Atrophic rhinitis and Allergic rhinitis-ENT 3rd MBBS

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3rd mbbs ENT

Transcript of Atrophic rhinitis and Allergic rhinitis-ENT 3rd MBBS

  • 1. By SREEJITH T

2. OZAENA Chronic inflammation of nose, characterized by atrophy of nasal mucosa and turbinate bones. nasal cavities are roomy ,filled with foul smelling crusts. 2 types Primary Secondary 3. PRIMARY ATROPHIC RHINITIS AETIOLOGY HERNIA HEREDITARY FACTORS ENDOCRINE DISTURBANCES RACIAL FACTORS NUTRITIONAL DEFICIENCY INFECTIVE AUTOIMMUNE PROCESS 4. PATHOLOGY Ciliated columnar epithelium replaced by stratified squamous type. Atrophy of seromucinous glands, venous blood sinusoids and nerve elements. Arteries in the mucosa, periosteum and bone show obliterative endarteritis. Bone of turbinates undergoes resorption causing widening of nasal chambers. Paranasal sinuses are small due to arrested development. 5. CLINICAL FEATURES MC females foul smell from the nose merciful anosmia nasal obstruction - crust formation. greenish or greyish black dry crusts covering the turbinates and septum. Epistaxis on removal of crust. nasal cavities appear roomy atrophy of turbinates 6. nasal mucosa pale septal perforation dermatitis of nasal vestibule saddle deformity of nose atrophic pharyngitis Pharyngeal mucosa appear dry and glazed with crusts atrophic laryngitis cough, hoarseness of voice hearing impairment X-ray paranasal sinus - opaque 7. TREATMENT Medical Nasal irrigation and removal of crusts 25% glucose in glycerine Local antibiotics Oestradiol therapy Placental extract Systemic use of streptomycin Potassium iodide 8. Surgical YOUNGS OPERATION Modified Youngs operation NARROWING THE NASAL CAVITIES Submucosal injection of teflon paste Insertion of fat, cartilage or teflon strips under the mucoperiosteum of the floor, lateral wall of nose, mucoperichondrium of the septum. Section and medial displacement of lateral wall of nose 9. SECONDARY ATROPHIC RHINITIS Syphilis Lupus Leprosy Rhinoscleroma Long standing purulent sinusitis Radiotherapy to nose Excessive surgical removal of turbinates UNILATERAL ATROPHIC RHINITIS Extreme deviation of nasal septum accompanied by atrophic rhinitis on the wider side 10. IgE mediated immunologic response of nasal mucosa to airborne allergens and is characterized by Watery nasal discharge Nasal obstruction Sneezing Itching in the nose 2 Types Seasonal Perennial 11. ETIOLOGY Inhalent allergens Seasonal allergens pollens Perennial allergens molds, dust mite, dander from animals Genetic predisposition 12. PATHOGENESIS Inhaled allergens IgE blood basophil / mast cell Subsequent exposure Ag +IgE degranulation of mast cells release preformed & newly formed chemical mediators vasodilatation, mucosal edema, infiltration of eosinophils, excessive secretion from nasal glands, smooth muscle contraction. 13. PRIMING EFFECT - mucosa earlier sensitized to an allergen will react to smaller doses of subsequent specific allergen and also get primed to other nonspecific antigens to which patient was not exposed cause nonspecific nasal hyper - reactivity 14. ALLERGIC RESPONSE- 2 phases Acute or early phase Within 530 min after exposure Sneezing, rhinorrhoea, nasal blockage, bronchospasm Due to release of vasoactive amines Late or delayed phase 2-8 hour after exposure Swelling, congestion, thick secretion Due to infiltration of inflammatory cells at the site of antigen deposition 15. CLINICAL FEATURES Seasonal nasal allergy Paroxysmal sneezing(10-20 sneezes at a time) Nasal obstruction Watery nasal discharge Itching of eyes, palate or pharynx 16. Perennial allergy Frequent colds Persistently stuffy nose Anosmia due to mucosal edema Postnasal drip Chronic cough Hearing impairment 17. SIGNS OF ALLERGY Nasal signs Transverse nasal crease Pale and edematous nasal mucosa: bluish Swollen turbinates Thin, watery or mucoid discharge Ocular signs Edema of the lids Congestion and cobblestone appearance of the conjunctiva Dark circles under the eyes(allergic shiners) 18. Otologic signs Retracted tympanic membrane Otitis media Pharyngeal signs Granular pharyngitis Laryngeal signs Hoarseness Edema of the vocal cords 19. NEW ALLERGIC RHINITIS AND ITS IMPACT ON ASTHMA (ARIA) CLASSIFICATION Duration of disease INTERMITTENT (symptoms are present for) Less than 4 days a week OR For less than 4 weeks PERSISTENT (symptoms are present for) More than 4 days a week OR For more than 4 weeks 20. Severity of disease MILD: None of the following symptoms are present Sleep disturbances Impairment of daily activities, leisure and sport Impairment of school or work Troublesome symptoms MODERATE TO SEVERE One or more of the above symptoms are present 21. INVESTIGATIONS Total and differential count Peripheral eosinophilia Nasal smear taken at the time of clinically active disease or after challenge test shows large number of eosinophils present in non allergic rhinitis also eg:NARES Skin test: helps to identify specific allergen Skin prick test: drop of conc. allergen solution volar surface of forearm introduce to the dermis central wheal and surrounding zone of erythema within 10-15 min +ve test Specific IgE measurement: in vitro test to find specific allergen 22. Radioallergosorbent test (RAST) invitro test measures specific IgE antibody concentration in serum Nasal provocation test 23. COMPLICATIONS Recurrent sinusitis Nasal polypi Serous otitis media Orthodontic problems Bronchial asthma 24. TREATMENT Avoidance of allergen. Treatment with drugs Antihistaminics Sympathomimetics (oral & topical) Corticosteroids Sodium cromoglycate Anticholinergics Leukotriene receptor antagonist Anti IgE 25. Immunotherapy allergen is given in gradually increasing doses till the maintenance dose is reached suppresses IgE formation raise the titre of specific IgG antibody subcutaneous, nasal, sublingual routes 26. STEP CARE APPROACH RECOMMENDED BY ARIA Mild intermittent disease oral antihistamines, intranasal cromolyn sodium Moderate / persistent disease intranasal corticosteroids Severe combination therapy (oral nonsedating antihistamines + intranasal steroids) Severe and persistent combination therapy + short course of oral steroids & immunotherapy Persistent nasal obstruction intranasal decongestants OR (oral decongestants + antihistamines) Avoid allergens and irritants in all forms of disease.