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Nasal mucosal hyperreactive rhinopathy
Allergic Rhinitis (AR)
Perennial~(PAR), Seasonal~(SAR) ( Pollinosis )
Morbidity: 10%~20%
Inhalant allergens——dust mite, house dust, pollen,
fungi, animal danders, cockroach ;
Food allergens——milk, eggs, fish and shrimp, mea
t, vegetables, fruits.
Mite
Mold
Pollen
Cat
Antigens for allergic rhinitis
变应性鼻炎的病因学 内在因素──遗传因素:有家族史者较
无家族史者发病危险高2~6倍母系第11对染色体长臂q段
外在因素(环境因素):基因表达受非遗传因素影响。7000对孪生儿,同时有 AR 症状者为21%
易感个体在一定环境条件作用下才发病
变应原与致敏靶细胞表面 IgE 结合
致敏靶细胞脱粒、释放、合成生物活性介质
肥大细胞
储备的介质 新合成的介质
组胺 缓激肽 白三烯 血小板活化因子 前列腺素 D2
毛细血管扩张、通透性增加,腺体分泌增多
嗜酸 / 碱性粒细胞
哮喘 鼻炎
发病机制
Pathology :
Type allergy
Allergic inflammation: Predominant T cells
& eosinophilic cells infiltrate.
Symptoms & Signs :
Nasal irritation and iching
recurrent attacks of paroxysma
l sneezing
copious watery rhinorrhea
nasal obstruction
鼻后滴漏
Diagnosis :
1 、 History ( allergen exposure, hypersensitivity,
family history )
2 、 Examination
3 、 Skin test: skin prick test
4 、 IgE antibody , Serum total IgE 、 special Ig
E
5 、 Nasal provocation or nasal chanllenge tests
Differential Diagnosis :
1 、 Vastomotor rhinitis
2 、 Nonallergic rhinitis with eosin
ophilia syndrome, NARES
3 、 Hyperreflectory rhinitis
4 、 Acute rhinitis
Complications :
1 、 Allergic sinusitis
2 、 Asthma
3 、 Secretory otitis media
4 、 Allergic pharyngolaryngitis
Treatment :
1 、 Avoidance
2 、 Drugs
1 ) Antihistamines
2 ) Corticosteroids
3 ) Sodium cromoglycate(SCG) Cromolyn sodium
4 ) Anticholinergic agents
5 ) Vasoconstrictor sympasthomimetics
3 、 Hyposensitization
4 、 Others : Traditional Chinese medicine, laser, operation
Nasal Polyp & Nasal Polyposis
Etiology : mutilfactors 1.allergic ; 2.chroni
c inflammation
Pathology : highly swelled connective tissu
e. Predominant eosinophilic cells infiltrate. Lym
phatic cells, neutrophils, basophils, mast cells.
Polyp in maxillary sinus ( L ), polyp in middle meatus( R )
Symptoms & Sign : persistent nasal obst
ruction , close nasal sound , hyposmia, rhi
norrhea, snore, “frog nose”
Antrochoanal polyp
Antrochoanal polyp
Diagnosis :
Anterior rhinoscopy : translucent, soft, smooth
masses. Endoscopy, X-ray and CT scanner.
Differential Diagnosis :
Papilloma inverted , angiofibroma of nasophar
ynx , malignant tumor of nasal cavity , meni
ngoencephalocele
Treatment : 1 、 conservative treatment——co
rticosteroids 2 、 surgical treatment
Polyps ( above ), papilloma ( below )
papilloma ( L ), MT of nasal cavity ( R )
Sinusitis
Acute suppurative sinusitis
Features of sinus anatomy :
1 、 small ostia of the sinuses ;
2 、 continuative mucosa between nasal
cavity and sinuses ;
3 、 contiguous of the ostia ;
4 、 location of the astia and features of the
sinuses.
Frontal Sinus
Ethmoid Sinus
Maxillary Sinus
Etiology :1 、 General factors: Poor general health (influenza, measles, whooping cough…)
2 、 Local factors :
Sinus diseases ;
Infective focus of eripheral organs ,
Direct infection ;
Nasal tampon (packing) ;
Rapid change of atmospheric pressure
ABS主要病原体:肺炎链球菌和嗜血流感杆菌
SAHP. Otolaryngol Head Neck Surg. 2004;130:1-45.
20-43%
22-35%
Anaerobes 0-9%
Staphylococcus aureus 0-8%
Other bacteria 4%
Moraxella catarrhalis
Other streptococci 3-9%
2-10%
S. pneumoniae
成人 Acute bacterial rhinosinusitis (ABS) 病因
H. influenzae
儿童 Acute bacterial rhinosinusitis (ABS) 病因
• ABS主要病原体:肺炎链球菌、嗜血流感杆菌和卡他莫拉菌
H. i nfl uenzae15-20%
S.pneum 25-30%
Sterile 20-35%
Anaerobes 2-5%
S.pyogenes 2-5%
M.catarrhalis15-20%
Otolaryngol Head Neck Surg. 2004;130:1-45.
Symptoms & Signs :General symptoms :
Malaise, fever.
Local symptoms:
1 ) Nasal obstruction sustained, with hyposmia
2 ) Suppurative rhinorrhea, streaky with blood, foul smell(odontogentic~)
3 ) headach or local ache
Antral pain——from inner canthus downwards across the cheek, upper alveolus on the affected side.
Ethmoidal pain——over bridge of the nose & inner canthus behind the eye.
Frontal pain——forehead, periodicity, persist for an hour or tow after getting up in the morning, and clear during the afternoon.
Sphenoidal pain——occipital or vertical headache.
Diagnosis :History ,Signs,
Anterior rhinoscopy,
Nasal endoscopy,
Radiological examination,
Puncture and irrigation of maxillary sinus
Treatment : Eradicate causes , keep
drainage ; control infection and prevent
complications
1 、 General treatment : take rest , antibiotics , antihistamine (if necessary )
2 、 Local treatment
3 、 Body drainage
4 、 Physical therapy
5 、 Puncture and irrigation of maxillary sinus
Maxillary sinus puncture and irragation
Chronic suppurative sinusitis
Etiology : Acute——Chronic
Symptoms & Signs :General~:
Local~ : rhinorrhea, nasal obstruction, headache, hyposmia, vision disorder
Diagnosis :1 、 History ;
2 、 Examination : anterior rhinoscopy, nasal
endoscopy
3 、 Radiological examination : CT or MRI
4 、 Puncture and irrigation of sinus
Normal image of nasal endoscopy
Maxillary sinusitis——pus in the middle meatus
Maxillary sinusitis(R)
Sphenoid sinusitis——pus in the sphenoethmoidal recess
Sphenoid sinusitis
Pansinusitis
Pansinusitis
Treatment :1 、 Intranasal medications : Corticosteroid , Vasoconstrictor sympasthomimetics
2 、 Puncture and irrigation of maxillary sinus
3 、 Displacement method——frontal sinusitis, ethmoidal sinusitis, sphenoidal sinusitis, pansinusitis
4 、 Surgery——traditional sinus surgery
Functional Endoscopic Sinus Surgery(FESS) Ostiometal complex OMC
Functional Endoscopic Sinus Surgery(FESS)
复习与思考:
1 、鼻腔外侧壁的解剖结构及其与临床的关系如何?
2 、变应性鼻炎有何临床表现,应与哪些疾病相鉴别?
3 、如何诊断鼻窦炎?
4 、鼻息肉应与哪些疾病相鉴别 ?
5 、上颌窦穿刺术有何临床意义?