family:&quot;Arial&quot;,sans-serif; mso-fareast-font-family:&quot;Times New Roman&quot;;mso-fareast-language:DE">Chirurgische Therapie</span>
**<span style="font-family:&quot;Arial&quot;,sans-serif">mangelnde Symptombesserung nach einem suffizienten medikamentösen Therapieversuch</span>
**<span style="font-family:&quot;Arial&quot;,sans-serif">Mangelnde Symptombesserung nach einem suffizienten medikamentösen Therapieversuch</span>
**<span style="font-family:&quot;Arial&quot;,sans-serif; mso-fareast-font-family:&quot;Times New Roman&quot;;mso-fareast-language:DE">bei entzündlichen Komplikationen</span>
**<span style="font-family:&quot;Arial&quot;,sans-serif; mso-fareast-font-family:&quot;Times New Roman&quot;;mso-fareast-language:DE">Bei entzündlichen Komplikationen</span>
***<span style="font-family:&quot;Arial&quot;,sans-serif;mso-fareast-font-family:&quot;Times New Roman&quot;; mso-fareast-language:DE">Abszesse</span>
***<span style="font-family:&quot;Arial&quot;,sans-serif;mso-fareast-font-family:&quot;Times New Roman&quot;; mso-fareast-language:DE">Abszesse</span>
***<span style="font-family:&quot;Arial&quot;,sans-serif; mso-fareast-font-family:&quot;Times New Roman&quot;;mso-fareast-language:DE">Orbitaödem</span>
***<span style="font-family:&quot;Arial&quot;,sans-serif; mso-fareast-font-family:&quot;Times New Roman&quot;;mso-fareast-language:DE">Orbitaödem</span>
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<br />
<references />

Latest revision as of 18:04, 9 August 2021

Therapie

Akute Rhinosinusitis

[2[1], 5[2]- 8[3]]

Spontanheilungsraten von > 50% nach 1 Woche, 60-80% nach 2 Wochen, und über > 90% nach 4 Wochen

Wenn Patient:innen innerhalb von 7 Tagen erneut vorstellig werden kann, dann bei viraler wie auch bei bakterieller Rhinosinusitis rein symptomatische Therapie.

  • Symptomatische Therapie
    • Kochsalzinhalationen
    • Nasale Anwendung von Salzlösungen z. B. als hochvolumige (≥150 ml), iso- bis leicht hypertone Spülung
  • Medikamentöse Therapie
    • Mukolytische/Sekretolytische Therapie
    • Dekongestiva
    • Analgetisch und antipyretisch


Bei Hinweisen für bakterielle Rhinosinusitis Benefit für Einsatz für antibiotische Therapie nicht gesichert. Ausnahme bei

  •  Radiologischer Nachweis von Sekretspiegeln oder Totalverschattung der NNH
  • Schmerzen + erhöhtes CRP
  • Mikrobiologischer Nachweis positiv


Klinische Situation Präferenz Substanz Dosierung Dauer Anpassungen Kommentar
Bakterielle Rhinu-sinusitis Therapie der Wahl Amoxicillin 500 mg p.o. 3x/d 7-10d -
Alternative Amoxicillin/ Clavulansäure 875/125 mg p.o. 3x/d - Resistenz-lage Pneumo-kokken


  •  Chirurgische Therapie
    • Bei Einschränkungen der regulären Ventilation und Drainage
    • Bei bakterieller Infektion und ungenügendem Ansprechen auf systemische Therapie


Chronische Rhinosinusitis

[2[1], 10[4]]

  • Symptomatische Therapie
    • Kochsalzinhalationen
    • Nasale Anwendung von Salzlösungen z. B. als hochvolumige (≥150 ml), iso- bis leicht hypertone Spülung
  • Medikamentöse Therapie
    • Mukolytische/Sekretolytische Therapie
    • Dekongestiva
    • Analgetisch und antipyretisch
    • Topische Kortikosteroide
  •  Biologika (bei Versagen etablierter Therapieformen)
    • Anti IgE-Antikörper (Omalizumab)
    • Anti IL-5-Antikörper (Mepolizumab, Reslizumab)
  • Antibiotika Einsatz keine klare Evidenz
    • Short-term Applikation
      • bei endoskopisch gewonnenem positivem Mibi Befund
    • Long-term Applikation
      • Generell keine Empfehlung
      • Im Einzelfall
        • bei CRSsNP (Chronic rhinosinusitis without nasal polyps) Clarithromycin bei Versagen der Standardtherapie evaluieren
        • Bei CRScNP (Chronic rhinosinusitis with nasal polyps) im Falle einer Rezidiv-Polyposis Doxycyclin evaluieren
  • Chirurgische Therapie
    • Mangelnde Symptombesserung nach einem suffizienten medikamentösen Therapieversuch
    • Bei entzündlichen Komplikationen
      • Abszesse
      • Orbitaödem
      • Endokranielle Komplikationen
      • Osteomyelitis im Bereich des Schädelknochens


  1. ↑ 1.0 1.1 Stuck BA, Bachert C, Federspil P, et al. [Rhinosinusitis guidelines of the German Society for Otorhinolaryngology, Head and Neck Surgery]. HNO. 2007;55(10):758-760, 762-764, 766-777. doi:10.1007/s00106-007-1589-6
  2. ↑ Sinusitis and antibiotics - PubMed. Accessed July 9, 2021. https://pubmed.ncbi.nlm.nih.gov/22541622/
  3. ↑ Patel, Z.M. Uncomplicated acute sinusitis and rhinosinusitis in adults: Treatment. 2020; Available from: https://www.uptodate.com/contents/uncomplicated-acute-sinusitis-and-rhinosinusitis-in-adults-treatment.
  4. ↑ Sedaghat AR. Chronic Rhinosinusitis. Am Fam Physician. 2017;96(8):500-506.
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