RHINOSINUSITIS
Prof .Dr. Jehad K. Albaba
Definition:

Rhinosinusitis is defined as inflammation of
the lining of the nose & sinusis.
Prof .Dr. Jehad K. Albaba
Classification

ALLERGIC:



SEASONAL.
PERENNIAL.
INFECTIOUS:


ACUTE.
CHRONIC.


Specific.
Non-specific
Prof .Dr. Jehad K. Albaba
Classification (Cont..)

OTHER

IDIOPATHIC.
IRRITANTS

OCCUPATIONAL.
EMOTIONAL
.

HORMONAL.
ATROPHIC.

DRUG-INDUCED.
Prof .Dr. Jehad K. Albaba
Prevalence Of Rhinttis
% GENERAL
POPULATION
Rhinitis symptoms
9-15 %
Allergic rhinitis
5-20%(2)
Prof .Dr. Jehad K. Albaba
Anatomy
Prof .Dr. Jehad K. Albaba
Anatomy (Conti..)
Artries of nose
Nerves of nose
Function of the nose






Airway
Heating and humidification
Filtration
Smell
Nose and voice
Nasal reflexes
Prof .Dr. Jehad K. Albaba
Clinical aspects of rhinosinusitis
Increase nasal secretion
 Nasal obstruction
 Bleeding or hemorrhagic secretion
 Fetor
 Altered or absent sense of smell
 Paine in the head or in the face.
 Disease of neighboring organs such as teeth,
lacrimal apparatus, eyes, mouth, throat, and lungs.

Prof .Dr. Jehad K. Albaba
Allergic rhinitis
Allergy
is an exaggerated harmful response of living tissue
when exposed to an allergen. Allergic rhinitis is very
common disease; it affects 15% of Americans and
10% of Europeans. The prevalence of disease is
increasing due to pollution; about 13% of patient has
hereditary factor.
Allergic rhinitis is antigen antibody reaction, IgE is the
main antibody.

Prof .Dr. Jehad K. Albaba
Predisposing factors
Non- immunological factors
The autonomic nervous system
Environmental factors continued
Autonomic imbalance
Humidity - Temperature
Unspecific hyper-reactivity
Air pollution
Adrenergic blockad
Aspirin intolerance – a receptor disease
Prof .Dr. Jehad K. Albaba
Allergens and allergen extracts
Inhaled allergens
Ingested allergens
Pollen
Food allergy
Moulds
Medications
Animal dander
Structure and occurrence
House dust -house
Dust mite
Allergen extracts
Feathers
Extraction
Other inhalant allergens
Potency
Stability
Occupational allergy
Standardization
Prof .Dr. Jehad K. Albaba
POTENTIAL INVOLVEMENT OF MULTIPLE
ORGANS WITH ALLERGIC RHNITIS


Clinical Association
 47.1% are having pulmonary allergy
 12.8% are having eczema skin allergy
 2.1% are having both pulmonary & eczema.
Sub clinical Association:
 20.3% are having sub clinical pulmonary allergy.
 75% are having sub clinical skin allergy.
Prof .Dr. Jehad K. Albaba
RHINITIS IN ASTHMATIC CHILDREN

Approximately 80% of children presenting with asthma
also have rhinitis.

Children with a history of allergic rhinitis are more likely
to suffer from exercise induced asthma.
Prof .Dr. Jehad K. Albaba
POSSIBLE REASONS FOR CO-EXISTENCE OF
RHINITIS AND ASTHMA

Common ciliated epithelium.

Both are associated with allergy.

Similar allergens are associated with both conditions.

Both have a familiar link with atopy.

Possible pathophysiological mechanism-sino-bronchial
reflex.
Prof .Dr. Jehad K. Albaba
Pathogenesis of allergic rhinitis

First exposure – sensitization
Prof .Dr. Jehad K. Albaba

second exposure – allergic symptoms
Allergic RHINITIS : SYMPTOMS
“SNEEZERS AND RUNNERS”:
Itchy nose, sneezing ,watery rhinorrhoea, nasal
congestion (variable), diurnal rhythm
( worse during day), often associated conjunctivitis.

“BLOCKERS”:
Little or no sneezing, thick catarrh (with post nasal
drip), No itch, constant symptoms-possibly worse
at night.

Prof .Dr. Jehad K. Albaba
DIAGNOSIS OF RHINITIS

Detailed medical history

E.N.T examination
 Endoscopy
 Nasal airway assessment

Other tests as appropriate:
Radiology, olfaction, blood tests.

Allergy tests:
nasal smear, nasal swab, RAST, total immunoglobulins.
Prof .Dr. Jehad K. Albaba
TREATMENT :
Allergic inflammation :
Allergen :
IgE antibody receptors on mucosal cells ( mast, basophiles,
eosinophils) .

Cell activation and accumulation:
Release of inflammatory mediators… clinical symptoms .

So, treatment is to break the process at any stage.
Prof .Dr. Jehad K. Albaba
AIMS OF MANAGEMENT OF RHINITIS

Relief of symptoms

Isolation and elimination of cause of symptoms

Awareness of associated problems
E.g. sinusitis, asthma
Prof .Dr. Jehad K. Albaba
ALLERGIC RHINITIS:
STEPWISE APPROACH TO TREATMENT
1.
Allergen avoidance
2.
Anti-histamines
3.
Topical nasal steroids or
systemic
4.
Decongestants
5.
Mast cells stabilizers
6.
Anti-leukatrines
7.
Anti-IgE
8.
Desensitisation
9.
Surgery
Prof .Dr. Jehad K. Albaba
Treatment of allergic rhinitis in adults *
Itch\Sneezing
Sodium
Cromoglycate
Discharge
Blockage Impaired
smell
+
+
-
+
Oral antihistamines
+++
++
+
-
Ipratropium bromide
-
+++
-
-
Topical decongestants
-
-
+++
-
+++
+++
++
+
+++
+++
+++
++
Topical
corticosteroids
Oral corticosteroids
MANAGEMENT OF RHINITIS WITH COEXISTENT ASTHMA


INTRANASAL CORTICOSTEROIDS: “(treating
upper airway inflammation) indirectly improves
asthma symptoms and decreases bronchial hyperreactivity…”
ANTIHISTAMINES : improve rhinitis but are
not shown to improve asthma.
Prof .Dr. Jehad K. Albaba
INDICATIONS FOR SURGERY

Anatomical abnormalities

Excessive mucosal swelling

Presence of irreversibly diseased tissue.
Prof .Dr. Jehad K. Albaba
Infective Rhinitis


Viral rhinitis (common cold)
Bacterial rhinitis
 Non-specific.



Specific.



Acute .
Chronic.
Syphilis.
TB.
Atrophic Rhinitis.
Prof .Dr. Jehad K. Albaba
Vaso motor Rhinitis
Imbalance in the autonomic nervous system.
Prof .Dr. Jehad K. Albaba
Sinusitis

Microbiology of sinusitis






Viruses
Pneumococci
Hemophilus Influenzae
Hemolytic streptococci
Anaerobes
Fungus
Prof .Dr. Jehad K. Albaba
Source of infection
Spread from nose
 Spread from sinus to sinus
 Spread from neighboring tissues i.e. from teeth
to maxilla.
 Blood borne

Prof .Dr. Jehad K. Albaba
Predisposing factors


Rhinitis wither infective or Allergic
Anatomical factors:




Deviated septum
Atresia
Cilliary immutility
Immuno compromised patient as diabetic or
organ transplant.
Prof .Dr. Jehad K. Albaba
Symptoms and signs of sinusitis






Pain, Headache, and Tenderness.
Discharge
Nasal obstruction
Anosmia – hyposmia or cacosmia
Eczema of the nostrils and conjunctivitis
General symptoms as cough, generalized weakness and
depression.
Prof .Dr. Jehad K. Albaba
Diagnosis


Clinically from signs and symptoms
Radiology will give



Mucosal thickening
Opaque sinus
Air fluid level
Prof .Dr. Jehad K. Albaba
Treatment





Decongestant.
Cleaning of discharge.
Antibiotics according to biogram.
Topical corticosteroid in presence of allergy.
Surgery.
Prof .Dr. Jehad K. Albaba
Complications of sinus infection




Extension to the external tissue.
Orbital complications.
Intracranial complications.
Osteomyelitis of the flat Bones of Skull.
Prof .Dr. Jehad K. Albaba
Protect your NOSE