Definition
🔹 Paranasal sinuses lined by pseudostratified ciliated Is an inflammatory condition affecting the lining mucosa of sinuses
and nasal passage
🔹
columnar epithelium with mucus-secreting goblet cells
Nasal Cycle:
-Normal alternating cyclic variation in thickness of nasal cavity 🔹
Variable in its clinical presentation
Proper diagnosis and classification is important for two reason:
mucosa -The prognosis and recommended treatment strategies can be
-Each side alternately demonstrates mucosal swelling different
-It can be mistaken for other common disorders such headache
syndrome or N allergy Definition :
It is an IgE- mediated hypersensitivity
disease of nasal mucosa to various antigens
Aetiology
🔹 Rhinogenic
characterized by two or more of the
-Acute viral rhinitis : the most common predisposing factor.
Swimming and diving 🔹
following symptoms:
🔹 nasal congestion
🔹
Nasal back.
Dental 🔹
🔹
anterior/posterior rhinorrhoea
sneezing
itchy nose
🔹
Due tooth infection, extraction lead to oroantral fistula.
Traumatic
🔹
Symptoms
FB
🔹Rhinitis
Fractures of walls of PNS develops when congestion becomes severe
Patient must experience at least two of the following
🔹
MICROBIOLOGY:
The most common organisms include ( Streptococcus
Pneumonia, haemophilus influenza, moraxella.
symptoms :
-Runny nose
-Obstruction in the nasal passage
-Nasal itching
🔹
-Sneezing
These symptoms may occur as a result of colds or
🔹
The Allergic Appearance:
🔹 chronic nasal congestion
Mouth breathing and a gaping mouth
clinical picture:
🔹
🔹Two major One major + 2 minor
NB Fever is a factor of acute RS.
environmental irritants, such as allergens, cigarette
smoke, chemicals, changes in temperature, stress,
exercise, or other factors
Facial pain:
Maxillary
🔹 Subdivided into:
-Intermittent (IAR) .v. persistent (PAR)
🔹
Frontal
Ethmoidal
sphenoidal
Acute Rhinosinusitis Severity classified as
-Mild -Moderate/severe
Signs:
Oedema and congestion of nasal
mucosa
Mucopurulent/ purulent discharge
Tenderness
Erythema and edema over the cheek
🔹
Treatment:
Systemic:
1 antibiotic: 10-14 d
2 analgesic and antipyretics
3 nasal decongestant incidence :
4 bed rest Common ( 10-20% of the population)
🔹nasal
Local:
Age: children, adolescent, adult.
🔹
Sex : no sex predliction DIAGNOSIS
🔹 decongestant and steam inhalation
Surgery:
🔹 History and Examination
Indicated only for treatment of
complicated acute RS with failure medical
Etiology :
Predisposing factors:
🔹
🔹
Nasal cytology-- eosinophils
Skin prick test
Radio allergo sorbent tests for specific IgE
treatment
1) hereditary : about 50% of allergic
pt give family history( Atopic). 🔹(Nasal allergen challenge)
(RAST)
Diagnosis: 2) physical: change in temperature.
🔹
🔹
🔹
Depend on three factors: Allergy Testing
Precipitating factors: Skin testing.
History: 2 major or one major and two minors/
Chronic rhinosinusitis is defined by the presence of symptoms for at least 3 ALLERGIC RHINITIS
🔹
3 months Skin testing is slightly more sensitive.
months and can occur with or without periods of acute exacerbation and with or
🔹 Physical examination 1 INHALANT: pollens ( grass, tress or Common allergens
CT-Scan without nasal polyposis. weed) dust mites , house dust -Outdoors: tree, grass, weed pollens
Etiology: RHINITIS 2 INGESTANT: Eggs, milk, fish -Indoors: dust mites, pet dander, cockroaches
and mold
Predisposing factors to chronic sinusitis
1- systemic: 🔺
Cause:
🔹 Prolonged obstruction of natural ostium of one or more of PNS lead to:
3 INFECTANTS: bacteria, fungi
🔹 🔹
PHARMACOTHERAPY
Poor immunity e.g. DM or prolonged steroid therapy Inadequate ventilation and drainage of the sinus.
Rhinosinusitis 4 INJECTANTS: drugs
🔹
Environmental factors e.g. Smoking or pollution. Bacteria to proliferate, causing mucosal thickening, worsening obstruction. Topical Nasal Treatments
🔹
2- inadequate treatment of acute sinusitis: Impaired Mucociliary clearance and oedema. Corticosteroids
🔹
Virulent or atypical organism Antihistamines
🔹Sodium
Inappropriate selection or short course of antibiotics. Cromoglycate
3- local factors: Decongestants
Septal deviation, abnormalities of concha/turbinates, or sinus openings.
🔹
mucosal disease e.g. Allergy, polyposis , or mucosal transport disease. Oral Treatments
Treatment:
🔹
🔹
Antihistamines
Corticosteroids
🔷 MEDICAL TREATMENT Chronic Rhinosinusitis 🔹 Antileukotrienes
Decongestants
Basically to treat any acute exacerbation and to prepare the patient to
🔹
surgery
A- SYSTEMIC:
🔹
TREATMENT 🔹
IMMUNOTHERAPY
Involves repeated administration of an allergen extract to
Antibiotics: 3-6 weeks
Antihistamine 🔹
🔹
Education/allergen Avoidance
Pharmacotherapy
🔹
induce a state of immunological tolerance
More effective in limited spectrum of allergies in particular
🔹
Mucolytic
🔹immunotherapy
🔹others – Nasal douching
🔹
seasonal pollen allergy
B- LOCAL
nasal decongestant
saline nasal irrigation
SURGERY
🔹 Severe symptoms failing to respond to usual treatment.
🔹Subcutaneous injection/sublingual route.
Studies indicate that 3 years therapy necessary .
🔷SURGICAL TREATMENT
local steroids
🔹 Functional endoscopic sinus surgery ( FESS) is the treatment of
choice. 🔹
OTHER TREATMENTS
Nasal douches
-The aim of fess is to restore function and patency of natural ostium of - adjuvant to other treatments
sinus to provide normal ventilation and drainage - studies indicate can be useful in children with seasonal
-Why called functional? rhinitis
Maintains the patency of sinus ostia.
Improve mucociliary clearance. 🔹
- pregnancy
Topical corticosteroids and oral antihistamines (non-
Preserve the parietal mucosa of the large sinuses.
🔹
sedating) form the mainstay of treatment.
Other drugs should only be considered as second-line
-old conventional surgery for treatment maxillary sinusitis:
1- inferior meatal antrostomy 🔹
treatment.
Immunotherapy in selected patients can be highly
effective.
2- caldwell-luc operation
-Old conventional surgery for treatment ethmoidal and frontal
sinusitis:
1- intranasal ethmoidectomy 🔹
ALLERGIC RHINITIS AND OTHER COMORBIDITIES
Up to 80% of patients with bilateral chronic
2- external frontoethmoidectomy ( Lynch-Howrth procedure)
3- frontal sinus trephination. 🔹
sinusitis have AR
🔹 Otitis media
🔹
ALLERGIC RHINITIS and ASTHMA
4-osteoplastic flap.
🔹 Conjunctivitis
🔹
🔹
10-40% of patients with AR have asthma
The majority of patients with asthma have AR
🔹
🔹
Lower respiratory tract infections
Dental problems – malocclusion, discoloration
🔹AR is a major risk factor for poor asthma control
All patients with AR should be assessed for asthma
🔹 Sleep disorders
1999 – Allergic Rhinitis and its impact on Asthma
(ARIA)
🔹
Extention of infection
🔹DIRECT
RETROGRADE THROBOPHELIPITIS
CLASSIFICATIONS Complications of sinusitis
Orbital
Cranial
Intracranial
Descending infections
by fatema okoff
🔷
🔹 Cranial Complications of sinusitis
🔹
🔷
Osteomyelitis of Maxilla and Frontal bone
Mucocele /pyocele
🔹
🔹
Intracranial complications
Extradural abscess
🔹
🔹
Meningitis
subdural abscess
🔷
🔹
intracranial abscess,
Descending infections:
Pharyngitis, Tonsillitis, Laryngitis, Otitis
🔹Symptoms of septic focus: as arthritis
medias, bronchitis.
🔹 Paranasal sinuses lined by pseudostratified ciliated Is an inflammatory condition affecting the lining mucosa of sinuses
and nasal passage
🔹
columnar epithelium with mucus-secreting goblet cells
Nasal Cycle:
-Normal alternating cyclic variation in thickness of nasal cavity 🔹
Variable in its clinical presentation
Proper diagnosis and classification is important for two reason:
mucosa -The prognosis and recommended treatment strategies can be
-Each side alternately demonstrates mucosal swelling different
-It can be mistaken for other common disorders such headache
syndrome or N allergy Definition :
It is an IgE- mediated hypersensitivity
disease of nasal mucosa to various antigens
Aetiology
🔹 Rhinogenic
characterized by two or more of the
-Acute viral rhinitis : the most common predisposing factor.
Swimming and diving 🔹
following symptoms:
🔹 nasal congestion
🔹
Nasal back.
Dental 🔹
🔹
anterior/posterior rhinorrhoea
sneezing
itchy nose
🔹
Due tooth infection, extraction lead to oroantral fistula.
Traumatic
🔹
Symptoms
FB
🔹Rhinitis
Fractures of walls of PNS develops when congestion becomes severe
Patient must experience at least two of the following
🔹
MICROBIOLOGY:
The most common organisms include ( Streptococcus
Pneumonia, haemophilus influenza, moraxella.
symptoms :
-Runny nose
-Obstruction in the nasal passage
-Nasal itching
🔹
-Sneezing
These symptoms may occur as a result of colds or
🔹
The Allergic Appearance:
🔹 chronic nasal congestion
Mouth breathing and a gaping mouth
clinical picture:
🔹
🔹Two major One major + 2 minor
NB Fever is a factor of acute RS.
environmental irritants, such as allergens, cigarette
smoke, chemicals, changes in temperature, stress,
exercise, or other factors
Facial pain:
Maxillary
🔹 Subdivided into:
-Intermittent (IAR) .v. persistent (PAR)
🔹
Frontal
Ethmoidal
sphenoidal
Acute Rhinosinusitis Severity classified as
-Mild -Moderate/severe
Signs:
Oedema and congestion of nasal
mucosa
Mucopurulent/ purulent discharge
Tenderness
Erythema and edema over the cheek
🔹
Treatment:
Systemic:
1 antibiotic: 10-14 d
2 analgesic and antipyretics
3 nasal decongestant incidence :
4 bed rest Common ( 10-20% of the population)
🔹nasal
Local:
Age: children, adolescent, adult.
🔹
Sex : no sex predliction DIAGNOSIS
🔹 decongestant and steam inhalation
Surgery:
🔹 History and Examination
Indicated only for treatment of
complicated acute RS with failure medical
Etiology :
Predisposing factors:
🔹
🔹
Nasal cytology-- eosinophils
Skin prick test
Radio allergo sorbent tests for specific IgE
treatment
1) hereditary : about 50% of allergic
pt give family history( Atopic). 🔹(Nasal allergen challenge)
(RAST)
Diagnosis: 2) physical: change in temperature.
🔹
🔹
🔹
Depend on three factors: Allergy Testing
Precipitating factors: Skin testing.
History: 2 major or one major and two minors/
Chronic rhinosinusitis is defined by the presence of symptoms for at least 3 ALLERGIC RHINITIS
🔹
3 months Skin testing is slightly more sensitive.
months and can occur with or without periods of acute exacerbation and with or
🔹 Physical examination 1 INHALANT: pollens ( grass, tress or Common allergens
CT-Scan without nasal polyposis. weed) dust mites , house dust -Outdoors: tree, grass, weed pollens
Etiology: RHINITIS 2 INGESTANT: Eggs, milk, fish -Indoors: dust mites, pet dander, cockroaches
and mold
Predisposing factors to chronic sinusitis
1- systemic: 🔺
Cause:
🔹 Prolonged obstruction of natural ostium of one or more of PNS lead to:
3 INFECTANTS: bacteria, fungi
🔹 🔹
PHARMACOTHERAPY
Poor immunity e.g. DM or prolonged steroid therapy Inadequate ventilation and drainage of the sinus.
Rhinosinusitis 4 INJECTANTS: drugs
🔹
Environmental factors e.g. Smoking or pollution. Bacteria to proliferate, causing mucosal thickening, worsening obstruction. Topical Nasal Treatments
🔹
2- inadequate treatment of acute sinusitis: Impaired Mucociliary clearance and oedema. Corticosteroids
🔹
Virulent or atypical organism Antihistamines
🔹Sodium
Inappropriate selection or short course of antibiotics. Cromoglycate
3- local factors: Decongestants
Septal deviation, abnormalities of concha/turbinates, or sinus openings.
🔹
mucosal disease e.g. Allergy, polyposis , or mucosal transport disease. Oral Treatments
Treatment:
🔹
🔹
Antihistamines
Corticosteroids
🔷 MEDICAL TREATMENT Chronic Rhinosinusitis 🔹 Antileukotrienes
Decongestants
Basically to treat any acute exacerbation and to prepare the patient to
🔹
surgery
A- SYSTEMIC:
🔹
TREATMENT 🔹
IMMUNOTHERAPY
Involves repeated administration of an allergen extract to
Antibiotics: 3-6 weeks
Antihistamine 🔹
🔹
Education/allergen Avoidance
Pharmacotherapy
🔹
induce a state of immunological tolerance
More effective in limited spectrum of allergies in particular
🔹
Mucolytic
🔹immunotherapy
🔹others – Nasal douching
🔹
seasonal pollen allergy
B- LOCAL
nasal decongestant
saline nasal irrigation
SURGERY
🔹 Severe symptoms failing to respond to usual treatment.
🔹Subcutaneous injection/sublingual route.
Studies indicate that 3 years therapy necessary .
🔷SURGICAL TREATMENT
local steroids
🔹 Functional endoscopic sinus surgery ( FESS) is the treatment of
choice. 🔹
OTHER TREATMENTS
Nasal douches
-The aim of fess is to restore function and patency of natural ostium of - adjuvant to other treatments
sinus to provide normal ventilation and drainage - studies indicate can be useful in children with seasonal
-Why called functional? rhinitis
Maintains the patency of sinus ostia.
Improve mucociliary clearance. 🔹
- pregnancy
Topical corticosteroids and oral antihistamines (non-
Preserve the parietal mucosa of the large sinuses.
🔹
sedating) form the mainstay of treatment.
Other drugs should only be considered as second-line
-old conventional surgery for treatment maxillary sinusitis:
1- inferior meatal antrostomy 🔹
treatment.
Immunotherapy in selected patients can be highly
effective.
2- caldwell-luc operation
-Old conventional surgery for treatment ethmoidal and frontal
sinusitis:
1- intranasal ethmoidectomy 🔹
ALLERGIC RHINITIS AND OTHER COMORBIDITIES
Up to 80% of patients with bilateral chronic
2- external frontoethmoidectomy ( Lynch-Howrth procedure)
3- frontal sinus trephination. 🔹
sinusitis have AR
🔹 Otitis media
🔹
ALLERGIC RHINITIS and ASTHMA
4-osteoplastic flap.
🔹 Conjunctivitis
🔹
🔹
10-40% of patients with AR have asthma
The majority of patients with asthma have AR
🔹
🔹
Lower respiratory tract infections
Dental problems – malocclusion, discoloration
🔹AR is a major risk factor for poor asthma control
All patients with AR should be assessed for asthma
🔹 Sleep disorders
1999 – Allergic Rhinitis and its impact on Asthma
(ARIA)
🔹
Extention of infection
🔹DIRECT
RETROGRADE THROBOPHELIPITIS
CLASSIFICATIONS Complications of sinusitis
Orbital
Cranial
Intracranial
Descending infections
by fatema okoff
🔷
🔹 Cranial Complications of sinusitis
🔹
🔷
Osteomyelitis of Maxilla and Frontal bone
Mucocele /pyocele
🔹
🔹
Intracranial complications
Extradural abscess
🔹
🔹
Meningitis
subdural abscess
🔷
🔹
intracranial abscess,
Descending infections:
Pharyngitis, Tonsillitis, Laryngitis, Otitis
🔹Symptoms of septic focus: as arthritis
medias, bronchitis.
