RHINOSINUSITIS

Prof .Dr. Jehad K. Albaba

:Definition

Rhinosinusitis is defined as inflammation of

the lining of the nose & sinusis.

Prof .Dr. Jehad K.

Albaba

Classification

ALLERGIC:

SEASONAL.
PERENNIAL.

INFECTIOUS:

ACUTE.
CHRONIC.

Specific.
Non-specific

Prof .Dr. Jehad K.

Albaba

Classification (Cont..)

OTHER

IDIOPATHIC.

IRRITANTS

OCCUPATIONAL.

EMOTIONAL
.

HORMONAL.

ATROPHIC.

DRUG-INDUCED.

Prof .Dr. Jehad K.

Albaba

Prevalence Of Rhinttis
GENERAL%
POPULATION
Rhinitis symptoms

% 9-15

Allergic rhinitis

(2)5-20%

Prof .Dr. Jehad K.

Albaba

Anatomy

Prof .Dr. Jehad K.

Albaba

Anatomy (Conti..)

Artries of nose

Nerves of nose

Function of the nose

Airway
Heating and humidification
Filtration
Smell
Nose and voice
Nasal reflexes
Prof .Dr. Jehad K.
Albaba

Clinical aspects of rhinosinusitis

Increase nasal secretion
Nasal obstruction
Bleeding or hemorrhagic secretion
Fetor
Altered or absent sense of smell
Paine in the head or in the face.
Disease of neighboring organs such as teeth,
lacrimal apparatus, eyes, mouth, throat, and lungs.

Prof .Dr. Jehad K.

Albaba

Allergic rhinitis
Allergy
is an exaggerated harmful response of living tissue
when exposed to an allergen. Allergic rhinitis is very
common disease; it affects 15% of Americans and
10% of Europeans. The prevalence of disease is
increasing due to pollution; about 13% of patient has
hereditary factor.
Allergic rhinitis is antigen antibody reaction, IgE is the
main antibody.

Prof .Dr. Jehad K.

Albaba

Predisposing factors
Non- immunological factors
The autonomic nervous system

Environmental factors continued

Autonomic imbalance

Humidity - Temperature

Unspecific hyper-reactivity

Air pollution

Adrenergic blockad

Aspirin intolerance a receptor disease

Prof .Dr. Jehad K.

Albaba

Allergens and allergen extracts

Inhaled allergens

Ingested allergens

Pollen

Food allergy

Moulds

Medications

Animal dander

Structure and occurrence

House dust -house

Dust mite

Allergen extracts

Feathers

Extraction

Other inhalant allergens

Potency
Stability

Occupational allergy

Standardization

Prof .Dr. Jehad K.

Albaba

POTENTIAL INVOLVEMENT OF MULTIPLE

ORGANS WITH ALLERGIC RHNITIS

Clinical Association
47.1% are having pulmonary allergy
12.8% are having eczema skin allergy
2.1% are having both pulmonary & eczema.
Sub clinical Association:
20.3% are having sub clinical pulmonary allergy.
75% are having sub clinical skin allergy.

Prof .Dr. Jehad K.

Albaba

RHINITIS IN ASTHMATIC CHILDREN

Approximately 80% of children presenting with asthma

also have rhinitis.

Children with a history of allergic rhinitis are more likely

to suffer from exercise induced asthma.

Prof .Dr. Jehad K.

Albaba

POSSIBLE REASONS FOR CO-EXISTENCE OF

RHINITIS AND ASTHMA

Common ciliated epithelium.

Both are associated with allergy.

Similar allergens are associated with both conditions.

Both have a familiar link with atopy.

Possible pathophysiological mechanism-sino-bronchial

reflex.
Prof .Dr. Jehad K.
Albaba

Pathogenesis of allergic rhinitis

First exposure sensitization

Prof .Dr. Jehad K.

Albaba

second exposure allergic symptoms

Prof .Dr. Jehad K.

Allergic RHINITIS : SYMPTOMS

SNEEZERS AND RUNNERS:

Itchy nose, sneezing ,watery rhinorrhoea, nasal
congestion (variable), diurnal rhythm
( worse during day), often associated conjunctivitis.

BLOCKERS:
Little or no sneezing, thick catarrh (with post nasal
drip), No itch, constant symptoms-possibly worse
at night.

Prof .Dr. Jehad K.

Albaba

DIAGNOSIS OF RHINITIS

Detailed medical history

E.N.T examination
Endoscopy
Nasal airway assessment

Other tests as appropriate:

Radiology, olfaction, blood tests.

Allergy tests:
nasal smear, nasal swab, RAST, total immunoglobulins.

Prof .Dr. Jehad K.

Albaba

:TREATMENT

Allergic inflammation :
Allergen :
IgE antibody receptors on mucosal cells ( mast, basophiles,
eosinophils) .

Cell activation and accumulation:

Release of inflammatory mediators clinical symptoms .

So, treatment is to break the process at any stage.

Prof .Dr. Jehad K.

Albaba

AIMS OF MANAGEMENT OF RHINITIS

Relief of symptoms

Isolation and elimination of cause of symptoms

Awareness of associated problems

E.g. sinusitis, asthma

Prof .Dr. Jehad K.

Albaba

ALLERGIC RHINITIS:
STEPWISE APPROACH TO TREATMENT
1.

2.
3.

Allergen avoidance
Anti-histamines
Topical nasal steroids or
systemic

4.

Decongestants

5.

Mast cells stabilizers

6.

Anti-leukatrines

7.

Anti-IgE

8.

Desensitisation

9.

Surgery

Prof .Dr. Jehad K.

Albaba

*Treatment of allergic rhinitis in adults

Itch\Sneezing
Sodium
Cromoglycate

Discharge

Blockage

Impaired
smell

Oral antihistamines

+++

++

Ipratropium bromide

+++

Topical decongestants

+++

+++

+++

++

+++

+++

+++

++

Topical
corticosteroids
Oral corticosteroids

MANAGEMENT OF RHINITIS WITH COEXISTENT ASTHMA

INTRANASAL CORTICOSTEROIDS: (treating

upper airway inflammation) indirectly improves
asthma symptoms and decreases bronchial hyperreactivity

ANTIHISTAMINES : improve rhinitis but are

not shown to improve asthma.

Prof .Dr. Jehad K.

Albaba

INDICATIONS FOR SURGERY

Anatomical abnormalities

Excessive mucosal swelling

Presence of irreversibly diseased tissue.

Prof .Dr. Jehad K.

Albaba

Infective Rhinitis

Viral rhinitis (common cold)

Bacterial rhinitis
Non-specific.

Specific.

Acute .
Chronic.
Syphilis.
TB.

Atrophic Rhinitis.
Prof .Dr. Jehad K.
Albaba

Vaso motor Rhinitis

Imbalance in the autonomic nervous system.

Prof .Dr. Jehad K.

Albaba

Sinusitis

Microbiology of sinusitis

Viruses
Pneumococci
Hemophilus Influenzae
Hemolytic streptococci
Anaerobes
Fungus

Prof .Dr. Jehad K.

Albaba

Source of infection
Spread from nose
Spread from sinus to sinus
Spread from neighboring tissues i.e. from teeth
to maxilla.
Blood borne

Prof .Dr. Jehad K.

Albaba

Predisposing factors
Rhinitis wither infective or Allergic
Anatomical factors:

Deviated septum
Atresia
Cilliary immutility

Immuno compromised patient as diabetic or

organ transplant.
Prof .Dr. Jehad K.
Albaba

Symptoms and signs of sinusitis

Pain, Headache, and Tenderness.

Discharge
Nasal obstruction
Anosmia hyposmia or cacosmia
Eczema of the nostrils and conjunctivitis
General symptoms as cough, generalized weakness and
depression.

Prof .Dr. Jehad K.

Albaba

Diagnosis

Clinically from signs and symptoms

Radiology will give

Mucosal thickening
Opaque sinus
Air fluid level

Prof .Dr. Jehad K.

Albaba

Treatment

Decongestant.
Cleaning of discharge.
Antibiotics according to biogram.
Topical corticosteroid in presence of allergy.
Surgery.

Prof .Dr. Jehad K.

Albaba

Complications of sinus infection

Extension to the external tissue.

Orbital complications.
Intracranial complications.
Osteomyelitis of the flat Bones of Skull.

Prof .Dr. Jehad K.

Albaba

Protect your NOSE