Non Allergic Rhinitis Prof Sameer Bafaqeeh M D
Non Allergic Rhinitis Prof. Sameer Bafaqeeh, M. D. University Professor in Rhinology & Rhinoplasty 11/27/2020 Professor Sameer Bafaqeeh 1
11/27/2020 Professor Sameer Bafaqeeh 2
Vasomotor Rhinitis Symptoms : as Perennial Allergic Rhinitis Ø Paroxsysmal course Ø Local Finding: Livid, pale nasal mucosa. Ø Profuse watery secretion Ø Nasal turbinates swollen Ø 11/27/2020 Professor Sameer Bafaqeeh 3
Vasomotor Rhinitis Pathogenesis n n 11/27/2020 Neurovascular disorder No specific antibodies Nonspecific reflex hypersensitivity Caused by various influences Professor Sameer Bafaqeeh 4
Vasomotor Rhinitis Pathogenesis n n 11/27/2020 Change of temperature or humidity Alcohol , dust, smoke, mechanical irritation, stress, anxiety neurosis, endocrine disorders, rhinitis of pregnancy. Drugs: (e. g. , antihypertensive agents as reserpine or beta-blockers, oral contraceptives) Drug abuse: (imidazoline & catechol derivatives, clomethiazole, etc. ) Professor Sameer Bafaqeeh 5
Vasomotor Rhinitis Diagnosis n n n 11/27/2020 Typical history Negative allergen tests No elevated Ig. E in the secretion Professor Sameer Bafaqeeh 6
Vasomotor Rhinitis Differential diagnosis 11/27/2020 n Allergic Rhinitis n Foreign body in the Nose n Common Cold Professor Sameer Bafaqeeh 7
Vasomotor Rhinitis Conservative Tretment n n n n 11/27/2020 Elimination of irritant factors Antihistamines Nasal decongestant drops Oral decongestant drugs Steroids (e. g. , beclomethasone) Metabolic & endocrine systems Sedatives Imidazoline preparations (Potential for habituation) Professor Sameer Bafaqeeh 8
Vasomotor Rhinitis Surgical Treatment Turbinate surgery Electrocautery, cry osurgery, laser n Correction of anatomical deformity n Conchotomy n Parasympathetic nasal fibers divisions (Pterygoid canal n. , vidian n. , greater petrosal n. ) M. C. F. n 11/27/2020 Professor Sameer Bafaqeeh 9
Vasomotor Rhinitis Prognosis 11/27/2020 n Uncertain n Suddenly improves n Resistant to treatment Professor Sameer Bafaqeeh 10
Rhinitis Sicca Anterior Symptoms Dryness n Irritation n Crusts formation n Nasal bleeding n 11/27/2020 Professor Sameer Bafaqeeh 11
Rhinitis Sicca Anterior Pathogenesis Anterior nasal mucosa injury n Dust n Nose picking n Extremes of temperature n 11/27/2020 Professor Sameer Bafaqeeh 12
Rhinitis Sicca Anterior Diagnosis Nasal septum is dry n Mucosal surface is: Raw, roughened, & granular. n Crustation ulceration Septal perforation n 11/27/2020 Professor Sameer Bafaqeeh 13
Rhinitis Sicca Anterior Differential Diagnosis Chemical injury (Chromium workers) n Iatrogenic septal perforation n Trauma n Lupus n Leprosy n syphilis n 11/27/2020 Professor Sameer Bafaqeeh 14
Rhinitis Sicca Anterior Treatment n n 11/27/2020 Nasal ointments Septal perforation closure Professor Sameer Bafaqeeh 15
Chronic Rhinitis Irritation Or Inflammation n Hypertrophied Nasal Mucosa n Hyperemia & edema n True tissue hypertrophy n 11/27/2020 Professor Sameer Bafaqeeh 16
Chronic Rhinitis SYMPTOMS Nasal obstruction n Tough, Stringy, Colorless secretions (rarely purulent) n Post nasal catarrh n Rhinolalia clausa &Epiphora n 2 nd dacryocystitis n 2 nd pharyngitis n 11/27/2020 Professor Sameer Bafaqeeh 17
Chronic Rhinitis SYMPTOMS Fatigue , sleeplessness n Unsteady or woozy feeling n Headache n Feeling of pressure in the head n n 11/27/2020 Psychological & physical wellbeing loss Professor Sameer Bafaqeeh 18
Chronic Rhinitis Pathogenesis n n n n n 11/27/2020 Recurrent inflammation Sinusitis Enlarged adenoid Nasopharyngeal tumor VMR & Side effects of drugs Tobacco, smoke, dust, chemicals, acquired toxins, temperature extremes , humidity Pregnancy, menstruation, menopause Endocrine disturbances Heart &circulatory diseases Infective allergy “late-type allergy” Professor Sameer Bafaqeeh 19
Chronic Rhinitis Diagnosis Long-standing disease n History of toxins n Dark red &bluish-violet swelling turbinate n Narrowed or obstructed nasal cavity n Nasal decongested n 11/27/2020 Professor Sameer Bafaqeeh 20
Chronic Rhinitis Diagnosis Granular nodular surface (Micro-polyps) nasal polypi n n 11/27/2020 Mulberry-like masses Professor Sameer Bafaqeeh 21
Chronic Rhinitis Differential diagnosis Sinusitis n Foreign bodies n Specific infections n Adenoidal hypertrophy n wegener’s granuloma n allergy n Tumors n 11/27/2020 Professor Sameer Bafaqeeh 22
Chronic Rhinitis Conservative Treatment of etiological agents n Drug overuse controlled n Endocrinologic investigation n Environment & occupation n Symptomatic treatment by decongestant nose drops (Not in long term) n 11/27/2020 Professor Sameer Bafaqeeh 23
Chronic Rhinitis Surgical Treatment Reduction of the inferior turbinate by sclerosing agents, cryoprobe, or the laser. -Electrocoagulation multiple, localized scars in N. M. -Cryosurgery partial obliteration -CO 2 or argon laser mucosal scars (evaporation or coagulation) n Turbinectomy or mucotomy n turbinoplasty n 11/27/2020 Professor Sameer Bafaqeeh 24
Pregnancy Rhinitis n n n 11/27/2020 Nasal swelling & obstruction 2 nd hafe of pregnancy Resolve after delivery Professor Sameer Bafaqeeh 25
Rhinitis Medicamentosa Reversible or irreversible damaged mucosa caused by topically or systemically applied drugs: n Hyper-plastic Rhinitis n Dryness of the nasal mucosa n Toxic Rhinopathy 11/27/2020 Professor Sameer Bafaqeeh 26
Rhinitis Medicamentosa Hyperplastic Rhinitis Mucosal swelling n Acetylsalicylic acid n Oral contraceptives n Guanethidine , hydantoin , estrogens, paraamino-salicylic acid, phenothiazine, rauwolfia preparations, n Beta-blocking drugs n Tetraethyl ammonium 11/27/2020 Professor Sameer Bafaqeeh 27
Rhinitis Medicamentosa Dryness of the Nasal Mucosa n Atropine, belladonna preparatios n Corticosteroids n Imidazoline, or catecholamine derivatives 11/27/2020 Professor Sameer Bafaqeeh 28
Rhinitis Medicamentosa Toxic Rhinopathy n n Ø 11/27/2020 #Vasoactive subsances Adrenalin or imidazoline derivatives as privine, nasivine. . . Habituation R. M. Autonomic vascular regulation failure O mucosal damage Local or systemic decongestant Acute intoxication in infants & small children Professor Sameer Bafaqeeh 29
Atrophic Rhinitis & Ozena Atrophic rhinitis+ foul smell = Ozena n Mainly in women n At puberty n Flattened & broad Face n 11/27/2020 Professor Sameer Bafaqeeh 30
Atrophic Rhinitis clinical presentation n n n n 11/27/2020 Greenish–yellow or brownish-black crusts Wide nasal cavity Atrophic mucosa & dry: Subepithelial layer fibrosis Fetid secretion &crusts (Ozena) Anosmia & social problem Nasal obstruction Mucosal changes in ph. , la. , & tr. , Professor Sameer Bafaqeeh 31
Atrophic Rhinitis Pathogenesis n n n n n 11/27/2020 Unknown but is multifactorial Common in orientals than in whites than in blacks Geographic concentration Abnormally wide nasal cavity Mucosal atrophy& bony nasal skeleton. M. G. & S. N. F. degenerate Respiratory epith. sq. metaplasia Destroyed mucociliary cleaning system Bacterial proteolysis decomposed the thick & gluey secretions Professor Sameer Bafaqeeh 32
2 nd Atrophic Rhinitis Nasal Trauma n Extensive surgery n Occupational exposure to: Glass, wood, asbestos, etc. n 11/27/2020 Professor Sameer Bafaqeeh 33
Atrophic Rhinitis Diagnosis Gluey, dry, greenish-yellow secretions & crusts ü wide nasal cavity & very small turbinates Ø Foul-smelling crusts in Ozena n 11/27/2020 Professor Sameer Bafaqeeh 34
Atrophic Rhinitis Differential Diagnosis Atrophic rhinitis with fetor (ozena) n Tumors of the Nose & Sinuses n Purulent Rhinitis & Sinusitis n Rhinolith & foreign body n Gumma due to stage III Syphilis n Nasal diphtheria &Nasal Tuberculosis n glanders n 11/27/2020 Professor Sameer Bafaqeeh 35
Atrophic Rhinitis Conservative Treatment Nasal douching n Alkaline nasal lotion n Greasy ointments n Oily nasal drops, emulsions , or ointments, ? ! Vitamin A n Steam inhalations n Osmotic Powders : Dextrose n 11/27/2020 Professor Sameer Bafaqeeh 36
Atrophic Rhinitis Operative Treatment Bolstering of the Nasal Mucosa (Cartilage or Bone chips) n n 11/27/2020 Median Displacement of the lateral nasal wall by internal rotation of the mobilized lateral nasal wall Professor Sameer Bafaqeeh 37
Nasal Diphtheria n 11/27/2020 Children older than 6 months Professor Sameer Bafaqeeh 38
Nasal Tuberculosis n Lupus n Exudative Ulcerative mucosal Tuberculosis 11/27/2020 Professor Sameer Bafaqeeh 39
Nasal Syphilis Stage 1 : infection from instruments n Stage 11 : very rare n Stage 111 : more common n 11/27/2020 Professor Sameer Bafaqeeh 40
Glanders n 11/27/2020 Soso Professor Sameer Bafaqeeh 41
Blastomycosis 11/27/2020 Professor Sameer Bafaqeeh 42
Rhinosporidiosis 11/27/2020 Professor Sameer Bafaqeeh 43
Other Mycoses 11/27/2020 Professor Sameer Bafaqeeh 44
Wegener’s Granulomatosis 11/27/2020 Professor Sameer Bafaqeeh 45
Lethal Midline Granuloma 11/27/2020 Professor Sameer Bafaqeeh 46
The 3 nd Riyadh Comprehensive International Rhinoplasty Course 21 April – 24 April 2008 King Saud University Hospitals -King Abdul-Aziz University Hospital 4 th Floor -King Kalid University Hospital Anatomy Department Prof. Sameer Bafaqeeh -Chairman of Organizing Committee -ENT Department -King Abdul-Aziz University Hospital 11/27/2020 Professor Sameer Bafaqeeh 47
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