Rhinosinusitis

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Rhinosinusitis

• Dr. Abdullah S. Al Yousef

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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.

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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.

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Symptoms

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

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• 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

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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

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Allergic Crease
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• Otologic signs
• Retraction of tympanic membrane and serous otitis
  media due to eustachian tube dysfunction

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

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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)

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Complications

• Sinusitis
• Otitis Media
• Asthma
• URTI
• Nasal Polyps

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Treatment

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

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Vasomotor Rhinitis

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

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Pathophysiology

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

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Symptoms

• Stuffy nose
• Runny nose
• Mucus in the throat (postnasal drip)

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Diagnosis

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

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Complications

• Nasal polyps
• Chronic sinusitis.
• Middle ear infections.

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Treatment

• Avoidance
• Saline nasal sprays, Corticosteroid nasal sprays,
  Antihistamine nasal sprays, Anticholinergic nasal
  sprays, Oral decongestants , Decongestant nasal
  sprays

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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.

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Pathogenesis

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

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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

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Non-specific symptoms

• Ear pain
• Headache
• Sore throat
• Bad breath (halitosis)
• Fatigue
• Fever

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Diagnosis

• Nasal endoscopy
• Imaging studies (CT,MRI)
• Nasal and sinus cultures
• Allergy testing

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Complications

• Asthma flare ups
• Chronic sinusitis
• Meningitis
• Vision problems
• Ear infection

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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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• Thank you