Allergic Rhinitis

ALLERGIC RHINITIS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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Vasomotor rhinitis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Nasal polyps ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Etiology: 1. Allergy: * Most accepted cause. * 90% of polyps -> oesinophilia. * Allergic rhinitis, Usually present. * 20-40% -> bronchial asthma. 2. Inflammatory, chronic sinusitis. Etiology: Inflammatory or retention cyst: Arise from mucosa of maxillary antrum -> directed posteriorly. After passage through sinus ostium -> directed towards the choana -> nasopharynx. 1- Ethmoidal 2- Antrochoanal

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],- Accumulated nasal discharge in the obstructed side.

Treatment: Allergic: 1. Medical -> small early polyps. * Systemic steroids. * Topical steroids. * Antibiotics ê 2ry infection. * Anti allergic treatment. 2. Surgery: * Simple polypectomy. * Intranasal ethmoidectomy (endoscopic or microscopic). - Preoperative & postoperative steroids should be given. - There is high rate recurrence 40% after surgery (9months -> 2years). Inflammatory : 1. Medical : * Antibiotics. * Decongestant. * Mucolytics. 2. Surgical : Transnasal endoscopic sinus surgery (FESS). Endoscopic removal of nasal, nasopharyngeal, and sinus parts through a wide middle meatal antrostomy. N.B: in recurrent cases -> radical antrum operation was done. N.B: Differential diagnosis of unilateral nasal mass: 1. Benign neoplasm especially inverted, firm papillary polyps. 2. Malignant neoplasm: unilateral, bad odor, soft, bleeding on touch mass. 3. Meningocele and encephalocoele: soft, pulsating, reddish, polyp with superior attachment to skull base. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Paranasal sinuses ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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Physiology of the paranasal sinuses ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Sinusitis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Definition: Acute inflammation of the mucous membrane lining the paranasal sinuses. One or more may be involved. Usually rhniosinustis. Chronic inflammation of the mucous membrane lining of the paranasal sinuses with irreversible pathological changes. Acute sinusitis Chronic sinusitis

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],1. Mucosa: congested, edematous with fibrosis. 2. Cilia: degeneration with loss of ciliary function. 3. Late cases: the mucosa is either atrophic or hypertrophic “irreversible pathology”. Pathology: Congestion & oedema of sinus mucosa  occlusion of sinus ostium  impairment of sinus drainage & mucociliary clearance  accumulation of secretions inside the sinus  stasis & infection with  pus formation.

Local: 1. 2. 3. Sites of sins pain & tenderness in acute & chronic sinusitis. Maxillary: pain & tenderness over affected sinus. Ethmoidal: Pain  in between eyes. Tenderness  inner canthus. Frontal: Pain  supra orbital & across forehead. Tenderness  above eyebrow. Floor of sinus. Sphenoid: pain  occipital. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

A) Medical: 1- General: - Same. - Antibiotics: for 4weeks. 2- Local : - Same. - Control of local nasal Predisposing factors. - Nasal wash: alkaline nasal wash. B) Surgical: Indication: 1) Failed medical treatment (up to 4 weeks). 2) Presence of mechanical obstruction in the nose. Treatment: A) Medical: 1- General: - Bed rest. - Plenty of fluids. - Antibiotics: for 10-14days. - Analgesics. - Mucolytics. 2- Local : - Decongestant nasal drops. - Steam inhalation. B) Surgical: Indication: aiming to Surgical drainage. 1) Failed medical ttt. 2) Complications: present or threatening. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Procedure: Nowadays; -> drainage of the affected sinus by functional endoscopic sinus surgery (FESS). Old: 1. Maxillary: puncture & lavage. 2. Frontal: frontal trephine. 3. Ethmoid: fthnoidectomy. 4. Sphenoid: sphenocthmoidectomy. Procedure: According to he affected sinus Sphenoid Sphenoid sinusotomy External Sphenoethroidectomy Ethmoids Intranasal ethnoidectomy External Frontoethroidectomy. Frontal Endoscopic clearance of frontal recess. External frontal operation  opening sinus floor & removal of diseased mucosa. Maxillary Endoscopic middle meatal antrostomy  widening of the normal ostium. ,[object Object],[object Object],[object Object],Recent “FESS” Old

Sinusitis in children ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Orbital complications ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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Osteomylitis of skull ,[object Object],[object Object],Treatment : Hospitalization. 1. Massive antibiotics. 2. Surgical drainage of abscess. 3. Treatment of sinusitis. Plain X-ray & CT scan. Investigations: Plain X-ray & CT scan X-ray -> moth-eaten appearance of posterior wall. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Pathology : Osteomylitis -> subperiosteal abscess (Pott’s puffy tumour) -> fistula. Same Frontal osteomylitis Maxillary osteomylitis

Intracranial complications ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Complications of sinusitis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Mucocel ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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Allergic Rhinitis

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Allergic Rhinitis