Nasal mucosal hyperreactive rhinopathy Allergic Rhinitis AR PerennialPAR

Nasal mucosal hyperreactive rhinopathy Allergic Rhinitis (AR) Perennial~(PAR), Seasonal~(SAR) （Pollinosis） Morbidity: 10%~20% Inhalant allergens——dust mite, house dust, pollen, fungi, animal danders, cockroach； Food allergens——milk, eggs, fish and shrimp, meat, vegetables, fruits.

Pollen Mite Mold Cat Antigens for allergic rhinitis

Pathology： Type allergy Allergic inflammation: Predominant T cells & eosinophilic cells infiltrate.

Symptoms & Signs： Nasal irritation and iching recurrent attacks of paroxysmal sneezing copious watery rhinorrhea nasal obstruction

Diagnosis： 1、History（allergen exposure, hypersensitivity, family history） 2、Examination 3、Skin test: skin prick test 4、Ig. E antibody，Serum total Ig. E 、special Ig. E 5、Nasal provocation or nasal chanllenge tests

Differential Diagnosis： 1、Vastomotor rhinitis 2、Nonallergic rhinitis with eosinophilia syndrome, NARES 3、Hyperreflectory rhinitis 4、Acute rhinitis

Complications： 1、Allergic sinusitis 2、Asthma 3、Secretory otitis media 4、Allergic pharyngolaryngitis Treatment： 1、Avoidance

2、Drugs 1）Antihistamines 2）Corticosteroids 3）Sodium cromoglycate(SCG) Cromolyn sodium 4）Anticholinergic agents 5）Vasoconstrictor sympasthomimetics 3、Hyposensitization 4、Others：Traditional Chinese medicine, laser, operation

Nasal Polyp & Nasal Polyposis Etiology：mutilfactors 1. allergic； 2. chronic inflammation Pathology：highly swelled connective tissue. Predominant eosinophilic cells infiltrate. Lymphatic cells, neutrophils, basophils, mast cells.

Symptoms & Sign：persistent nasal obstruction，close nasal sound，hyposmia, rhinorrhea, snore, “frog nose” Polyp in maxillary sinus（L），polyp in middle meatus（R）

Antrochoanal polyp

Antrochoanal polyp

Diagnosis： Anterior rhinoscopy：translucent, soft, smooth masses. Endoscopy, X-ray and CT scanner. Differential Diagnosis： Papilloma inverted，angiofibroma of nasopharynx，malignant tumor of nasal cavity， meningoencephalocele Treatment： 1、conservative treatment—— corticosteroids 2、surgical treatment

Polyps（above），papilloma（below）

papilloma（L），MT of nasal cavity （R）

Sinusitis Acute suppurative sinusitis Features of sinus anatomy： 1、small ostia of the sinuses； 2、continuative mucosa between nasal cavity and sinuses； 3、contiguous of the ostia； 4、location of the astia and features of the sinuses.

Frontal Sinus Ethmoid Sinus Maxillary Sinus

Etiology： 1、General factors: Poor general health (influenza, measles, whooping cough…) 2、Local factors： Sinus diseases； Infective focus of eripheral organs， Direct infection； Nasal tampon (packing)； Rapid change of atmospheric pressure

成人Acute bacterial rhinosinusitis (ABS)病因 ABS主要病原体：肺炎链球菌和嗜血流感杆菌 Staphylococcus aureus 0 -8% Anaerobes 0 -9% Other streptococci 3 -9% Moraxella catarrhalis Other bacteria 4% S. pneumoniae 20 -43% 2 -10% 22 -35% H. influenzae SAHP. Otolaryngol Head Neck Surg. 2004; 130: 1 -45.

儿童Acute bacterial rhinosinusitis (ABS)病因 • ABS主要病原体：肺炎链球菌、嗜血流感杆菌和卡他莫拉菌 Otolaryngol Head Neck Surg. 2004; 130: 1 -45.

Symptoms & Signs： General symptoms： Malaise, fever. Local symptoms: 1）Nasal obstruction sustained, with hyposmia 2） Suppurative rhinorrhea, streaky with blood, foul smell(odontogentic~) 3）headach or local ache

Antral pain——from inner canthus downwards across the cheek, upper alveolus on the affected side. Ethmoidal pain——over bridge of the nose & inner canthus behind the eye. Frontal pain——forehead, periodicity, persist for an hour or tow after getting up in the morning, and clear during the afternoon. Sphenoidal pain——occipital or vertical headache.

Diagnosis： History， Signs, Anterior rhinoscopy, Nasal endoscopy, Radiological examination, Puncture and irrigation of maxillary sinus

Treatment：Eradicate causes，keep drainage； control infection and prevent complications 1、General treatment：take rest，antibiotics， antihistamine (if necessary ) 2、Local treatment 3、Body drainage 4、Physical therapy 5、 Puncture and irrigation of maxillary sinus

Maxillary sinus puncture and irragation

Chronic suppurative sinusitis Etiology：Acute—— Chronic Symptoms & Signs： General~: Local~： rhinorrhea, nasal obstruction, headache, hyposmia, vision disorder

Diagnosis： 1、History； 2、Examination：anterior rhinoscopy, nasal endoscopy 3、Radiological examination：CT or MRI 4、Puncture and irrigation of sinus

Normal image of nasal endoscopy

Maxillary sinusitis——pus in the middle meatus

Maxillary sinusitis(R)

Sphenoid sinusitis——pus in the sphenoethmoidal recess

Sphenoid sinusitis

Pansinusitis

Pansinusitis

Treatment： 1、Intranasal medications：Corticosteroid， Vasoconstrictor sympasthomimetics 2、Puncture and irrigation of maxillary sinus 3、Displacement method——frontal sinusitis, ethmoidal sinusitis, sphenoidal sinusitis, pansinusitis 4、Surgery——traditional sinus surgery Functional Endoscopic Sinus Surgery(FESS) Ostiometal complex OMC

Functional Endoscopic Sinus Surgery(FESS)