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RHINOSINUSITIS&NASAL POLYPOSIS
Rhinosinusitis common complication AR40 % chronic sinusitis alergyAdult childrenInflamatory mucous membraneUSA incidence 18%Socioeconomic problem
Pathophysiology of Rhinosinusitis
Symptoms RhinosinusitisMajor symptomsFacial pain/pressureFacial congestion/fullnessNasal obstruction/blockageNasal discharge/ purulence/post nasal dripHyposmia/anosmiafeverMinor symptomsHeadacheFeverHalitosis FatiqueDental painCoughEarpain/pressure/fullness
RHINOSINUSITISDiagnosis :Medical historyPhysical examainationPurulent secretionPatencyt of sinus out flow tractEdemaX-ray
RHINOSINUSITIS
Medical managementNon sedating antihistamineDecongestan Intranasal steroidAntibiotics (severe)Surgycal
NASAL POLYPOSISPolyps smooth, grade like structure arise from inflamed mucosa lining pranasal sinuses.Allergy ??EosinophiliaIL 5EotaxinrantesIntranasal CorticosteroidUntreated nasal polypsRelapse preventionPost operative
POLYPOSISSmooth, grape like
Skin testnot identify all possible allergen
Local production Ig E
Prevalence polyposis in allergic rhinitis
PATHOPSHYSIOLOGY TNF a epithelial cellVCAM-1 EPITHELIAL CELLIL 1 epithelial cellEOSINOPHIL >>Migration through blood vessel wallRelease of eosinophil granule proteinAlteration of Na & Cl fluxEDEMAInjury to air way epithelial cells by allergen, virus or traumaRegeneration of airway epitheliumBasal cell hyperplasiaSquamous cell hyperplasiaGoblet cell hyperplasiaDetective CFTR migrationAnti IL 1Anti TNF aAnti VCAM 1Anti VLA 1
POLYPOSISDiagnosis :HistoryPhysical examination (RA/Endoscopy)LaboratoryX ray/ CT scan
POLYPOSISHistoryNasal congestionHyposmia/ anosmiaSneezingRhinorrhea
POLYPOSISPhysical examination Multiple/ dingleSmoothGrade-likeGelatinousCommon arise from ethmoid/ ostial region
POLYPOSISLaboratory Skin testingHistamine / Ig Epolyps fluids
X ray/ CT scan
POLYPOSISSTAGING Grade 1 : polyps do not prolaps middle turbinate (endoscopy)Grade 2 : polyps extend bellow middle turbinate (rhinoscopy anterior)Grade 3 : polyps massive
POLYPOSISGuideline for the management Primary goal : relief patient symptomsSecondary goal :Infections