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Laryngorhinootologie 2013; 92(11): 763-776
DOI: 10.1055/s-0033-1355415
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© Georg Thieme Verlag KG Stuttgart · New York

Akute Rhinosinusitis bei Erwachsenen – EPOS 2012 Teil II

Acute Rhinosinusitis in Adults – EPOS 2012 Part II
H. Riechelmann
,
A. Giotakis
,
F. Kral
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Publication History

Publication Date:
30 October 2013 (online)

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Zusammenfassung

Die Rhinosinusitis (RS) ist eine Entzündung der Schleimhaut von Nase und Nasennebenhöhlen, die im Regelfall gemeinsam betroffen sind. Es gibt zahlreiche Leitlinien und Positionspapiere zur Rhinosinusitis. Aktuell und umfassend ist das Positionspapier „EPOS 2012“ der European Rhinologic Society und der European Academy of Allergy and Clinical Immunology. Die EPOS2012-Expertengruppe sieht als zentrales pathophysiologisches Element dieser Erkrankung die Entzündung an, nicht die Infektion. Zunächst werden diagnostische Kriterien für die RS allgemein (akut und chronisch) definiert. Rhinosinusitiden mit einer Krankheitsdauer unter 12 Wochen werden als akut kategorisiert. Ungefähr 10% der Bevölkerung Europas leiden im Jahresmittel an einer akuten Rhinosinusitis. Die akute RS wird weiter unterteilt in akut viral, akut postviral und akut bakteriell. Für die einzelnen Subtypen der akuten RS wurden dezidierte diagnostische Kriterien entwickelt. Die akut virale RS entspricht einem oberen Atemwegsinfekt, die akut postvirale RS stellt eine Zwischenstufe zur akut bakteriellen RS dar. Für die akut virale RS findet sich im Positionspapier eine Bewertung von OTC-Erkältungsmitteln. Der Stellenwert einer topischen Steroidtherapie bei der akut postviralen RS wird anhand aktueller Studien dargestellt. Die Indikationen und die Vor- und Nachteile einer antibiotischen Therapie bei akut bakterieller RS werden von der EPOS2012-Expertenkommission kritisch gewertet. Insgesamt erfährt dieses medizinisch, pharmazeutisch und gesundheitsökonomisch relevante Gebiet derzeit eine Neuorientierung, die sich in den nächsten Jahren auch im Praxis-Alltag bemerkbar machen wird.

Abstract

Rhinosinusitis (RS) is an inflammatory disorder of the mucous membranes of the nose and paranasal sinuses, which are almost always affected concurrently. The EPOS2012 position paper initiated by the European Rhinologic Society and the European Academy of Allergy and Clinical Immunology is a recent comprehensive source on this common disease affecting approximately 20% of the population worldwide.

Inflammation, not infection, is considered the cornerstone of RS, which is considered a temporal and pathophysiologic disease continuum with various subtypes. Acute rhinosinusitis is ­diagnosed, if typical symptoms last less than 12 weeks. It affects approximately 10% of the European population. Acute RS is further subdivided into acute viral, acute postviral and acute bacterial RS. Acute viral RS lasts less than 10 days with decreasing symptom intensity, while acute postviral RS is characterized by longer duration or a sudden increase of symptom seve­rity around the 5th day (‘double sickening’). Acute bacterial RS is assumed if 3 of the following 5 criteria are additionally met: Discoloured discharge (with unilateral predominance), severe local pain (with unilateral predominance), fever (>38ºC), elevated ESR/CRP, and ‘double ­sickening’.

For the treatment of acute viral RS, nasal saline irrigations and OTC cold remedies are advised. In acute postviral RS, additional topical steroids are suggested. Advantages and disadvantages of antibiotic treatment in acute bacterial RS are detailed. Overall, the new EPOS position paper infers a reorientation in this area of high medical, pharmaceutical and economic relevance.

Schlüsselwörter

Akute Rhinosinusitis - Leitlinien - akut viral - akut postviral - akut bakteriell

Key words

acute rhinosinusitis - guidelines - adult - classification - nasal polyps
 

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