Obstruction/Congestion



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Obstruction/Congestion

  • Obstruction/Congestion

  • Discharge/Purulence

  • +/- Pain/Pressure

  • +/-Hyposmia/Anosmia









Moderate-severe

  • Moderate-severe

  • one or more items

  • . abnormal sleep

  • . impairment of daily activities, sport, leisure

  • . abnormal work and school

  • . troublesome symptoms





History is often very suggestive

  • History is often very suggestive























  • “no published prospective reports on the incidence of infective rhinosinusitis in populations with and without clearly defined allergic rhinosinusitis”

  • EPOS 2007





Acute

  • Acute

  • Chronic

    • Specific
      • Bacterial
      • Fungal
    • Non-specific


Obstruction/Congestion

  • Obstruction/Congestion

  • OR

  • Discharge/Purulence

  • +/- Pain/Pressure

  • +/-Hyposmia/Anosmia





Obstruction/Congestion

  • Obstruction/Congestion

  • Discharge/Purulence

  • +/- Pain/Pressure

  • +/-Hyposmia/Anosmia







54% Sensitivity and 46% Specificity in sinusitis (Kuhn, 1986)

  • 54% Sensitivity and 46% Specificity in sinusitis (Kuhn, 1986)

  • 75% of Plain X-Rays do not correlate with CT (McAlister and Lusk, 1989)



Aspergillosis Blastomycosis

  • Aspergillosis Blastomycosis

  • Rhinosporoidosis Cryptococcosis

  • Phycomycosis Actinomycosis

  • Candidiasis Hisptoplasmosis

  • Sporotrichosis Mucormycosis



Non-invasive

  • Non-invasive

    • Fungal ball (mycetoma)
    • Allergic fungal sinusitis (AFS)
  • Invasive



Non-invasive

  • Non-invasive

    • Fungal ball (mycetoma)
    • Allergic fungal sinusitis (AFS)
  • Invasive

    • Chronic invasive (indolent) fungal rhinosinusitis
    • Acute invasive (fulminant) fungal rhinosinusitis






Type I Hypersensitivity

  • Type I Hypersensitivity

  • 80% of Patients Have Diffuse Polyps

  • Elevated IgE to Fungus and Positive Skin Test

  • Thick Greenish Secretions with Fungal Hyphae



Sinus opacification

  • Sinus opacification

  • Expansion

  • Bony erosion

  • No tissue invasion



Acute

  • Acute

  • Chronic

    • Specific
      • Bacterial
      • Fungal
    • Non-specific
      • Immune deficiency
        • Systemic
        • Local




Dextrocardia

  • Dextrocardia

  • Rhinosinusitis

  • Bronchiectasis

  • Infertility









Infective Rhinosinusitis (Pseudomonas)

  • Infective Rhinosinusitis (Pseudomonas)

  • 37% of Patients Have Polyps

  • Viscid Secretions

  • Polyps in Children







Deviation of nasal septum

  • Deviation of nasal septum

  • Nasal polyps

  • Hypertrophy of inferior turbinates

  • Enlarged adenoids

  • Foreign bodies

  • Choanal atresia







Nasal obstruction

  • Nasal obstruction

  • Anosmia

  • Postnasal drip



  • Gray-pink glistening structures

  • Insensitive





36% of Patients Have Diffuse Polyps

  • 36% of Patients Have Diffuse Polyps

  • Bone Expansion

  • High Recurrence Rate













Idiopathic

  • Idiopathic

  • NARES

  • Occupational

  • Hormonal

  • Drugs

  • Food

  • Irritants

  • Emotional



Nasal Hyperactivity to

  • Nasal Hyperactivity to

    • Cold air
    • Temperature changes
    • Tobacco, pollutants
    • Perfumes, bleach


Neuronal markers in allergic rhinitis: expression and correlation with sensory testing.

  • Neuronal markers in allergic rhinitis: expression and correlation with sensory testing.

  • S O’Hanlon, P Facer, K Simpson, G Sandhu, HA Saleh, P Anand.

  • Laryngoscope 2007 Sep;117(9):1519-27.

  • Increased Nerve Fiber Expression of Sensory Sodium Channels Nav1.7, Nav1.8, and Nav1.9 in Rhinitis.

  • SM Keh , P Facer, K Simpson, G Sandhu, HA Saleh, P Anand.

  • Laryngoscope. 2008; 118(4):573-9.

  • The role of neuronal mechanisms in allergic rhinitis.

  • S O’Hanlon, SM Keh, HA Saleh

  • Otorinolaringologia. 2008;58: 17-30.



  • Non-atopic

  • Females > males

  • Eosinophilia

  • Steroid responsive



Symptoms improve in weekends and holidays

  • Symptoms improve in weekends and holidays

  • Allergic

  • Non-allergic



storage mites

  • storage mites

  • grain

  • latex

  • glues and guar gum

  • rats, mice, guinea pigs

  • basilis subtilis enzymes

  • wood dust e.g. mahogany, western red cedar

  • isotonic acid hydrazine/trimellitic anhydride



Pregnancy

  • Pregnancy

  • Puberty

  • Premenstrual

  • Hypothyroidism

  • Acromegaly

  • Old man’s drip



Local

  • Local

    • Rhinitis medicamentosa
  • Systemic

    • Antihypertensives
    • Aspirin
    • Contraceptive pill


Benzoates, salicylates

  • Benzoates, salicylates

  • Tetrazine

  • Colourings



Pollution

  • Pollution

  • Gustatory





















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