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5 rhinitis
 

5 rhinitis

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  • Let us begin with ‘Acute Rhinitis’
  • What is acute rhinitis? Acute rhinitis usually is an infectious disease, which is caused by viruses and bacteria. The starting point for the disease is exposure to cold or irritation of nasal mucous membrane by dust and chemical substances. --------characterized by a runny nose and stuffiness and usually caused by the common cold. Most frequently rhinitis is caused by viruses, which reach the nasal mucous membrane together with the inhaled air. The treatment includes their elimination and setting up such conditions, which prevent viruses from spreading. Acute rhinitis (runny nose) is one of the most frequent diseases. It means acute inflammation of the nasal mucous membrane and is followed by nasal dysfunction (which affects respiration, protection, olfaction, moistening and warming of the inhaled air, etc.)
  • Symptoms start 1 to 3 days after infection. Usually, the first symptom is a scratchy or sore throat or discomfort in the nose. Later, people start sneezing, have a runny nose, and feel mildly ill. Fever is not common, but a mild fever may occur at the beginning of the cold. At first, secretions from the nose are watery and clear and can be annoyingly plentiful, but eventually, they become thicker, opaque, yellow-green, and less plentiful. Many people also develop a mild cough. Symptoms usually disappear in 4 to 10 days, although the cough often lasts into the second week.
  • Acute edema of the nasal mucous membrane can lead to inflammation of sinuses ( maxillary sinusitis, frontal sinusitis and some other kinds of sinusitis ), middle year ( otitis ), eye mucosa ( conjunctivitis ), and further inflammation of the other respiratory organs ( pharyngitis, laryngitis, tracheitis, bronchitis, pneumonia ).
  • For relieving nasal congestion, inhaled decongestants are better than forms taken by mouth. However, taking inhaled forms for more than 3 to 5 days, then stopping, may make congestion worse than it was originally. Antihistamines will help dry a runny nose, but be care for some of them can cause drowsiness. Newer antihistamines, available only by prescription, are less likely to cause drowsiness . If the infection last longer and discharge keep, we will consider about the antibiotics.
  • Chronic rhinitis is usually an extension of rhinitis caused by inflammation or an infection. However, it also may occur with diseases such as syphilis, tuberculosis, rhinoscleroma (a skin disease characterized by very hard, flattened tissues that first appear on the nose), rhinosporidiosis (an infection in the nose characterized by bleeding polyps), leishmaniasis, blastomycosis, histoplasmosis, and leprosy—all of which are characterized by the formation of inflamed lesions (granulomas) and the destruction of soft tissue, cartilage, and bone. Chronic rhinitis causes nasal obstruction, pus-filled discharge from the nose, and frequent bleeding. The formation of inflamed lesions and the destruction of soft tissue, cartilage, and bone.
  • Chronic rhinitis is usually an extension of rhinitis caused by inflammation or an infection. However, it also may occur with diseases such as syphilis, tuberculosis, rhinoscleroma (a skin disease characterized by very hard, flattened tissues that first appear on the nose), rhinosporidiosis (an infection in the nose characterized by bleeding polyps), leishmaniasis, blastomycosis, histoplasmosis, and leprosy—all of which are characterized by the formation of inflamed lesions (granulomas) and the destruction of soft tissue, cartilage, and bone. Chronic rhinitis causes nasal obstruction, pus-filled discharge from the nose, and frequent bleeding. The formation of inflamed lesions and the destruction of soft tissue, cartilage, and bone.
  • Sinuses have small orifices (ostia) which open into recesses (meati) of the nasal cavities. Meati are covered by turbinates (conchae). Turbinates consist of bony shelves surrounded by erectile soft tissue. There are 3 turbinates and 3 meati in each nasal cavity (superior, middle, and inferior).
  • Rhinosinusitis simply defined is an inflammatory and/or infectious condition of 1 or more of the paranasal sinus cavities. Acute rhinosinusitis (ARS) implies that the duration of the condition is less than 1 month. Most cases of ARS are community acquired and are associated with viral upper respiratory tract infections (URI), although other causes may be responsible. It is estimated that 0.5 to 2% of colds result in ARS, and up to 1 in 20 URI lead to acute bacterial rhinosinusitis (ABRS). Acute infectious rhinosinusitis can be broken down into several different categories based on several characteristics including location of occurrence (hospital- or community acquired), immune status of the patient, and offending microorganism (viral, bacterial, and/or fungal).
  • Nasal polyps or tumors. These tissue growths may block the nasal passages or sinuses. Allergic reactions. Allergic triggers include fungal infection of the sinuses. Deviated nasal septum. A crooked septum — the wall between the nostrils — may restrict or block sinus passages. Trauma to the face. A fractured or broken facial bone may cause obstruction of the sinus passages. Other medical conditions. The complications of cystic fibrosis, gastroesophageal reflux, or HIV and other immune system diseases may result in nasal blockage. Respiratory tract infections. Infections in your respiratory tract — most commonly, colds — can inflame and thicken your sinus membranes, blocking mucus drainage and creating conditions ripe for growth of bacteria. These infections can be viral, bacterial or fungal in nature. Allergies such as hay fever. Inflammation that occurs with allergies may block your sinuses. Immune system cells.
  • Nasal endoscopy. A thin, flexible tube (endoscope) with a fiber-optic light inserted through your nose allows your doctor to visually inspect the inside of your sinuses. Imaging studies. Images taken using computerized tomography (CT) or magnetic resonance imaging (MRI) can show details of your sinuses and nasal area. These may identify a deep inflammation or physical obstruction that's difficult to detect using an endoscope. Nasal and sinus cultures. Laboratory tests are generally unnecessary for diagnosing chronic sinusitis. However, in cases in which the condition fails to respond to treatment or is progressing, tissue cultures may help pinpoint the cause, such as identifying a bacterial pathogen. An allergy test. If your doctor suspects that the condition may be brought on by allergies, an allergy skin test may be recommended. A skin test is safe and quick and can help pinpoint the allergen that's responsible for your nasal flare-ups.
  • Prevention Take these steps to reduce your risk of getting chronic sinusitis: Avoid upper respiratory infections. Minimize contact with people who have colds. Wash your hands frequently with soap and water, especially before your meals. Carefully manage your allergies. Work with your doctor to keep symptoms under control. Avoid cigarette smoke and polluted air. Tobacco smoke and air contaminants can irritate and inflame your lungs and nasal passages. Use a humidifier. If the air in your home is dry, such as it is if you have forced hot air heat, adding moisture to the air may help prevent sinusitis. Be sure the humidifier stays clean and free of mold with regular, thorough cleaning.
  • Endoscopic sinus surgery - also called endoscopy or sinoscopy - is a procedure used to remove blockages in the sinuses (the spaces filled with air in some of the bones of the skull). These blockages cause sinusitis, a condition in which the sinuses swell and become clogged, causing pain and impaired breathing.
  • What Are The Most Common Complications? It is important to note that no surgery is successful in 100% of cases. All surgeries have the potential for complications. With endoscopic sinus surgery, as with most surgeries, serious complications are uncommon. Most complications are not serious and are easily treated with antibiotics or other simple measures. Any complications from endoscopic sinus surgery are the same as with any type of sinus surgery. While complications are infrequent with all sinus surgeries, there are fewer incidents with endoscopic sinus surgery than the more invasive traditional surgeries. The most common serious complication, which occurs in approximately 2% of cases, is leakage of the body's spinal fluid. This is usually discovered during the surgery itself and repaired at that time so that no adverse effects will occur. The worst and most rare complication is blindness, which is caused by damage to the optic nerve in the eye.

5 rhinitis 5 rhinitis Presentation Transcript

  • Acute Rhinitis Chronic Rhinitis Acute Rhinosinusitis Chronic Rhinosinusitis Nasal endoscope Surgery Otorhinolaryngology The Third Affiliated Hospital of Sun Yat-sen University Zhang Gehua [email_address]
    • Introduction 3 min
    • Anatomy 5min
    • Acute rhinitis 5min
    • Chronic Rhinitis 5min
    • Actue Rhinosinusitis 20 min
    • Chronic Rhinosinusitis 20 min
    • Nasal endoscope surgery 15 min
    • Conclusion & Questions 10 min
    Schedule
  • Acute Rhinitis
  • Definition
    • Acute Rhinitis: An acute condition which affects the nasal mucous caused by inflammation.
    Characterized ------ runny nose and stuffiness, usually caused by the common cold
  • Symptoms
    • latent period: 1~3days Course: 7 ~ 10days
    • Sore throat
    • Discomfort in the nose
    • Sneezing, Runny nose (watery & clear ---thicker & yellow -green)
    • Mild fever
    • Mild cough
    • Others: Headaches, Decrease in ability to smell, Nasal obstruction
  • Complications
    • Sinuses (maxillary sinusitis, frontal sinusitis and some other kinds of sinusitis)
    • Middle ear (otitis)
    • Eye mucosa (conjunctivitis)
    • Other respiratory organs (pharyngitis,
    • laryngitis, tracheitis, bronchitis, pneumonia)
  • Treatment
    • Decongestants: which help open clogged nasal passages (<7days)
    • Antihistamines: which help dry a runny nose
    • Cough syrups: which may make coughing easier by thinning secretions or suppressing cough
    • Antibiotics:
  • Chronic Rhinitis
    • Chronic rhinitis is usually an extension of acute rhinitis caused by inflammation or an infection.
    • ------It also may occur with diseases such as syphilis, tuberculosis, rhinoscleroma , rhinosporidiosis, leishmaniasis, blastomycosis, histoplasmosis, and leprosy.
    Definition
    • nasal obstruction
    • pus-filled discharge from the nose
    • frequent bleeding
    Symptoms
    • Medication:
    • Decongestants
    • Chinese medicine
    • nasal spray (nasonex, flonex)
    • Surgery:
    • partial inferior turbinectomy
    • inferior turbinate ablation…....
    Treatment
  • Rhinosinusitis
  • Anatomy
  • Anatomy Frontal sinus eye Maxillary sinus Inferior turbinate Middle turbinate Uncinate process
  • Sinus Drainage Schema
    • Anterior group :
    • Maxillary
    • Anterior ethmoid  Middle meatal
    • Frontal
    • Posterior group :
    • Sphemoid  Sphenoethmiodal recess Olfacotory cleft
    • Posterioe ethmoid  Supper meatal
    Sinus Drainage
  • Definitions of rhinosinusitis ------ based on the duration clinical signs and symptoms
    • Acute rhinosinusitis : <4 weeks
    • Subacute rhinosinusitis : 4 to 12 weeks
    • Chronic rhinosinusitis : >12 weeks
    • Recurrent acute rhinosinusitis : ≥4 episodes/yr (each episode lasting ≥7 to 10 days plus no intervening signs of CRS)
    • Acute exacerbation of chronic rhinosinusitis :sudden worsening of CRS, return to baseline after treatment
    • 1996,American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS)
  • Definition
    • Acute Rhinitisinusitis : Inflammatory and/or infectious condition of 1 or more of the paranasal sinus cavities.
    Acute rhinosinusitis (ARS) implies that the duration of the condition is less than 1 month.
  • Epidemiology
    • 0.5 to 2% of cold result in ARS (acute rhinosinusitis)
    • Up to 1 in 20 URI (upper respiratory tract infections) lead to ABRS (acute bacterial rhinosinusitis)
    • One billion cases of acute viral rhinosinusitis can be anticipated annually
    • 20 million cases of ABRS are expected annually
    • Approximately 2% of people with acute viral rhinosinusitis go on to develop ABRS
    • The diagnosis of ABRS accounted for 21% and 9% of all adult and pediatric antibiotic prescriptions, respectively
    • Affects 32 million US adults annually
  • Cost
    • Resulted in 11.7 million office visits as well as 1.2 million hospital outpatient unit visits
    • Generated direct annual costs in excess of $3.4 billion in that same year
  • Pathogenesis
    • Viral:
    • R hinovirus
    • Influenza A and B viruses
    • Parainfluenza virus
    • Respiratory symcytial virus
    • Adenovious….
    Bacterial: Streptococcus pneumoniae Haemophilus influenzae, Moraxella catarrhalis Streptococcus intermedius, Streptococcus pyogenes, Staphylococcus aureus anaerobic bacteria
  • Diagnosis
    • Viral URI’s symptoms:
    • Rhinorrhea
    • sneezing
    • nasal airway obstruction
    • facial congestion
    • hyposmia
    • sore throat
    • cough
    • eustachian tube dysfunction
    • Fevers
    • myalgias
  • Diagnosis
    • Bacterial:
    • The clinical signs and symptoms lack sensitivity (69%) and specificity (64%).
    • when a viral URI does not resolve after 10 days or is worsening at 5 to 7 days.
    • signs and symptoms:
    • ------nasal drainage
    • ------facial pressure/pain
    • ------decreased/absent olfaction
    • ------fever, cough, fatigue, dental pain, and/or ear pressure.
  • Complications
    • Orbital Complications
    Intracranial Complications Meningitis Epidural Abscess Subdural Abscess Intracerebral Abscess Preseptal Cellulitis Orbital Cellulitis Subperiosteal Abscess Orbital Abscess Cavernous Sinus Thrombosis
  • Treatment
    • In the adult population with mild disease and no antibiotics in the prior 6 weeks
    • the following choices may be considered: amoxicillin/clavulanate, amoxicillin, cefpodoxime proxetil, cefuroxime axetil, or cefdinir
    • In patients with β-lactam allergies, trimethoprim-sulfamethoxazole, docycline, azithromycin, clarithromycin, erythromycin, or telithromycin may be used
    • Bacteriologic failure rates range from 20 to 25%. In those patients who have received antimicrobials in the prior 6 weeks, fluoroquinolones or higher dose amoxicillin clavulanate may be considered
    • Failure to respond to treatment within 72 hours requires a switch to another antimicrobial and/or reevaluation of the patient
  • Treatment
    • In the pediatric population, the choices are similar to the adult population with 2 exceptions:
    • ------dosing is based upon weight
    • ------fluoroquinolones are not an option in the pediatric population
    • A 10-day treatment course with 1 of the above antimicrobials is recommended
    • An inappropriate antibiotic of insufficient duration may prolong infection and potentially morbidity of the disease.
    • Chronic rhinosinusitis (CRS): is a clinical disorder that encompasses a heterogeneous group of infectious and inflammatory conditions affecting the paranasal sinuses.
    Definition
    • There were 18.3 million patient office visits for CRS despite many patients not seeking medical attention.(2001)
    • CRS affects men and women equally, but subtypes of CRS appear to have different gender distributions. For example, CRS with NPs associated with aspirin-sensitivity has a female predominance of 2:1
    • Sinus disease is more common in the Midwest and South than in the northeast and western United States and the incidence is lower during the summer months compared to the other seasons.
    Epidemiology
  • Sinusitis or Rhinosinusitis
    • Sinusitis was the commonly accepted terminology for
    • inflammation of the paranasal Sinuses
    • Now- ----- Sinusitis has gradually been phased out in
    • favor of rhinosinusitis because nasal inflammation
    • almost always coincides with inflammatory paranasal
    • sinus involvement.
    • Anatomic Factors:
    • Heller cells, silent sinus syndrome or a narrow frontal sinus ……
    • Mucociliary Dysfunction:
    • ------Intrinsic factors leading to ciliary dysfunction include primary ciliary dyskinesia or Kartagener syndrome.
    • ------Extrinsic factors that disrupt mucociliary clearance include injury by environmental irritants, endogenous mediators of infl ammation, or surgical trauma.
    • Bone Inflammation:
    • Bone may play an active role in the disease process and that, at a minimum; the inflammation associated with CRS may spread through the Haversian system within the bone.
    • Biofilms:
    • Recent investigations have found that bacteria such as P. aeruginosa form biofilms in the sinuses that may lead to recalcitrant sinus disease……
    CRS without NP ------ ETIOLOGY AND PATHOPHYSIOLOGY
    • Allergic Fungal Rhinosinusitis:
    • Eosinophilic Chronic Rhinosinusitis
    • Ig E Independent Fungal Inflammation
    • Aspirin-Sensitive Nasal Polyposis
    • Bacterial Superantigen
    CRS with NP ------ ETIOLOGY AND PATHOPHYSIOLOGY
  • Symptoms
  • Symptoms
    • History of URI or allergic rhinitis, History of previous episodes of sinusitis
    • Pressure, pain, or tenderness over sinuses (Increased pain in the morning, subsiding in the afternoon)
    • Nasal obstruction or congestion, causing difficulty breathing through nose
    • Malaise, Low-grade temperature
  • Symptoms
    • Persistent nasal discharge, often purulent
    • Postnasal drip
    • Cough, worsens at night
    • Mouthing breathing, snoring
    • Sore throat, bad breath
    • Headache
    • Ear pain
  • Clinical Presentations
    • Periorbital edema
    • Cellulitis
    • Nasal mucosa is reddened or swollen
    • Percussion or palpation tenderness over a sinus
    • Nasal discharge, thick, sometimes yellow or green
    • Postnasal discharge in posterior pharynx
    • Difficult transillumination
    • Swelling or boggy pale turbinates
    • History and Physical Examination:
    • Nasal obstruction, nasal congestion, and postnasal discharge are the most common symptoms
    • Tenderness to palpation or percussion in the periorbital, forehead, or cheek areas.
    • Nasal Endoscopy:
    • allows the assessment of mucosal hyperemia, edema, the gross appearance and sites of origin of NPs, and septal deformities or other anatomic abnormalities impacting sinus drainage.
    • Laboratory: Allergy testing, Elevated IgE……
    • Radiology: coronal CT scan, MRI
    Evaluation
  • Diagnosis
    • Nasal endoscopy
    • Imaging studies (CT scanning)
    • Nasal and sinus cultures
    • An allergy test
    • Anterior group :
    • Maxillary
    • Anterioe ethmoid  Middle meatal
    • Frontal
    • Posterior group :
    • Sphemoid  Sphenoethmiodal recess Olfacotory cleft
    • Posterioe ethmoid  Supper meatal
    • Sign
    • Pus : Middle meatal  Anterior sinus
    • Olfacotory cleft  Posterior sinus
    Diagnosis
  • Complications of Sinusitis
    • Ear infection
    • Asthma flare ups
    • Orbital cellulitis or abscess, Vision problems
    • Meningitis, Brain abscess
    • Cavernous sinus thrombosis
    • Subdural empyema
    • Antimicrobial Therapy
    • Systemic Corticosteroid Therapy
    • Topical Corticosteroid Therapy
    • Antileukotriene Therapy
    • Other Medical and Ancillary Therapies
    Management
    • Avoid upper respiratory infections
    • Carefully manage your allergies
    • Avoid cigarette smoke and polluted air
    • Use a humidifier
    Prevention
  • Endoscopic Sinus Surgery
  • What is ESS
    • Endoscopic sinus surgery ------ is a procedure used to remove blockages in the sinuses .
    • This surgery does not involve cutting through the skin, as it is performed entirely through the nostrils. Therefore, most people can go home the same day.
  • Advantages
    • Is less painful
    • Leaves no visible scars
    • Causes less bleeding
    • Creates less discomfort after surgery
    • Requires less packing in the nose after surgery
    • Has a faster recovery period
    • Has a higher success rate
  • Surgical Technique
    • Uncinectomy
    • Ethomoidectomy
    • Sphenoidotomy with Ethomoidectomy
    • Frontal Recess Surgery ( Draf Type 1 )
    • Frontal Sinusotomy ( Draf Type 2 )
    • Maxillary Antrostomy
  • Postoperative Care
    • Medical therapy-----antibiotic, saline spray,
    • oral steroids……
    • Local management of the postoperative cavity:
    • -----remove nasal package (48 h after operation)
    • -----nasal endoscopy and cleaning of the cavity
    • (around 1 week after operation)
    • Follow up-----at least 6 months!
  • Follow up after ESS 2009 年 6 月 1 日 2008 年 10 月 8 日 2008 年 9 月 8 日 2008 年 8 月 18 日 2008 年 7 月 31 日 2008 年 7 月 14 日
  • Complications
    • Hemorrhage
    • CSF leak
    • Orbital injury
    • Nasolacrimal duct injury
    • Recurrence
  • pituitary adenoma resection
  • adenoidal hypertrophy Adenoidectomy
  • [email_address] 85253045 85252239 ☎ Thank for your attention