1.antihistamines are the best treatment for symptomatic relief, but the classic antihistamines are often soporific .
2. Steroids :injection;or oral medication; the local inhalers and sprays
3.sympathomimetic and vasoconstrictor drugs (in the form of drops and sprays)
4. mast cell stabilizer(in the form of inhalers and sprays): Sodium cromoglycate (Rynacrom), for example, prevents the type I hypersensitivity reaction being initiated by the arrival of the antigen in the nasal mucosa
Through skin testing, we can identify the exact of the allergen. Weekly injections of increasing dosage of the allergen are given for several months before the expected exposure; this implies starting early in the year in the case of hay pollinosis. Yearly boosting injections are also needed. But its safety in still in question.
Nasal polyps are greyish masses of pedunculated tissue resembling a bunch of grapes. They are generally multiple, nearly always bilateral and produce nasal blockage by their presence. It has a very high recurrence rate.
The cause is essentially unknown. Vasomotor imbalance, saccharide abnormalities , allergy , infections, aspirin hypersensitivity and the change of micro-environment in the middle meatus may all have a role. The cause of nasal polyps is a result of many factors action.
Histologically polyps have a ciliated columnar epithelium, a loose vascular grossly edematous stroma, and are infiltrated with plasma cells and many eosinophils. The epithelium may become squamous if the polyp presents at the nostril.
physical examination : polyps looks soft, bleeds uneasily and are painless. In less advanced cases, smaller polyps may closely resemble blobs of mucus but are not cleared by blowing the nose. In advanced cases , the multiple grey polypoidal masses may totally fill the nose bilaterally, the external nose may become broadened ,the condition is known as “frog face”.
Sinusitis is the inflammatory condition mucous membrane lining of the sinuses .
The maxillary sinus clinically the most commonly affected, followed by the ethmoid, frontal and sphenoid sinuses in that order .
Maxillary sinusitis may occur alone or with involvement of the other sinuses. Infection in the other groups of sinuses rarely occurs without maxillary sinusitis, and indeed the key to their treatment is generally the control of the maxillary sinusitis itself.
The mucous membrane passes through all the usual stages of infection ： outpuring of secretion , purulent, ineffective ciliary action , destructive cilia, membrane thicken, granulation , fibrous tissue formation
Maxillary sinus pain :an aching over the antrum, often with aching in the upper teeth. There may be tenderness on pressing in the region of the canine fossa .
Frontal sinus pain :is known as a ' vacuum frontal headache '. A distinctive symptom of frontal sinus infection is pain above the eye .coming on at morning ,releasing at afternoon. Tapping over the frontal region may be painful.
Ethmoidal headache is usually deep-seated and felt behind the eyes, with tenderness around the region of the inner canthus .
sphenoidal headache is usually described as being felt deeply in the centre of the head .
2.physical examination: reddened and oedematous, especially those of middle turbinate, middle meatus and uncinate process. A trickle of pus will be seen coming from middle meatus or olfactory sulcus.
3.X-ray examination and CT scanning
4.Diagnostic wash-out (proof puncture). Investigation of the maxillary air sinus can be carried out by puncture through the inferior meatus.Wash-out is a diagnostic procedure to demonstrate the contents of the maxillary sinus.
1. medical treatment: nasal decongestive drops or sprays (Ephedrine 0.5-1.0% in normal saline) and steroid inhalers and sprays are used to promote sinus drainage; antibiotic according to bacteriology report
4.surgical treatment is occasionally needed in the treatment of acute sinusitis. It is reserved for those patients in whom improvement is not occurring and in whom pain or headache continues to be severe.
CHRONIC SINUSITIS Clinical features Diagnosis Treatment:
2.physical examination: reddened, oedematous and hypertrophy especially those of middle turbinate, middle meatus and uncinate process; A trickle of pus coming from middle meatus or olfactory sulcus; the formation of polyps.
3. X-ray examination and CT scanning are the best means of imaging the sinuses
medical treatment: nasal decongestive drops or sprays (Ephedrine 0.5-1.0% in normal saline) and steroid inhalers and sprays are used to promote sinus drainage; antibiotic according to bacteriology report
method of maxillary sinus wash-out
operation on the nasal cavity and sinus. Endoscopic sinus surgery is operated broadly.