و ما أوتيتم من العلم إلا قليلا صدق الله العظيم الدكتور سعد يونس سليمان

Inflammatory conditions of the nasal cavity (Rhinitis) Rhinitis: is inflammation of the nasal cavity which may be caused by a variety of factors, the most common are: (1) VIRAL RHINITIS (2) ALLERGIC RHINITIS (3) NON-ALLERGIC RHINITIS (4) ATROPHIC RHINITIS (5) RHINITIS MEDICAMENTOSA.

VIRAL RHINITIS Is also called coryza or common cold The virus is transmitted by means of airborne droplet Most common virus rhinovirus and corona virus. The infection occur only when; (1) Lowered individual's resistance. (2) Increased concentration and virulence of the virus. Common in winter. Affect all age group especially children and young adult.

CLINICAL FEATURE The course of the disease may be described in 4 stages ; (1) Prodromal or ischaemic stage (2) Early reaction or irritation (3) Stage of venous stasis and secondary infection (4) Resolution;

1. Prodromal or ischaemic stage; ..few hours ..stage of local invasion and generalized nasal ischaemia .. hot, dry or tickling spot at the site of invasion with patent nasal airway

2. Early reaction or irritation ; ..few hours or days ..infection spread to the adjacent mucus membrane ..sorethroat , sneezing, watery discharge and obstruction .. red and swollen mucus membrane with mild fever

3. Stage of venous stasis and secondary infection .. After the 2nd day ..dusky bluish mucosa with mucopurulent discharge ..maximum obstruction and toxaemia

4. Resolution; .. after 5-10 days recovery takes place.

TREATMENT 1. Isolation of the patient. 2. Bed rest. 3. Decongestant nasal drops. 4. Steam inhalation. 5. Analgesic. 6. Antihistamine. 7. Antibiotics is not indicated .

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(2) ALLERGIC RHINITIS Definition ; Is an IgE-mediated hypersensitivity of the nasal mucus membrane characterized by …sneezing …itching …watery nasal discharge …nasal obstruction. Aetiology; .. genetically inherited tendency to develop an exaggerated IgE response to extrinsic allergens.

Pathophysiology

HISTORY DIAGNOSIS ..Symptoms ..When it occur? ..What initiate its attack? ..Previous history of infantile eczema and wheezy bronchitis ..Family history of allergy.

.. Anterior rhinoscopy; EXAMINATION .. Typical physical eye findings ( injected conjunctiva with watery discharge and eyelid puffiness). .. Anterior rhinoscopy; … normal … oedematous bluish-gray mucosa covered with watery mucus. … inferior turbinate swollen with polypoidal appearance.

(1) Skin prick test . (3) Increase serum IgE level. INVESTIGATION (2) Nasal cytology ; A characteristic of nasal secretion is the large number of eosinophils, especially just after an acute attack. (3) Increase serum IgE level.

TREATMENT (1) Avoidance of specific allergens. (2) Pharmacotherapy; Antihistamine: 1st generation antihistamine; (diphenhydramine and chlorpheniramine). 2nd generation antihistamine;( Fexofenadine and Loratidine) Steroids: ( local or systemic) Topical anticholinergic agent; (nasal ipratropium bromide). Mast-cell stabilizing agent: ( nasal disodium chromoglycate) (3) Immunotherapy. By repeated administration of specific allergens, the body "get used to" the allergen, which can result in fewer or less severe symptoms.

(3) NON-ALLERGIC RHINITIS: (Intrinsic or vasomotor rhinitis) Definition; is non –infective, non-allergic condition suspected to be due to autonomic imbalance within the nasal cavity. Symptoms ; Identical to those of allergic rhinitis. Pathogenesis ; Overactive parasympathetic system… IgE- mediated mechanism do not play a role . Provoked by non-specific exogenous factors. Diagnosis: Typical history … Negative allergen test . No elevated IgE in the secretion.

Treatment: (1) Avoidance of irritant (e.g. cigarette smoke). (2) Topical nasal steroids. (3) When there is copious watery discharge, the addition of nasal anticholenergic (nasal ipratropium bromide) is usually recommended. (4) Surgery ; Correction of associated septal deviation and turbinate hypertrophy. Vidian neurectomy : disruption of parasympathetic fibers to the nasal mucosa.

(4) ATROPHIC RHINITIS Is a chronic nasal disease characterized by ; Progressive atrophy of the mucosa and underlying bone of turbinates . The presence of viscid secretion which rapidly dries and form crusts which emit a characteristic foul odour called ozaena. An abnormal patency of nasal passages .

Is still unknown but it can be divided into ; Aetiology: Is still unknown but it can be divided into ; (1) Primary (idiopathic) atrophic rhinitis : this may be due to; … infection with Klibsiella ozaenae bacteria.. … endocrine imbalance. … heredity . … poor nutrition. … autonomic disease (recently) . (2) Secondary atrophic rhinitis: may be due to : Extensive nasal surgery. Occupational exposure to glass, wood, asbestos …etc. Irradiation.

Clinical picture: Symptoms: Signs: Nasal obstruction Epistaxis Anosmia. Signs: (1) The presence of nasal fetor, not appreciated by the patient who is anosmic. (2) Green yellow and black crust lining the nasal cavity and there detachment reveals a bleeding and ulcerated mucosa. (3) Wide nasal cavity.

Differential diagnosis: (1) Tumors of the nose and sinuses. (2) Purulent rhinitis and sinusitis especially of dental origin. (3) Rhinolith and foreign body (unilateral nasal obstruction and foul- smelling secretion).

Treatment: Medical ; Surgical: (1) Nasal irrigation with alkaline solution. (2) Regular nasal cleansing and removal of crusts, followed by (3) Nasal drops composed of 25% glucose in glycerin which inhibit proteolytic organs. (4) Rifampicin 600 mg orally once daily for 6 months. Surgical: Closure of one or both nostrils by plastic surgery.

(5) RHINITIS MEDICAMENTOSA: This condition is the result of over-medication with local nasal decongestant (e.g. oxymetazoline, phenylephrine, and xylometazoline nasal sprays). Local nasal decongestant brings releif to the patient with enlarged inferior turbinates. When the effect wears off a rebound phenomenon occurs . Reflex vasodilatation causes turbinate hypertrophy. If the decongestant treatment is repeated , a chronic nasal obstruction unresponsive to decongestant results.

Treatment: (1) Immediate cessation of the decongestant . (2) Nasal or systemic steroids. (3) If this is not successful then inferior turbinectomy may be required.

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