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RHINOSINUSITIS
Prof .Dr. Jehad K. Albaba
Definition:
Rhinosinusitis is defined as inflammation of the lining of the nose & sinusis.
Prof .Dr. Jehad K. Albaba
Classification
ALLERGIC:
SEASONAL.PERENNIAL.
INFECTIOUS:
ACUTE. CHRONIC.
Specific. Non-specific
Prof .Dr. Jehad K. Albaba
Classification (Cont..)OTHER
IDIOPATHIC.
OCCUPATIONAL.
HORMONAL.
DRUG-INDUCED.
Prof .Dr. Jehad K. Albaba
IRRITANTS
EMOTIONAL.
ATROPHIC.
Prevalence Of Rhinttis
Prof .Dr. Jehad K. Albaba
Anatomy
Prof .Dr. Jehad K. Albaba
Anatomy (Conti..)
Artries of nose
Nerves of nose
Function of the nose
Airway Heating and humidification Filtration Smell Nose and voice Nasal reflexes
Prof .Dr. Jehad K. Albaba
Clinical aspects of rhinosinusitis
Increase nasal secretionNasal obstructionBleeding or hemorrhagic secretion Fetor Altered or absent sense of smellPaine in the head or in the face.Disease of neighboring organs such as teeth, lacrimal apparatus, eyes, mouth, throat, and lungs.
Prof .Dr. Jehad K. Albaba
Allergic rhinitis
Allergy is an exaggerated harmful response of living tissue when exposed to an allergen. Allergic rhinitis is very common disease; it affects 15% of Americans and 10% of Europeans. The prevalence of disease is increasing due to pollution; about 13% of patient has hereditary factor. Allergic rhinitis is antigen antibody reaction, IgE is the main antibody.
Prof .Dr. Jehad K. Albaba
Predisposing factorsNon- immunological factors
Prof .Dr. Jehad K. Albaba
Allergens and allergen extracts
Prof .Dr. Jehad K. Albaba
POTENTIAL INVOLVEMENT OF MULTIPLE ORGANS WITH ALLERGIC RHNITIS Clinical Association47.1% are having pulmonary allergy12.8% are having eczema skin allergy2.1% are having both pulmonary & eczema. Sub clinical Association:20.3% are having sub clinical pulmonary allergy.75% are having sub clinical skin allergy.
Prof .Dr. Jehad K. Albaba
RHINITIS IN ASTHMATIC CHILDREN Approximately 80% of children presenting with asthma also have rhinitis.
Children with a history of allergic rhinitis are more likely to suffer from exercise induced asthma.
Prof .Dr. Jehad K. Albaba
POSSIBLE REASONS FOR CO-EXISTENCE OF RHINITIS AND ASTHMACommon ciliated epithelium.
Both are associated with allergy.
Similar allergens are associated with both conditions.
Both have a familiar link with atopy.
Possible pathophysiological mechanism-sino-bronchial reflex.
Prof .Dr. Jehad K. Albaba
Pathogenesis of allergic rhinitis
First exposure sensitization
Prof .Dr. Jehad K. Albaba
second exposure allergic symptoms
Prof .Dr. Jehad K. Albaba
Allergic RHINITIS : SYMPTOMS
SNEEZERS AND RUNNERS: Itchy nose, sneezing ,watery rhinorrhoea, nasal congestion (variable), diurnal rhythm ( worse during day), often associated conjunctivitis. BLOCKERS:Little or no sneezing, thick catarrh (with post nasal drip), No itch, constant symptoms-possibly worse at night.
Prof .Dr. Jehad K. Albaba
DIAGNOSIS OF RHINITIS
Detailed medical history
E.N.T examinationEndoscopyNasal airway assessment
Other tests as appropriate: Radiology, olfaction, blood tests.
Allergy tests: nasal smear, nasal swab, RAST, total immunoglobulins.
Prof .Dr. Jehad K. Albaba
TREATMENT : Allergic inflammation : Allergen : IgE antibody receptors on mucosal cells ( mast, basophiles, eosinophils) . Cell activation and accumulation: Release of inflammatory mediators clinical symptoms .
So, treatment is to break the process at any stage.
Prof .Dr. Jehad K. Albaba
AIMS OF MANAGEMENT OF RHINITIS
Relief of symptoms
Isolation and elimination of cause of symptoms
Awareness of associated problems
E.g. sinusitis, asthma
Prof .Dr. Jehad K. Albaba
ALLERGIC RHINITIS:STEPWISE APPROACH TO TREATMENT
Prof .Dr. Jehad K. Albaba
Treatment of allergic rhinitis in adults *
MANAGEMENT OF RHINITIS WITH CO-EXISTENT ASTHMA
INTRANASAL CORTICOSTEROIDS: (treating upper airway inflammation) indirectly improves asthma symptoms and decreases bronchial hyper-reactivity
ANTIHISTAMINES : improve rhinitis but are not shown to improve asthma.
Prof .Dr. Jehad K. Albaba
INDICATIONS FOR SURGERY
Anatomical abnormalities
Excessive mucosal swelling
Presence of irreversibly diseased tissue.
Prof .Dr. Jehad K. Albaba
Infective Rhinitis
Viral rhinitis (common cold)Bacterial rhinitis Non-specific.Acute .Chronic.Specific.Syphilis.TB.Atrophic Rhinitis.
Prof .Dr. Jehad K. Albaba
Vaso motor Rhinitis
Imbalance in the autonomic nervous system.
Prof .Dr. Jehad K. Albaba
Sinusitis
Microbiology of sinusitis
VirusesPneumococciHemophilus Influenzae Hemolytic streptococciAnaerobes Fungus
Prof .Dr. Jehad K. Albaba
Source of infection
Spread from noseSpread from sinus to sinusSpread from neighboring tissues i.e. from teeth to maxilla.Blood borne
Prof .Dr. Jehad K. Albaba
Predisposing factors
Rhinitis wither infective or Allergic Anatomical factors: Deviated septumAtresiaCilliary immutility
Immuno compromised patient as diabetic or organ transplant.
Prof .Dr. Jehad K. Albaba
Symptoms and signs of sinusitis
Pain, Headache, and Tenderness. Discharge Nasal obstruction Anosmia hyposmia or cacosmiaEczema of the nostrils and conjunctivitisGeneral symptoms as cough, generalized weakness and depression.
Prof .Dr. Jehad K. Albaba
Diagnosis
Clinically from signs and symptomsRadiology will give
Mucosal thickening Opaque sinus Air fluid level
Prof .Dr. Jehad K. Albaba
Treatment
Decongestant.Cleaning of discharge. Antibiotics according to biogram.Topical corticosteroid in presence of allergy.Surgery.
Prof .Dr. Jehad K. Albaba
Complications of sinus infection
Extension to the external tissue. Orbital complications. Intracranial complications. Osteomyelitis of the flat Bones of Skull.
Prof .Dr. Jehad K. Albaba
Protect your NOSE