Prepared by Dr. Muaid I.Aziz FICMS
It’s a group of disorders characterized by inflammation of the mucosa of the nose & pns.
Viral Bacterial fungal
Acute ( < 4 wks ) Subacute (4-12 wks) Recurrent acute ( 4 or more acute episode / year ) Chronic ( > 12 wks ) Acute exacerbations of chronic RS
Host factors Inviromental factors
Host Factors Systemic Allergic rhinitis Immunodeficiency Genetic/congenital cystic fibrosis, ciliary dyskinesia Local Anatomic obstruction Gastro - esophageal reflux Dental infection Trauma Enviromental factors Microorganisms viral illness Pollutants cigarette smoke Medications Rhinitis medicamentosa
Streptococcus pneumoniae Haemophilus influenzae Moraxilla catarrhalis Staph. aureus
"major" criteria facial pain nasal obstruction Hyposmia purulence on examination Fever ( only in ARS) "minor" criteria Headache halitosis Fatigue dental pain cough otalgia
AB Decongestant Surgical drainge Correction of any predisposing factors
Most common predisposing factor in adults Second most common in children (after viral URI) Allergic rhinitis leads to mucosal inflammation and hypertrophy blocking the ostiomeatal complex
DIGNOSIS 2 OR more of the following sx 1. Blockage / congestion 2. Discharge 3. Facial pain 4. Hyposmia + POLYPS, Mucopurulent discharge from m.m or oedema in mm + or Ct scan changes
CRS Infectious Allergy Treat Etiology – Allergen Avoidance –Antibiotics –Surgery Treat Etiology – Allergen Avoidance –Antibiotics –Surgery IL-5, IL-4 IL-8, IF- GM-CSF IL-5, IL-4 IL-8, IF- GM-CSF Attenuate Inflammation –Nasal douching –Steroids –Decongestant –Antibiotic / Macrolides –Antifungal –Antihistamine / Antileukotrienes –Who knows what else? Attenuate Inflammation –Nasal douching –Steroids –Decongestant –Antibiotic / Macrolides –Antifungal –Antihistamine / Antileukotrienes –Who knows what else? Anatomic
Non infective non allergic Perennial rhinitis VMR Its an adult onset or childhood onset?
Idiopathic Occupational Hormonal Drug induced Food induced Emotionally induced Atrophic rhinitis
ESINOPHILIC (OBSTRUCTION) NON- ESINOPHILIC(RHINORRHOEA) Moderate /sever obstruction Mild/moderate rhinorrhoea Minimal sneezing Usual hyposmia Marked mucosal swelling Marked turbinate hypertrophy Frequent polyp Mild Sever Minimal Rare Mild never
Polypous. Its part of chronic rhinosinusitis Its more frequent in non-allergic than in allergic rhinitis Nasal polyps are round, smooth, soft, translucent yellow or pale glistening structure attached to the nasal or sinus mucosa by a narrow stalk or pedicle, some time be red after repeated trauma & infection Non-tender moved backwards when probed. Commonly arise from the ethmoidal sinuses, they arise from beneath middle turbinate anteriorly & above middle turbinate posteriorly. In maxillary sinuses, some time after surgery Bilateral & multiple
The aspirin traid Allergic fungal sinusitis Allergy ? Its a disease of adult Ciliary dysfunction disorder ?
Symptoms Nasal blockage Running & sneezing Sense of smell Pain Postnasal drip Epistaxis
Signs Hyponasal voice Polyp seen externally or on anterior rhinoscopy Mouth breathing
Investigation Plain X-R CT-Scan
Treatment Medical ( steroid)? / 1 month Surgical
etiology Unilateral or bilateral Maxillary sinus origin ( floor, lateral wall ) Unilateral nasal obstruction ? on inspiration or expiration? Examination / normal ? X-R Surgical or medical ?