5 rhinitis
DESCRIPTION
TRANSCRIPT
Acute RhinitisAcute RhinitisChronic RhinitisChronic Rhinitis
Acute Acute RhinosinusitisRhinosinusitisChronic Chronic RhinosinusitisRhinosinusitis
Nasal endoscope SurgerNasal endoscope Surgeryy
OtorhinolaryngologOtorhinolaryngologyy
The Third Affiliated Hospital of Sun Yat-sen University The Third Affiliated Hospital of Sun Yat-sen University Zhang Gehua [email protected] Gehua [email protected]
------undergraduate students course 2009
Introduction 3 min Anatomy 5min Acute rhinitis 5min Chronic Rhinitis 5min Actue Rhinosinusitis 20 min Chronic Rhinosinusitis 20 min Nasal endoscope surgery 15 min Conclusion & Questions 10 min
ScheduleSchedule
------undergraduate students course 2009
Acute Acute RhinitisRhinitis
------undergraduate students course 2009
DefinitionDefinition
Acute Rhinitis: An acute condition which affects
the nasal mucous caused by inflammation.
Characterized------ runny nose and stuffiness,
usually caused by the common cold
------undergraduate students course 2009
SymptomsSymptoms
latent period: 1~3days Course: 7 ~ 10days Sore throat Discomfort in the nose Sneezing, Runny nose (watery & clear ---thicker &
yellow -green) Mild fever Mild cough Others: Headaches, Decrease in ability to smell,
Nasal obstruction
------undergraduate students course 2009
ComplicationsComplications
Sinuses (maxillary sinusitis, frontal sinusitis and
some other kinds of sinusitis)
Middle ear (otitis)
Eye mucosa (conjunctivitis)
Other respiratory organs (pharyngitis,
laryngitis, tracheitis, bronchitis, pneumonia)
------undergraduate students course 2009
TreatmentTreatment
Decongestants: which help open clogged nasal passages (<7days)
Antihistamines: which help dry a runny nose Cough syrups: which may make coughing easier by
thinning secretions or suppressing cough Antibiotics:
------undergraduate students course 2009
Chronic Chronic RhinitisRhinitis
------undergraduate students course 2009
Chronic rhinitis is usually an extension of acute rhinitis
caused by inflammation or an infection.
------It also may occur with diseases such as syphilis,
tuberculosis, rhinoscleroma , rhinosporidiosis,
leishmaniasis, blastomycosis, histoplasmosis, and
leprosy.
DefinitionDefinitionDefinitionDefinition
------undergraduate students course 2009
nasal obstruction
pus-filled discharge from the nose
frequent bleeding
SymptomsSymptomsSymptomsSymptoms
------undergraduate students course 2009
Medication: Decongestants Chinese medicine nasal spray (nasonex, flonex)
Surgery: partial inferior turbinectomy inferior turbinate ablation…....
TreatmentTreatmentTreatmentTreatment
------undergraduate students course 2009
RhinosinusitisRhinosinusitis
------undergraduate students course 2009
AnatomyAnatomy
------undergraduate students course 2009
AnatomyAnatomy
Frontal sinus
eye
Maxillary sinus
Inferior turbinate
Middle turbinate
Uncinate process
------undergraduate students course 2009
Sinus Drainage SchemaSinus Drainage Schema
------undergraduate students course 2009
Anterior group: MaxillaryAnterior ethmoid Middle meatal Frontal
Posterior group :Sphemoid Sphenoethmiodal recess Olfacotory cleftPosterioe ethmoid Supper meatal
Sinus DrainageSinus Drainage
------undergraduate students course 2009
Definitions of rhinosinusitisDefinitions of rhinosinusitis ------------based on the duration clinical signs and based on the duration clinical signs and symptomssymptoms Acute rhinosinusitis: <4 weeks Subacute rhinosinusitis : 4 to 12 weeks Chronic rhinosinusitis : >12 weeks Recurrent acute rhinosinusitis: ≥4 episodes/yr (each episode
lasting ≥7 to 10 days plus no intervening signs of CRS) Acute exacerbation of chronic rhinosinusitis :sudden worsening
of CRS, return to baseline after treatment
1996,American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS)
------undergraduate students course 2009
DefinitionDefinition
Acute Rhinitisinusitis: Inflammatory and/or
infectious condition of 1 or more of the
paranasal sinus cavities.
Acute rhinosinusitis (ARS) implies that the
duration of the condition is less than 1 month.
------undergraduate students course 2009
EpidemiologyEpidemiology
0.5 to 2% of cold result in ARS (acute rhinosinusitis) Up to 1 in 20 URI (upper respiratory tract infections) lead to ABRS
(acute bacterial rhinosinusitis)
One billion cases of acute viral rhinosinusitis can be anticipated annually
20 million cases of ABRS are expected annually
Approximately 2% of people with acute viral rhinosinusitis go on to develop ABRS
The diagnosis of ABRS accounted for 21% and 9% of all adult and pediatric antibiotic prescriptions, respectively
Affects 32 million US adults annually
------undergraduate students course 2009
CostCost
Resulted in 11.7 million office visits as well as 1.2 million hospital outpatient unit visits
Generated direct annual costs in excess of $3.4 billion in that same year
------undergraduate students course 2009
PathogenesisPathogenesis
Viral:Viral: Rhinovirus Influenza A and B
viruses Parainfluenza virus Respiratory symcytial
virus Adenovious….
Bacterial:Bacterial: Streptococcus pneumoniae
Haemophilus influenzae,
Moraxella catarrhalis
Streptococcus intermedius,
Streptococcus pyogenes,
Staphylococcus aureus
anaerobic bacteria
------undergraduate students course 2009
DiagnosisDiagnosis
Viral URI’s symptoms: Rhinorrhea sneezing nasal airway obstruction facial congestion hyposmia sore throat cough eustachian tube dysfunction Fevers myalgias
------undergraduate students course 2009
DiagnosisDiagnosis
Bacterial: The clinical signs and symptoms lack sensitivity (69%) and specificity
(64%). when a viral URI does not resolve after 10 days or is worsening at 5 to 7
days. signs and symptoms:
------nasal drainage
------facial pressure/pain
------decreased/absent olfaction
------fever, cough, fatigue, dental pain, and/or ear pressure.
------undergraduate students course 2009
ComplicationsComplications
Orbital Complications Intracranial Complications
MeningitisEpidural AbscessSubdural AbscessIntracerebral Abscess
Preseptal CellulitisOrbital CellulitisSubperiosteal AbscessOrbital AbscessCavernous Sinus Thrombosis
------undergraduate students course 2009
TreatmentTreatment
In the adult population with mild disease and no antibiotics in the prior 6 weeks
the following choices may be considered: amoxicillin/clavulanate, amoxicillin, cefpodoxime proxetil, cefuroxime axetil, or cefdinir
In patients with β-lactam allergies, trimethoprim-sulfamethoxazole, docycline, azithromycin, clarithromycin, erythromycin, or telithromycin may be used
Bacteriologic failure rates range from 20 to 25%. In those patients who have received antimicrobials in the prior 6 weeks, fluoroquinolones or higher dose amoxicillin clavulanate may be considered
Failure to respond to treatment within 72 hours requires a switch to another antimicrobial and/or reevaluation of the patient
------undergraduate students course 2009
Treatment Treatment
In the pediatric population, the choices are similar to the adult population with 2 exceptions:
------dosing is based upon weight
------fluoroquinolones are not an option in the pediatric population
A 10-day treatment course with 1 of the above antimicrobials is recommended
An inappropriate antibiotic of insufficient duration may prolong infection and potentially morbidity of the disease.
------undergraduate students course 2009
Chronic rhinosinusitis (CRS): is a clinical disorder
that encompasses a heterogeneous group of infectious and inflammatory conditions affecting the paranasal sinuses.
DefinitionDefinitionDefinitionDefinition
------undergraduate students course 2009
There were 18.3 million patient office visits for CRS despite many patients not seeking medical attention.(2001)
CRS affects men and women equally, but subtypes of CRS appear to have different gender distributions. For example, CRS with NPs associated with aspirin-sensitivity has a female predominance of 2:1
Sinus disease is more common in the Midwest and South than in the northeast and western United States and the incidence is lower during the summer months compared to the other seasons.
EpidemiologyEpidemiologyEpidemiologyEpidemiology
------undergraduate students course 2009
Sinusitis Sinusitis or or RhinosinusitisRhinosinusitis
Sinusitis was the commonly accepted terminology for
inflammation of the paranasal Sinuses
Now------ Sinusitis has gradually been phased out in
favor of rhinosinusitis because nasal inflammation
almost always coincides with inflammatory paranasal
sinus involvement.
------undergraduate students course 2009
Anatomic Factors: Heller cells, silent sinus syndrome or a narrow frontal sinus ……
Mucociliary Dysfunction: ------Intrinsic factors leading to ciliary dysfunction include primary ciliary
dyskinesia or Kartagener syndrome.
------Extrinsic factors that disrupt mucociliary clearance include injury by environmental irritants, endogenous mediators of infl ammation, or surgical trauma.
Bone Inflammation: Bone may play an active role in the disease process and that, at a minimum; the
inflammation associated with CRS may spread through the Haversian system within the bone.
Biofilms: Recent investigations have found that bacteria such as P. aeruginosa form
biofilms in the sinuses that may lead to recalcitrant sinus disease……
CRS without NPCRS without NP------ ------ ETIOLOGY AND PATHOPHYSIOLOGYETIOLOGY AND PATHOPHYSIOLOGY
CRS without NPCRS without NP------ ------ ETIOLOGY AND PATHOPHYSIOLOGYETIOLOGY AND PATHOPHYSIOLOGY
------undergraduate students course 2009
Allergic Fungal Rhinosinusitis:
Eosinophilic Chronic Rhinosinusitis
Ig E Independent Fungal Inflammation
Aspirin-Sensitive Nasal Polyposis
Bacterial Superantigen
CRS with NPCRS with NP------ ------ ETIOLOGY AND PATHOPHYSIOLOGYETIOLOGY AND PATHOPHYSIOLOGY
CRS with NPCRS with NP------ ------ ETIOLOGY AND PATHOPHYSIOLOGYETIOLOGY AND PATHOPHYSIOLOGY
------undergraduate students course 2009
SymptomsSymptoms
------undergraduate students course 2009
SymptomsSymptoms
History of URI or allergic rhinitis, History of previous episodes of sinusitis
Pressure, pain, or tenderness over sinuses (Increased pain in the morning, subsiding in the afternoon)
Nasal obstruction or congestion, causing difficulty breathing through nose
Malaise, Low-grade temperature
------undergraduate students course 2009
SymptomsSymptoms
Persistent nasal discharge, often purulent Postnasal drip Cough, worsens at night Mouthing breathing, snoring Sore throat, bad breath Headache Ear pain
------undergraduate students course 2009
Clinical PresentationsClinical Presentations
Periorbital edema Cellulitis Nasal mucosa is reddened or swollen Percussion or palpation tenderness over a sinus Nasal discharge, thick, sometimes yellow or green Postnasal discharge in posterior pharynx Difficult transillumination Swelling or boggy pale turbinates
------undergraduate students course 2009
EvaluationEvaluationEvaluationEvaluation
History and Physical Examination: Nasal obstruction, nasal congestion, and postnasal discharge
are the most common symptoms
Tenderness to palpation or percussion in the periorbital, forehead, or cheek areas.
Nasal Endoscopy:
allows the assessment of mucosal hyperemia, edema, the gross appearance and sites of origin of NPs, and septal deformities or other anatomic abnormalities impacting sinus drainage.
Laboratory: Allergy testing, Elevated IgE……
Radiology: coronal CT scan, MRI
------undergraduate students course 2009
DiagnosisDiagnosis
Nasal endoscopyImaging studies (CT scanning)Nasal and sinus culturesAn allergy test
------undergraduate students course 2009
Anterior group: Maxillary
Anterioe ethmoid Middle meatal
Frontal
Posterior group :Sphemoid Sphenoethmiodal recess Olfacotory cleft
Posterioe ethmoid Supper meatal Sign Pus : Middle meatal Anterior sinus
Olfacotory cleft Posterior sinus
DiagnosisDiagnosis
------undergraduate students course 2009
Complications of SinusitisComplications of Sinusitis
Ear infection Asthma flare upsOrbital cellulitis or abscess, Vision problemsMeningitis, Brain abscessCavernous sinus thrombosisSubdural empyema
------undergraduate students course 2009
Antimicrobial Therapy
Systemic Corticosteroid Therapy
Topical Corticosteroid Therapy
Antileukotriene Therapy
Other Medical and Ancillary Therapies
ManagementManagementManagementManagement
------undergraduate students course 2009
Avoid upper respiratory infections Carefully manage your allergies Avoid cigarette smoke and polluted air Use a humidifier
PreventionPreventionPreventionPrevention
------undergraduate students course 2009
Endoscopic Sinus SurgeryEndoscopic Sinus Surgery
------undergraduate students course 2009
What is ESSWhat is ESS
Endoscopic sinus surgery ------ is a procedure used to remove blockages in the sinuses .
This surgery does not involve cutting through the skin, as it is performed entirely through the nostrils. Therefore, most people can go home the same day.
------undergraduate students course 2009
Advantages Advantages
Is less painful Leaves no visible scars Causes less bleeding Creates less discomfort after surgery Requires less packing in the nose after surgery Has a faster recovery period Has a higher success rate
------undergraduate students course 2009
Surgical TechniqueSurgical Technique
UncinectomyEthomoidectomySphenoidotomy with EthomoidectomyFrontal Recess Surgery (Draf Type 1)Frontal Sinusotomy (Draf Type 2)Maxillary Antrostomy
------undergraduate students course 2009
Postoperative CarePostoperative Care
Medical therapy-----antibiotic, saline spray, oral steroids……
Local management of the postoperative cavity: -----remove nasal package (48 h after operation) -----nasal endoscopy and cleaning of the cavity (around 1 week after operation)
Follow up-----at least 6 months!
------undergraduate students course 2009
20092009 年年 66 月月 11日日
Follow up after ESSFollow up after ESS
20082008 年年 1010 月月 88日日
20082008 年年 99 月月 88日日
20082008 年年 88 月月 1818日日
20082008 年年 77 月月 3131日日
20082008 年年 77 月月 1414日日
------undergraduate students course 2009
ComplicationsComplications
Hemorrhage CSF leakOrbital injuryNasolacrimal duct injuryRecurrence
------undergraduate students course 2009
pituitary adenoma pituitary adenoma resection resection
------undergraduate students course 2009
adenoidal hypertrophy
Adenoidectomy Adenoidectomy
------undergraduate students course 2009
85253045 85252239☎
Thank forThank for
your attentionyour attention