1. Rhinosinusitis Dr. Abdullah S. Al Yousef

2. 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 IgE binds to the surface of mast cells in the lining of the nose. -Re-exposure to the allergen results in allergen binding to IgE 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.

3. 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.

4. Symptoms Itchy nose, mouth, eyes, throat, skin, or any area Problems with smell Runny nose Sneezing Tearing eyes

5. 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

6. 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

7. Allergic Crease

8. Otologic signs Retraction of tympanic membrane and serous otitis media due to eustachian tube dysfunction

9. Pharyngeal signs Granular pharyngitis due to hyperplasia of submucosal lymphoid tissue Laryngeal signs Hoarseness of voice Oedema of vocal cords

10. 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)

11. Complications Sinusitis Otitis Media Asthma URTI Nasal Polyps

12. Treatment Education (Avoidance, Salt Water Solution) Mild: Antihistamines, Decongestants - Antihistamines, Decongestants, Nasal corticosteroids Severe: Injected Corticosteroids, Immunotherapy (Allergy Shots)

13. Vasomotor Rhinitis Non Allergic Causes may include odors, medication, changes in the weather, stress, foods and chronic health conditions.

14. Pathophysiology Nonallergic rhinitis occurs when blood vessels in your nose expand (dilate), filling the nasal lining with blood and fluid.

15. Symptoms Stuffy nose Runny nose Mucus in the throat (postnasal drip)

16. Diagnosis Diagnosed by ruling out other causes of allergy. -Skin Test and Blood Test.

17. Complications Nasal polyps Chronic sinusitis. Middle ear infections.

18. Treatment Avoidance Saline nasal sprays, Corticosteroid nasal sprays, Antihistamine nasal sprays, Anticholinergic nasal sprays, Oral decongestants, Decongestant nasal sprays

19. 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.

20. Pathogenesis Viral (Rhinovirus) Bacterial (H.Influenza, Strep Pneumonia) Fungal Other ( Allergies, Tumor, Deviated Nasal Septum )

21. 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

22. Non-specific symptoms Ear pain Headache Sore throat Bad breath (halitosis) Fatigue Fever

23. Diagnosis Nasal endoscopy Imaging studies (CT,MRI) Nasal and sinus cultures Allergy testing

24. Complications Asthma flare ups Chronic sinusitis Meningitis Vision problems Ear infection

25. 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

26. Thank you