Infectious rhinitis

Infectious rhinosinusitisPrepared byDr. Muaid I.Aziz FICMSRhinosinusitisIts a group of disorders characterized by inflammation of the mucosa of the nose & pns.

Causes

Viral Bacterial fungalClinical classificationAcute ( < 4 wks )Subacute (4-12 wks)Recurrent acute ( 4 or more acute episode / year )Chronic ( > 12 wks )Acute exacerbations of chronic RS Rhinosinusitis pathophysiology

Host factors Inviromental factorsPredisposing Factors In rhinosinusitisHost FactorsSystemic Allergic rhinitisImmunodeficiencyGenetic/congenitalcystic fibrosis, ciliary dyskinesiaLocalAnatomic obstructionGastro - esophageal refluxDental infectionTrauma

Enviromental factorsMicroorganismsviral illnessPollutantscigarette smokeMedicationsRhinitis medicamentosa bacteriologyStreptococcus pneumoniae Haemophilus influenzae Moraxilla catarrhalisStaph. aureus

Rhinosinusitis Symptoms"major" criteriafacial painnasal obstructionHyposmiapurulence on examinationFever ( only in ARS)"minor" criteriaHeadachehalitosisFatiguedental paincough otalgia

NASAL ENDOSCOPY

Role of imaging in rhinosinusitis

ARS treatmentABDecongestantSurgical draingeCorrection of any predisposing factorsAllergies in CRSMost common predisposing factor in adultsSecond most common in children (after viral URI) Allergic rhinitis leads to mucosal inflammation and hypertrophy blocking the ostiomeatal complex

Management of CRSDIGNOSIS 2 OR more of the following sxBlockage / congestionDischargeFacial pain Hyposmia + POLYPS , Mucopurulent discharge from m.m or oedema in mm + or Ct scan changes

Possible Strategies for Treating CRSCRSInfectiousAllergyTreatEtiologyAllergen AvoidanceAntibioticsSurgeryIL-5, IL-4IL-8, IF-GM-CSFAttenuateInflammationNasal douchingSteroidsDecongestantAntibiotic / MacrolidesAntifungal Antihistamine / AntileukotrienesWho knows what else?Anatomic17Slide 73Possible Strategies for Treating CRS (chronic rhinosinusitis)ReferenceAdapted by Bradley Marple from Benninger M, Ferguson B, Hadley J, Hamilos D, Jacobs M, Kennedy D, Lanza D, Marple B, Osguthorpe J, Stankiewicz J, Anon J, Denneny J, Emanuel I, Levine H. Adult Chronic Rhinosinusitis: Definitions, Diagnosis, Epidemiology, and Pathophysiology. Otolaryngol Head Neck Surg 2003;129(suppl 3):S1-32.Intrinsic rhinitis Non infective non allergicPerennial rhinitisVMRIts an adult onset or childhood onset?

Non allergic rhinitisIdiopathicOccupationalHormonalDrug inducedFood inducedEmotionally inducedAtrophic rhinitisClinical presentationEsinophilic (obstruction)Non-esinophilic(rhinorrhoea)Moderate /sever obstructionMild/moderate rhinorrhoeaMinimal sneezingUsual hyposmiaMarked mucosal swellingMarked turbinate hypertrophyFrequent polyp

MildSeverMinimalRareMildMild

neverNasal polyposis

Nasal polyposisPolypous .Its part of chronic rhinosinusitisIts more frequent in non-allergic than in allergic rhinitis Nasal polyps are round , smooth , soft , translucent yellow or pale glistening structure attached to the nasal or sinus mucosa by a narrow stalk or pedicle , some time be red after repeated trauma & infectionNon-tender moved backwards when probed.Commonly arise from the ethmoidal sinuses , they arise from beneath middle turbinate anteriorly & above middle turbinate posteriorly .In maxillary sinuses , some time after surgeryBilateral & multiple

Etiology & associated diseasesThe aspirin traidAllergic fungal sinusitisAllergy ?Its a disease of adult Ciliary dysfunction disorder ?

Clinical presentation Symptoms Nasal blockageRunning & sneezingSense of smell PainPostnasal dripEpistaxis Signs Hyponasal voicePolyp seen externally or on anterior rhinoscopyMouth breathing

InvestigationPlain X-RCT-Scan

TreatmentMedical ( steroid)? / 1 monthSurgical

Antro choanal polyp ( killians polyp)etiologyUnilateral or bilateralMaxillary sinus origin ( floor , lateral wall )Unilateral nasal obstruction ? on inspiration or expiration?Examination / normal ? X-R Surgical or medical ?

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