This document discusses the clinical evaluation of rhinosinusitis through physical examination. It begins by outlining the most common signs and symptoms of both acute and chronic rhinosinusitis, including headache, facial pain, nasal congestion, and thick nasal discharge. It then describes the components of the physical examination, including inspection of the face for swelling, palpation of the sinuses for tenderness, anterior rhinoscopy to examine the nasal cavity, and nasal endoscopy which provides the best visualization of the sinus drainage pathways and ostia. The systematic examination with these techniques helps differentiate between viral, bacterial, and allergic causes of rhinosinusitis and guides diagnosis and treatment.
Rhinosinusitis is commonly referred to as sinusitis. Here, we walk you through its classification, predisposing factors, pathophysiology, signs, symptoms, diagnosis, treatment, complications, and prognosis.
Rhinisinusitis bullet point,type,causative organism,investigation,treatment
quick overview ,easy understanding
ref:Scott-Brown's Otorhinolaryngology and Head and Neck Surgery
Rare presentation of left maxillary sinusitis: A Case Reportiosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
Rhinosinusitis is commonly referred to as sinusitis. Here, we walk you through its classification, predisposing factors, pathophysiology, signs, symptoms, diagnosis, treatment, complications, and prognosis.
Rhinisinusitis bullet point,type,causative organism,investigation,treatment
quick overview ,easy understanding
ref:Scott-Brown's Otorhinolaryngology and Head and Neck Surgery
Rare presentation of left maxillary sinusitis: A Case Reportiosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
Bệnh viêm xoang ngày càng phổ biến ở Việt Nam ta. Nếu để các triệu chứng viêm kéo dài có thể dẫn đến trường hợp nặng hơn là viêm xoang mãn tính, viêm đa xoang. Bệnh có thể xuất hiện ở người lớn, trung niên và thậm chí là trẻ em. Vậy làm thế nào để điều trị viêm xoang mãn tính? Tìm hiểu ngay một vài thông tin cần thiết về bệnh này qua bài viết sau đây.
Điều trị viêm xoang liệu có gặp khó khăn?
Nguồn: Trích https://venusglobal.com.vn/viem-xoang-man-tinh/
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A detailed and accurate presentation on the Dental Management of Respiratory and Adrenal Disorders.
Presentation deals specifically what a dental health care professional should care for himself and the patient while managing Respiratory and Adrenal disorders.
presentation by Dr. Ishaan Adhaulia
Sinusitis is defined as inflammation of the mucosal lining of the sinus passages. Frequent attacks of sinusitis for over three months, also known as chronic sinusitis, result in the thickening of the mucosal membranes and an excess production of nasal and sinus secretions. These secretions are usually thick and sticky and frequently predispose the sinuses to bacterial infection.
https://www.icliniq.com/articles/ent-health/sinusitis-causes-symptoms-and-treatment
Similar to Clinical evaluation-of-rhinosinusitis-history-and-physical-examination 1997-otolaryngology---head-and-neck-surgery (20)
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
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Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
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Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
2. Otolaryngology-
Head and Neck Surgery
Volume 117 Number 3 Part 2 HADLEYand SCHAEFER $?
Table 1. Clinical evaluation of rhinosinusitis
Symptom complex
Major criteria
Headache
Facial pain and pressure
Nasal congestion
Thick, colored postnasaldrainage
Olfactory disturbance
Minor criteria
Fever
Halitosis
Children only:
Cough
Irritability
and mucoevacuants may help to maintain ostial paten-
cy and to reduce inflammation by promoting drainage.
Cough, a nonspecific symptom of rhinosinusitis,
may be confused with the onset of an asthmatic condi-
tion. This symptom, which is common in children with
rhinosinusitis, usually diminishes or is eliminated with
treatment of the infection. Cough tends to be more
common at night.6 In acute and chronic flfinosinusitis
the cough reflex may be provoked by the p:roduction of
chemical mediators, leukotrienes, and other factors that
give rise to hronchoconstriction and irrkated neural
endings. A vagal reflex, mediated from pressure recep-
tors within the paranasal sinuses, may also be institut-
ed.
Another common symptom and one of tile major cri-
teria for the diagnosis of rhinosinusitis is a diminished
or lost sense of smell. The inflammatory response of the
nasal mucosa hinders odorants from migrating to the
olfactory placode in the upper recesses of the nasal cav-
ity. Chronic rhinosinusifis may predispose', patients to
nasal polyposis, which aggravates hyposmia and may
lead to anosmia.7
Fever is more common in the early stages of acute
rhinosinusitis. Although fever is more common in chil-
dren and adolescents, it may also be present in adult rhi-
nosinusitis shortly after an upper respiratory infection.
Knowledge of the seasonal recurrence of symptoms
and known triggers of symptoms is helpful in differen-
tiating allergic rhinitis from acute rhinosinusitis. In
patients with allergy the nasal membranes; respond to
provocation by allergens with the release of chemical
mediators from the resident mast cells of the nasal
mucosa. Histamine is the primary mediator of the early
phase leading to rhinorrhea, edema, and the symptoms
of sneezing and congestion. Late-phase reactions from
the influence of cellular responses prolong :he reaction,
giving the impression of persistent nasal congestion.
Patients with allergic rhinitis usually have a history
of allergic response.6 Typical symptoms include a thin
watery nasal discharge, intermittent sneezing, and a
Table 2. Physical signs
External physical findings: swelling and erythema
Swelling and erythema: maxillary region, ocular or
orbital region, and frontal region
Findings on anterior rhinoscopy
Hyperemia
Edema
Crusts
Purulence
Polyps
After topical nasal decongestion: improvement or
worsening of symptoms
Findings on nasal endoscopy*
Bluish discoloration of turbinates
Purulence at ostiomeatal complex or other sinus ostia
Polyp formation, with size and location of polyps noted
Septal deflections
Concha bullosa
Paradoxic turbinates
Other anomalies
*Examinationwitha rigid or flexiblenasalendoscopeshouldbe a
standardpart of the physicalexaminationin the specialist'soffice.
Culturesobtainedunderendoscopicguidanceculturesmay be
obtainedto aid in the diagnosis.
runny, itchy nose. Allergic responses can predispose
patients to have acute or chronic rhinosinusitis as a
result of the inflammatory response and resultant
obstruction of the ostia of the paranasal sinuses.
The differential diagnosis of chronic rhinosinusitis
includes asthma, gastroesophageal reflux disease, and
chronic allergic rhinitis. All of these conditions may
exist simultaneously.
PHYSICAL EXAMINATION
In addition to the major symptom complex for rhi-
nosinusitis, the physical examination plays a major role
in the diagnosis of acute or chronic rhinosinusitis. The
examination begins with the facial features. Swelling,
erythema, and edema localized over the involved
cheekbone or periorbital area may be immediately rec-
ognized in the acute forms of the disease (Table 2).
These signs are apparent predominantly in the morning,
and they improve gradually while the patient is upright.
Patients with chronic rhinosinusitis usually have no
facial swelling or edema.
The sinuses are palpated to test for tenderness.
Percussion of the teeth may direct attention toward an
inflamed paranasal sinus.
ANTERIOR RHINOSCOPY
Anterior rhinoscopy is an examination of the nasal
cavity performed with a nasal speculum under good
illumination. The examination should include visual-
ization of the nasal septum to assess for septal deviation
causing obstruction and identification of the nasal
turbinates and their characteristics.
3. $I0 HADLEYand SCHAEFER
Otolaryngology-
Head and Neck Surgery
September 1997
Acute rhinosinusitis is characterized by hyperemia
of the nasal mucosa and edema. Hyperemia is defined
as an increase in the vascularity of the nasal mucosa, so
that it appears reddened as opposed to the normal pink
color. The presence of nasal crusts represents drying of
the nasal mucus or purulence. These crusts may be
sparse, or they may involve most of the affected side.
Mucopurulent discharge is common in the middle mea-
tus (between the inferior and middle turbinates).
Purulence located in the middle meatus is found in
patients with acute maxillary, ethmoidal, and frontal
sinusitis. Purulence located more posteriorly in the
superior meatus and sphenoidal recess is characteristic
of posterior ethmoidal or sphenoidal sinusitis.
Nasal polyposis predisposes patients to the recurrent
symptoms of chronic sinusitis. Polyps present as glis-
tening pedunculated masses with a sometimes bluish or
yellowish hue that differentiates them from the normal
pink-colored nasal mucosa.7 Polyps may be hidden
within the recesses of the middle meatus complex.
Therefore despite good illumination, they may not be
seen on the routine nasal examination. Polyps are rela-
tively common in chronic rhinosinusitis, but they are
present only infrequently in acute stages unless the
patient has an underlying predisposition for nasal poly-
posis.
Topical nasal decongestion with an ct-agonist agent
such as phenylephrine hydrochloride is useful in the
diagnosis of acute or chronic rhinosinusitis. The reac-
tion of mucous membranes to the application of an ct-
agonist agent aids in visualizing the recesses of the
nasal cavity. After the topical administration of this
agent, the physician should look for signs of the
improvement of congestion or the worsening of symp-
toms.
Nasal cultures obtained without endoscopy are not
specific for the identification of bacteria responsible for
acute rhinosinusitis. 8-1° These cultures are frequently
contaminated with Staphylococcus aureus and are not
well correlated with the results of paranasal sinus aspi-
ration.
NASAL ENDOSCOPY
Nasal endoscopy has revolutionized the diagnosis
and treatment of rhinosinusitis, a'4 As standard proce-
dure patients with a history of recurrent acute or chron-
ic rhinosinusitis should be examined with a rigid or
flexible nasal endoscope in the specialist's office. The
concepts of rigid nasal endoscopy are difficult to learn
in the primary care office, and the technique requires
extensive training and expertise.
Nasal endoscopy provides reliable visualization of
all accessible areas of the sinus drainage pathways.
Thus endoscopic examination should be performed
before evaluation by CT scanning. After the nasal cav-
ity is anesthetized with a topical agent, the rigid endo-
scope is advanced to visualize the middle turbinate,
which is displaced medially. Nasal endoscopy should
visualize all regions of the ostiomeatal complex to
appreciate subtle signs of obstruction and to detect
nasal polyps hidden from routine nasal examination.
The procedure is easily performed with the use of topi-
cal anesthesia in adults and adolescents and in cooper-
ative children.
During nasal endoscopy the physician should look
specifically for purulence at the ostiomeatal complex
and the sphenoethmoidal recess, polyp formation at the
junction of opposing mucosal surfaces, structural
abnormalities that predispose patients to recurrent rhi-
nosinusitis, and other findings. Appropriate directed
nasal cultures obtained with nasal endoscopy may cor-
relate better with those obtained by sinus aspiration.
Cultures directed with endoscopy are obtained with a
microculturette that is directed into the appropriate
sinus ostia.
SYSTEMATIC NASAL ENDOSCOPY
To diagnose and evaluate the extent of sinonasal dis-
orders, the nasal endoscopist requires appropriate
equipment and a systematic approach to the nasal
examination.4 Appropriate equipment includes at least
one 0-degree telescope or one wide-angle 25-degree
telescope, a fiberoptic light source, and a light cord.
The telescopes are manufactured in diameters of 4.0
and 2.7 mm. The smaller scopes are recommended for
use in children or in patients with difficult nasal anato-
my such as a deviated nasal septum.
Because the sinuses and nose are elements of the
upper aerodigestive tract, the examination of this
region should be performed in the context of a com-
plete examination of the head and neck. Unless con-
traindicated, topical vasoconstrictive and anesthetic
agents should be used to enhance visualization of the
nose; some investigators recommend examining the
nose both before and after the administration of these
agents. Otoscopy and examination of the other regions
of the head and neck can be performed first, thereby
allowing several minutes for the topical agent to
enhance the nasal examination. The nose should then
be systematically examined.
One approach is to divide the examination into three
regions. The inferior examination consists of passing a
0-degree endoscope along the floor of the nose to visu-
alize the orifice of the nasolacrimal duct, the inferolat-
eral nasal wall, the eustachian tube orifice, and the
nasopharynx. The second passage should be at approx-
4. Otolaryngology-
Head and Neck Surgery
Volume 117 Number 3 Part 2 HADLEYand SCHAEFER S! 1
imately a 30-degree angle from the floor of the nose to
examine the sphenoethmoidal recess, the middle mea-
tus, and the sphenoidal ostium. Then the superior pas-
sage should be directed toward the frontal recess to
examine these cells, the attachment of the middle
turbinate, and the superior recess between the middle
turbinate and the nasal septum.
Endoscopic findings can be divided iJlto allergic or
inflammatory, infectious, and anatomic. Nonspecific
allergic and inflammatory findings include a bluish dis-
coloration and boggy distention of the nasal mucosa.
Inflamed red mucous membranes may a{so be seen. 11
Nasal polyps reflect an inflammatory process, which
correlates positively with allergy testing in 50% of
patients. Infectious findings include purulent secretions
draining from the involved sinus(es), fungal hyphae,
inspissated secretions from allergic fungal rhinosinusi-
tis, and loss of nasal tissue from invasive bacterial and
fungal pathogens. Physical findings in the acquired
immunodeficiency syndrome are nonspecific. Anatomic
findings should be viewed in the context of the patient's
specific problem. For example, a concha bullosa or a
deviated septum is significant when lhe structure
obstructs the outflow of a specific sinus.
CONCLUSION
Because rhinosinusitis is an illness with a significant
impact on quality of life, 1,12 it must be appropriately
diagnosed and treated. The physician needs to properly
assess the patient's history and symptoms and then
progress through a structured physical examination to
look for signs that lead to an appropriate diagnosis.
Proper medical treatment is based on the findings of a
sound history and a careful physical examination.
Although imaging techniques can accurately show the
inflammation within sinus ostia, they are relatively
expensive to use for following a patient's response to
therapy.
REFERENCES
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2. Donald PJ, Gluckman JL, Rice DH. The sinuses. New York:
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7. Larsen PL, Tos M. Origin of nasal polyps. Laryngoscope
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10. WaldE, Milmoe GJ, BowerA, et al,Acute maxillarysinusitisin
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clinical practice guideline. Otolaryngol Head Neck Surg
1996;l15:1i5-21. (gradeA)
12. Williams JW Jr, Simel DL, Roberts L. Clinical evaluation for
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