Download Rhinitis

‫و ما أوتيتم من العلم إال قليال‬
‫صدق هللا العظيم‬
‫الدكتور‬
‫سعد يونس سليمان‬
Inflammatory conditions of the nasal cavity
)Rhinitis(
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Rhinitis: is inflammation of the nasal cavity which
may be caused by a variety of factors, the most
common are:
(1) VIRAL RHINITIS
(2)
(3)
(4)
(5)
ALLERGIC RHINITIS
NON-ALLERGIC RHINITIS
ATROPHIC RHINITIS
RHINITIS MEDICAMENTOSA.
(1) VIRAL RHINITIS
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Is also called coryza or common cold
The virus is transmitted by means of airborne droplet
Most common virus rhinovirus and corona virus.
The infection occur only when;
(1) Lowered individual's resistance.
(2) Increased concentration and virulence of the
virus.
Common in winter.
Affect all age group especially children and young
adult.
CLINICAL FEATURE
The course of the disease may be described
in 4 stages ;
(1) Prodromal or ischaemic stage
(2) Early reaction or irritation
(3) Stage of venous stasis and secondary infection
(4) Resolution;
1. Prodromal or ischaemic stage;
..few hours
 ..stage of local invasion and generalized
nasal ischaemia
 .. hot, dry or tickling spot at the site of
invasion with patent nasal airway
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2. Early reaction or irritation ;
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..few hours or days
..infection spread to the adjacent mucus
membrane
..sorethroat , sneezing, watery discharge and
obstruction
.. red and swollen mucus membrane with
mild fever
3. Stage of venous stasis and
secondary infection

.. After the 2nd day
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..dusky bluish mucosa with
mucopurulent discharge
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..maximum obstruction and
toxaemia
4. Resolution;
.. after 5-10 days recovery takes place.
TREATMENT
1.
2.
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Isolation of the patient.
Bed rest.
Decongestant nasal drops.
Steam inhalation.
Analgesic.
Antihistamine.
Antibiotics is not indicated .
Any Question?
(2) ALLERGIC RHINITIS
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Definition ;
Is an IgE-mediated hypersensitivity of
the nasal mucus membrane characterized by
…sneezing
…itching
…watery nasal discharge
…nasal obstruction.
Aetiology;
.. genetically inherited tendency to develop an
exaggerated IgE response to extrinsic allergens.
Atopic disease
Eczema
Allergic Rhinitis
Asthma
ALLERGENS
INGESTED
INHALANT
PERINEAL
SEASONAL
Pathophysiology
DIAGNOSIS
HISTORY
..Symptoms
..When it occur?
..What initiate its attack?
..Previous history of infantile
eczema and wheezy bronchitis
..Family history of allergy.
EXAMINATION
.. Typical physical eye findings
( injected conjunctiva with watery
discharge and eyelid puffiness).
.. Anterior rhinoscopy;
… normal
… oedematous bluish-gray
mucosa covered with watery
mucus.
… inferior turbinate swollen
with polypoidal appearance.
INVESTIGATION
(1) Skin prick test .
(2) Nasal cytology ;
A characteristic of
nasal secretion is the
large number of
eosinophils, especially
just after an acute
attack.
(3) Increase serum
IgE level.
TREATMENT
(1) Avoidance of specific allergens.
(2) Pharmacotherapy;
Antihistamine:
1st generation antihistamine; (diphenhydramine and chlorpheniramine).
2nd generation antihistamine;( Fexofenadine and Loratidine)
Steroids: ( local or systemic)
Topical anticholinergic agent; (nasal ipratropium bromide).
Mast-cell stabilizing agent: ( nasal disodium chromoglycate)
(3) Immunotherapy.
By repeated administration of specific allergens, the body "get used to"
the allergen, which can result in fewer or less severe symptoms.
(3) NON-ALLERGIC RHINITIS: (Intrinsic
or vasomotor rhinitis)
Definition; is non –infective, non-allergic condition suspected
to be due to autonomic imbalance within the nasal cavity.
Symptoms ; Identical to those of allergic rhinitis.
Pathogenesis ;
Overactive parasympathetic system…
IgE- mediated mechanism do not play a role .
Provoked by non-specific exogenous factors.
Diagnosis:
Typical history …
Negative allergen test .
No elevated IgE in the secretion.
Treatment :
(1) Avoidance of irritant (e.g. cigarette smoke).
(2) Topical nasal steroids.
(3) When there is copious watery discharge, the
addition of nasal anticholenergic (nasal
ipratropium bromide) is usually recommended.
(4) Surgery ;
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Correction of associated septal deviation and turbinate
hypertrophy.
Vidian neurectomy : disruption of parasympathetic
fibers to the nasal mucosa.
(4) ATROPHIC RHINITIS
Is a chronic nasal disease characterized by ;
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Progressive atrophy of the mucosa and underlying
bone of turbinates .
The presence of viscid secretion which rapidly dries
and form crusts which emit a characteristic foul
odour called ozaena.
An abnormal patency of nasal passages .
Aetiology:
Is still unknown but it can be divided into;
(1) Primary (idiopathic) atrophic rhinitis :
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this may be due to;
… infection with Klibsiella ozaenae bacteria..
… endocrine imbalance.
… heredity .
… poor nutrition.
… autonomic disease (recently) .
(2)
Secondary atrophic rhinitis:
may be due to :
• Extensive nasal surgery.
• Occupational exposure to glass, wood, asbestos …etc.
• Irradiation.
Clinical picture:
Symptoms:
Nasal obstruction
Epistaxis
Anosmia.
Signs:
(1) The presence of nasal fetor, not appreciated by the patient
who is anosmic.
(2) Green yellow and black crust lining the nasal cavity and
there detachment reveals a bleeding and ulcerated mucosa.
(3) Wide nasal cavity.
Differential diagnosis:
(1) Tumors of the nose and sinuses.
(2) Purulent rhinitis and sinusitis especially of dental
origin.
(3) Rhinolith and foreign body (unilateral nasal
obstruction and foul- smelling secretion).
Treatment:
Medical ;
(1) Nasal irrigation with alkaline solution.
(2) Regular nasal cleansing and removal of crusts,
followed by
(3) Nasal drops composed of 25% glucose in glycerin
which inhibit proteolytic organs.
(4) Rifampicin 600 mg orally once daily for 6 months.
Surgical:
Closure of one or both nostrils by plastic surgery.
(5) RHINITIS MEDICAMENTOSA:
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..over-medication with local nasal decongestant
Local nasal decongestant brings releif to the patient
with enlarged inferior turbinates.
When the effect wears off a rebound phenomenon
occurs.
Reflex vasodilatation causes turbinate hypertrophy.
If the decongestant treatment is repeated , a chronic
nasal obstruction unresponsive to decongestant
results.
Treatment:
(1) Immediate cessation of the decongestant.
(2) Nasal or systemic steroids .
(3) If this is not successful then inferior
turbinectomy may be required.
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