rhinosinus.ppt

RHINOSINUSITIS

Prof .Dr. Jehad K. Albaba

Definition:

Rhinosinusitis is defined as inflammation of the lining of the nose & sinusis.


Classification

ALLERGIC:

SEASONAL.PERENNIAL.

INFECTIOUS:

ACUTE. CHRONIC.

Specific. Non-specific


Classification (Cont..)OTHER

IDIOPATHIC.

OCCUPATIONAL.

HORMONAL.

DRUG-INDUCED.


IRRITANTS

EMOTIONAL.

ATROPHIC.

Prevalence Of Rhinttis


Anatomy


Anatomy (Conti..)

Artries of nose

Nerves of nose

Function of the nose

Airway Heating and humidification Filtration Smell Nose and voice Nasal reflexes


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.


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.


Predisposing factorsNon- immunological factors


Allergens and allergen extracts


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.


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.


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.


Pathogenesis of allergic rhinitis

First exposure sensitization


second exposure allergic symptoms


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.


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.


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.


AIMS OF MANAGEMENT OF RHINITIS

Relief of symptoms

Isolation and elimination of cause of symptoms

Awareness of associated problems

E.g. sinusitis, asthma


ALLERGIC RHINITIS:STEPWISE APPROACH TO TREATMENT


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.


INDICATIONS FOR SURGERY

Anatomical abnormalities

Excessive mucosal swelling

Presence of irreversibly diseased tissue.


Infective Rhinitis

Viral rhinitis (common cold)Bacterial rhinitis Non-specific.Acute .Chronic.Specific.Syphilis.TB.Atrophic Rhinitis.


Vaso motor Rhinitis

Imbalance in the autonomic nervous system.


Sinusitis

Microbiology of sinusitis

VirusesPneumococciHemophilus Influenzae Hemolytic streptococciAnaerobes Fungus


Source of infection

Spread from noseSpread from sinus to sinusSpread from neighboring tissues i.e. from teeth to maxilla.Blood borne


Predisposing factors

Rhinitis wither infective or Allergic Anatomical factors: Deviated septumAtresiaCilliary immutility

Immuno compromised patient as diabetic or organ transplant.


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.


Diagnosis

Clinically from signs and symptomsRadiology will give

Mucosal thickening Opaque sinus Air fluid level


Treatment

Decongestant.Cleaning of discharge. Antibiotics according to biogram.Topical corticosteroid in presence of allergy.Surgery.


Complications of sinus infection

Extension to the external tissue. Orbital complications. Intracranial complications. Osteomyelitis of the flat Bones of Skull.


Protect your NOSE

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rhinosinus.ppt