RHINITISRHINITIS

Miss H. Babar-CraigMiss H. Babar-Craig

RhinitisRhinitis

Two main types :Two main types :

1. ALLERGIC RHINITIS1. ALLERGIC RHINITIS

2. NON-ALLERGIC RHINITIS2. NON-ALLERGIC RHINITIS A. EosinophilicA. Eosinophilic B. Non-eosiniphilicB. Non-eosiniphilic

Allergic RhinitisAllergic Rhinitis

AETIOLOGYAETIOLOGY

Type 1 Ig E Hypersensitivity reaction in Type 1 Ig E Hypersensitivity reaction in the mucous membranes of the nasal the mucous membranes of the nasal airwaysairways

Can be seasonal or perennialCan be seasonal or perennial

ALLERGENSALLERGENS

Pollens, moulds , house dust mite, animal Pollens, moulds , house dust mite, animal epitheliaepithelia

Lateral Nasal AnatomyLateral Nasal Anatomy

Allergic RhinitisAllergic Rhinitis

CLINICAL FEATURES :CLINICAL FEATURES : 1. Rhinorrhoea, anterior or PND1. Rhinorrhoea, anterior or PND 2. Nasal irritation, itching, vestibulitis2. Nasal irritation, itching, vestibulitis 3. Sneezing, ichy watery eyes3. Sneezing, ichy watery eyes 4. Allergic Salute Sign4. Allergic Salute Sign 5. Long term nasal obstruction, anosmia, 5. Long term nasal obstruction, anosmia,

polypspolyps

SAMTER’S Triad Aspirin allergy, asthma, SAMTER’S Triad Aspirin allergy, asthma, polypspolyps

Allergic RhinitisAllergic Rhinitis

Allergic RhinitisAllergic Rhinitis

Investigations :Investigations :

1. Allergy tests, skin prick, blood 1. Allergy tests, skin prick, blood RAST testsRAST tests

2. CT sinuses only if sinusitis or 2. CT sinuses only if sinusitis or polyps.polyps.

Allergic RhinitisAllergic Rhinitis

Management :Management : 1. Avoidance, dust/allergy advice sheet1. Avoidance, dust/allergy advice sheet 2. Antihistamines2. Antihistamines 3. Topical Steroid Sprays – nasonex, 3. Topical Steroid Sprays – nasonex,

flixonaseflixonase 4. Oral steroids4. Oral steroids 5. Surgical – Submucous diathermy5. Surgical – Submucous diathermy

Turbinate reductionTurbinate reduction

Non-Allergic RhinitisNon-Allergic Rhinitis

Two typesTwo types 1. Eosinophilic1. Eosinophilic 2. Non-eosinophilic2. Non-eosinophilic

Also known as intrinsic of non-Also known as intrinsic of non-infectiveinfective

Nasal secretions may or may not Nasal secretions may or may not contain numbers of eosinophilscontain numbers of eosinophils

Non-Allergic RhinitisNon-Allergic Rhinitis

Predisposing Factors :Predisposing Factors : 1. Family history1. Family history 2. Preceding infection, leading to 2. Preceding infection, leading to

mucosal hypersensitivity.mucosal hypersensitivity. 3. Psychological, emotional factors3. Psychological, emotional factors 4. Endocrine, pregnancy, menstruation4. Endocrine, pregnancy, menstruation 5. Pollution, fumes, industrial agents, 5. Pollution, fumes, industrial agents,

smokesmoke 6. Smoking, alcohol6. Smoking, alcohol

Non-Allergic RhinitisNon-Allergic Rhinitis

Clinical Features :Clinical Features : 1. Older age, perennial1. Older age, perennial 2. Nasal obstruction2. Nasal obstruction 3. Rhinorrhoea3. Rhinorrhoea 4. Polyps, anosmia4. Polyps, anosmia 5. Sinusitis more common5. Sinusitis more common

Non-Allergic Rhinitis Non-Allergic Rhinitis

Management:Management: 1. Antibiotics1. Antibiotics 2. Nasal steroids2. Nasal steroids 3. Nasal decongestion eg ephedrine, 3. Nasal decongestion eg ephedrine,

otrivineotrivine 4. Surgical – Septoplasty4. Surgical – Septoplasty - Submucous diathermy- Submucous diathermy - Turbinate Reduction- Turbinate Reduction - FESS- FESS