慢性副鼻腔炎

―難治例の病態とその対応―

抄録

The pathophysiology of eosinophilic chronic rhinosinusitis (ECRS), a type of refractory chronic sinus inflammation accompanied by numerous infiltrations of activated eosinophils in paranasal sinus mucosa and/or nasal polyps, remains unknown, and several complex mechanisms are considered to promote eosinophil accumulation. Inflammatory entities, including cytokines—IL-5 and GM-CSF, chemokines such as eotaxin, and chemical mediators such as CysLTs are reportedly related to eosinophilic sinonasal mucosal inflammation. ECRS should be managed by focusing directly on inhibiting local eosinophil infilitration. Related surgical procedures include mechanical removal of diseased mucosal lesions and opening the bony wall septum of affected sinuses to enhance postoperative maintenance. Local and/or systemic steroids and leukotriene receptor antagonists are also recommended. Local steroid administration effectively prevents nasal polyposis relapse. Meticulous follow-up is needed in all cases because although adequate combinations of surgery and postoperative therapy keep most subjects with ECRS enjoy some relief, no treatment yet completely reliefes ECRS.