Rhinosinusitis

Dr. Abdullah S. Al Yousef

Allergic Rhinitis• Definition :An inflammatory disorder of the nose which occurs when the

membranes lining the nose become sensitized to allergens: -Sensitization to an allergen results in the production of

immunoglobulin (Ig) E which is specific to that allergen. This IgE binds to the surface of mast cells in the lining of the nose.

-Re-exposure to the allergen results in allergen binding to IgE on the surface of mast cells. This triggers the release of histamine and other inflammatory mediators from the mast cells.

-Histamine and other inflammatory mediators act on cells, nerve endings, and blood vessels to produce symptoms.

Types

• Allergic rhinitis may be categorized into:• Seasonal allergic rhinitis/hay fever: this occurs at

certain times of the year. When due to tree pollen or grass it is known as hay fever. Other allergens include mould spores and weeds.

• Perennial rhinitis (= persistent): this occurs throughout the year. Allergens commonly include house dust mites and domestic pets.

Symptoms

• Itchy nose, mouth, eyes, throat, skin, or any area

• Problems with smell • Runny nose • Sneezing • Tearing eyes

Symptoms that may develop later include:• Stuffy nose (nasal congestion) • Coughing • Clogged ears and decreased sense of smell • Sore throat • Puffiness under the eyes • Fatigue and irritability • Headache • Memory problems and slowed thinking

Signs

Nasal signs • Transverse nasal crease (allergic crease) – A black transverse line across the middle of nose – Occurs due to constant rubbing of the nose in the upward

direction resembling a salute – allergic salute

• Swollen turbinates • Pale, oedematous, bluish nasal mucosa • Thin watery discharge

Allergic Crease

Otologic signs • Retraction of tympanic membrane and serous

otitis media due to eustachian tube dysfunction

Pharyngeal signs • Granular pharyngitis due to hyperplasia of

submucosal lymphoid tissue

Laryngeal signs • Hoarseness of voice • Oedema of vocal cords

Diagnosis• History ( Symptoms, Past History, Drugs, Family History )

• Examination :-Nose, for swollen nasal mucous membranes and structural

defects. -Ears, for fluid in the middle ear and the appearance of the

eardrum. -Sinus areas, for tenderness and signs of infection. -Mouth, to see whether you have changes from breathing only

through your mouth. -Back of throat, for signs of postnasal drip or infection, such as

red, raised, bumpy tissue.

• Allergy Testing (Skin Prick Test, Blood Test)

Complications

• Sinusitis• Otitis Media• Asthma• URTI• Nasal Polyps

Treatment

• Education (Avoidance, Salt Water Solution)• Mild: Antihistamines, Decongestants - Antihistamines, Decongestants, Nasal

corticosteroids• Severe: Injected Corticosteroids,

Immunotherapy (Allergy Shots)

Vasomotor Rhinitis

• Non Allergic

• Causes may include odors, medication, changes in the weather, stress, foods and chronic health conditions.

Pathophysiology

• Nonallergic rhinitis occurs when blood vessels in your nose expand (dilate), filling the nasal lining with blood and fluid.

Symptoms

• Stuffy nose • Runny nose • Mucus in the throat (postnasal drip)

Diagnosis

• Diagnosed by ruling out other causes of allergy.

-Skin Test and Blood Test.

Complications

• Nasal polyps • Chronic sinusitis. • Middle ear infections.

Treatment

• Avoidance• Saline nasal sprays, Corticosteroid nasal

sprays, Antihistamine nasal sprays, Anticholinergic nasal sprays, Oral decongestants , Decongestant nasal sprays

Acute Suppurative Rhinitis

• Definition :Acute sinusitis (acute rhinosinusitis) causes the

cavities around your nasal passages (sinuses) to become inflamed and swollen. This interferes with drainage and causes mucus to build up.

Pathogenesis

• Viral (Rhinovirus)• Bacterial (H.Influenza, Strep Pneumonia)• Fungal• Other ( Allergies, Tumor, Deviated Nasal

Septum )

Symptoms

• Yellow or green discharge • Nasal congestion • Pain, tenderness, swelling and pressure

around your eyes, cheeks, nose or forehead • Aching in your upper jaw and teeth • Reduced sense of smell and taste • Cough, which may be worse at night

Non-specific symptoms

• Ear pain • Headache • Sore throat • Bad breath (halitosis)• Fatigue • Fever

Diagnosis

• Nasal endoscopy • Imaging studies (CT,MRI)• Nasal and sinus cultures • Allergy testing

Complications

• Asthma flare ups• Chronic sinusitis • Meningitis • Vision problems • Ear infection

Treatment

• Saline nasal spray • Nasal corticosteroids • Decongestants • Pain relievers -Antibiotic treatment is generally needed only if

you have a bacterial infection, especially if the infection is severe, recurrent or persistent

Thank you