Published on March 15, 2014
Allergic rhinitis Definition: hypersensitivity of the sinonasal mucosa to antigenic materials. Characterized by recurrent attacks of: Sneezing Itching Rhinorrhea Nasal obstruction
Types: seasonal (hay fever) Perennial Perennial with seasonal exacerbations Predisposing factors: Genetic (50%) atopic patient Temperature changes Emotional (anxiety)
Exciting factors: (antigen) Inhalants: pollens (seasonal), house dust mites (perennial) Ingestants: fish, milk, eggs. Injectants: penicillin. Infectants: fungal (allergic fungal sinusitis) Contactants: face powder.
House dust mites are found in all homes. They are microscopic organisms that thrive in warm and humid houses with lots of food – human skin. The mites prefer to live in beds and, because we spend about a third of the day in bed, we inhale large quantities of dust mite allergens (The excretion of the mites contains a number of protein substances).
Mechanism (pathogenesis): When allergens are inhaled (1st time), the body produces antibodies (IgE) which become fixed to the mast cells of nasal mucosa. On re-exposure these antibodies cause the release of a chemical mediators mainly histamine by the degranulation of mast cells that leads to: swelling and edema of the nasal mucosa Vasodilatation and increased capillary dilatation Increased secretions Cellular infiltration (esinophils)
Symptoms: recurrent attacks of itching, sneezing, rhinorreah (runners), obstruction (blockers), other allergic manifestations (conjunctivitis, bronchial asthma, eczema), mild facial pain and headache.
Signs: A. Enlarged turbinates (pale bluish) B. Polyps (bilateral, multiple, glistening, pale bluish, soft, mobile, insensitive, middle meatus)
Investigations: a. Nasal cytology: esinophils b. Nasal challenge test c. Skin prick test d. Serum IgE e. RAST f. C.T scan (polyps)
How Can I Treat Allergic Rhinitis? Very often, the most common question that is asked is 'What can I do about Allergic Rhinitis?'. In general, there are 3 ways to deal with Allergic Rhinitis 1. Avoid the cause of Allergic Rhinitis. If you are allergic to a particular substance, avoid it! As long as you are no where near it, you're not going to get an allergic reaction to it. Of course, there are some things that we are unable to completely limit exposure to, such as house dust mites or pollen. Still, it does help if we are able to reduce our exposure to allergens.
2. Use of Medication. While it is very effective in controlling allergic rhinitis symptoms yet it is not a cure ( either local or systemic corticosteroids, antihistamines, decongestants). 3. Immunotherapy. The third option is the way of curing Allergic Rhinitis, and that is to engage in some form of desensitization of the body over a period of time to the extent that it builds up enough tolerance to the allergens (injection of gradually increasing doses of the allergen leads to production of blocking antibodies IgG which binds with the antigen instead of IgE.
Role of surgery: I. Reduction of enlarged inferior turbinates (partial turbinectomy, laser, submucous diathermy). II. Removal of polyps (functional endoscopic sinus surgery).
Antro-choanal polyp Pedenculated edematous mucosa arising from the maxillary antrum and prolapse through the nose to the nasopharynx. May be inflammatory with no esinophils in it. It causes a unilateral nasal obstruction and discharge. It is a single unilateral pale jelly-like polyp. CT is diagnostic and TTT is endoscopic surgery.
What is vasomotor rhinitis? Non allergic perennial rhinitis due to disturbance of autonomic nerve supply of the nose (parasympathetic over activity). What is rhinitis medicamentosa? also known as rebound rhinitis or chemical rhinitis, is a condition characterized by nasal congestion without rhinorrhea or sneezing that is triggered by the abuse of topical vasoconstrictive medications. Management of rhinitis medicamentosa is focused on withdrawal of nasal decongestants "weaning" .
CT scan shows reveals a tooth-like structure within the floor of the maxillary sinus. This radiograph and subsequent surgery was consistent with a dentigerous cyst. This cyst has arisen from the crown area of an unerupted tooth. The Caldwell-Luc approach was used to expose and remove this impacted tooth and the cyst.
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