1. Prepared by Dr. Muaid I.Aziz FICMS

2.  It’s a group of disorders characterized by inflammation of the mucosa of the nose & pns.

3.  Viral  Bacterial  fungal

4.  Acute ( < 4 wks )  Subacute (4-12 wks)  Recurrent acute ( 4 or more acute episode / year )  Chronic ( > 12 wks )  Acute exacerbations of chronic RS

5.  Host factors  Inviromental factors

6.  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

7.  Streptococcus pneumoniae  Haemophilus influenzae  Moraxilla catarrhalis  Staph. aureus

8.  "major" criteria facial pain nasal obstruction Hyposmia purulence on examination Fever ( only in ARS)  "minor" criteria Headache halitosis Fatigue dental pain cough otalgia

14.  AB  Decongestant  Surgical drainge  Correction of any predisposing factors

15.  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

16.  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

17. 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

18.  Non infective non allergic  Perennial rhinitis  VMR  Its an adult onset or childhood onset?

19.  Idiopathic  Occupational  Hormonal  Drug induced  Food induced  Emotionally induced  Atrophic rhinitis

20. 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

22.  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

23.  The aspirin traid  Allergic fungal sinusitis  Allergy ?  Its a disease of adult  Ciliary dysfunction disorder ?

24.  Symptoms  Nasal blockage  Running & sneezing  Sense of smell  Pain  Postnasal drip  Epistaxis

25.  Signs  Hyponasal voice  Polyp seen externally or on anterior rhinoscopy  Mouth breathing

26.  Investigation  Plain X-R  CT-Scan

27.  Treatment  Medical ( steroid)? / 1 month  Surgical

29.  etiology  Unilateral or bilateral  Maxillary sinus origin ( floor, lateral wall )  Unilateral nasal obstruction ? on inspiration or expiration?  Examination / normal ?  X-R  Surgical or medical ?