Rhinosinusitis Dr. Abdullah S. Al Yousef
Allergic Rhinitis • Definition : An inflammatory disorder of the nose which occurs when the membranes lining the nose become sensitized to allergens : -Sensitization to an allergen results in the production of immunoglobulin (Ig) E which is specific to that allergen. This Ig. E binds to the surface of mast cells in the lining of the nose. -Re-exposure to the allergen results in allergen binding to Ig. E on the surface of mast cells. This triggers the release of histamine and other inflammatory mediators from the mast cells. -Histamine and other inflammatory mediators act on cells, nerve endings, and blood vessels to produce symptoms.
Types • Allergic rhinitis may be categorized into: • Seasonal allergic rhinitis/hay fever: this occurs at certain times of the year. When due to tree pollen or grass it is known as hay fever. Other allergens include mould spores and weeds. • Perennial rhinitis (= persistent): this occurs throughout the year. Allergens commonly include house dust mites and domestic pets.
Symptoms • Itchy nose, mouth, eyes, throat, skin, or any area • Problems with smell • Runny nose • Sneezing • Tearing eyes
Symptoms that may develop later include: • • Stuffy nose (nasal congestion) Coughing Clogged ears and decreased sense of smell Sore throat Puffiness under the eyes Fatigue and irritability Headache Memory problems and slowed thinking
Signs Nasal signs • Transverse nasal crease (allergic crease) – A black transverse line across the middle of nose – Occurs due to constant rubbing of the nose in the upward direction resembling a salute – allergic salute • Swollen turbinates • Pale, oedematous, bluish nasal mucosa • Thin watery discharge
Allergic Crease
Otologic signs • Retraction of tympanic membrane and serous otitis media due to eustachian tube dysfunction
Pharyngeal signs • Granular pharyngitis due to hyperplasia of submucosal lymphoid tissue Laryngeal signs • Hoarseness of voice • Oedema of vocal cords
Diagnosis • History ( Symptoms, Past History, Drugs, Family History ) • Examination : -Nose, for swollen nasal mucous membranes and structural defects. -Ears, for fluid in the middle ear and the appearance of the eardrum. -Sinus areas, for tenderness and signs of infection. -Mouth, to see whether you have changes from breathing only through your mouth. -Back of throat, for signs of postnasal drip or infection, such as red, raised, bumpy tissue. • Allergy Testing (Skin Prick Test, Blood Test)
Complications • • • Sinusitis Otitis Media Asthma URTI Nasal Polyps
Treatment • Education (Avoidance, Salt Water Solution) • Mild: Antihistamines, Decongestants - Antihistamines, Decongestants, Nasal corticosteroids • Severe: Injected Corticosteroids, Immunotherapy (Allergy Shots)
Vasomotor Rhinitis • Non Allergic • Causes may include odors, medication, changes in the weather, stress, foods and chronic health conditions.
Pathophysiology • Nonallergic rhinitis occurs when blood vessels in your nose expand (dilate), filling the nasal lining with blood and fluid.
Symptoms • Stuffy nose • Runny nose • Mucus in the throat (postnasal drip)
Diagnosis • Diagnosed by ruling out other causes of allergy. -Skin Test and Blood Test.
Complications • Nasal polyps • Chronic sinusitis. • Middle ear infections.
Treatment • Avoidance • Saline nasal sprays, Corticosteroid nasal sprays, Antihistamine nasal sprays, Anticholinergic nasal sprays, Oral decongestants , Decongestant nasal sprays
Acute Suppurative Rhinitis • Definition : Acute sinusitis (acute rhinosinusitis) causes the cavities around your nasal passages (sinuses) to become inflamed and swollen. This interferes with drainage and causes mucus to build up.
Pathogenesis • • Viral (Rhinovirus) Bacterial (H. Influenza, Strep Pneumonia) Fungal Other ( Allergies, Tumor, Deviated Nasal Septum )
Symptoms • Yellow or green discharge • Nasal congestion • Pain, tenderness, swelling and pressure around your eyes, cheeks, nose or forehead • Aching in your upper jaw and teeth • Reduced sense of smell and taste • Cough, which may be worse at night
Non-specific symptoms • • • Ear pain Headache Sore throat Bad breath (halitosis) Fatigue Fever
Diagnosis • • Nasal endoscopy Imaging studies (CT, MRI) Nasal and sinus cultures Allergy testing
Complications • • • Asthma flare ups Chronic sinusitis Meningitis Vision problems Ear infection
Treatment • Saline nasal spray • Nasal corticosteroids • Decongestants • Pain relievers -Antibiotic treatment is generally needed only if you have a bacterial infection, especially if the infection is severe, recurrent or persistent
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