Nasal mucosal hyperreactive rhinopathy Allergic Rhinitis (AR)

1. Nasal mucosal hyperreactive rhinopathy Allergic Rhinitis (AR) Perennial~(PAR), Seasonal~(SAR) （Pollinosis） Morbidity: 10%~20% Inhalant allergens——dust mite, house dust, pollen, fungi, animal danders, cockroach； Food allergens——milk, eggs, fish and shrimp, meat, vegetables, fruits.

2. Pollen Mite Cat Mold Antigens for allergic rhinitis

3. 变应性鼻炎的病因学 内在因素──遗传因素：有家族史者较无家族史者发病危险高２～６倍母系第１１对染色体长臂ｑ段 外在因素（环境因素）：基因表达受非遗传因素影响。７０００对孪生儿，同时有AR 症状者为２１％ 易感个体在一定环境条件作用下才发病

4. 发病机制 变应原与致敏靶细胞表面IgE结合 致敏靶细胞脱粒、释放、合成生物活性介质 肥大细胞 嗜酸/碱性粒细胞 储备的介质 新合成的介质 组胺 缓激肽 白三烯 血小板活化因子 前列腺素D2 毛细血管扩张、通透性增加，腺体分泌增多 鼻炎 哮喘

10. Pathology： Type  allergy Allergic inflammation: Predominant T cells & eosinophilic cells infiltrate.

11. Symptoms & Signs： Nasal irritation and iching recurrent attacks of paroxysmal sneezing copious watery rhinorrhea nasal obstruction

12. 鼻后滴漏

13. Diagnosis： 1、History（allergen exposure, hypersensitivity, family history） 2、Examination 3、Skin test: skin prick test 4、IgE antibody，Serum total IgE 、special IgE 5、Nasal provocation or nasal chanllenge tests

14. Differential Diagnosis： 1、Vastomotor rhinitis 2、Nonallergic rhinitis with eosinophilia syndrome, NARES 3、Hyperreflectory rhinitis 4、Acute rhinitis

15. Complications： 1、Allergic sinusitis 2、Asthma 3、Secretory otitis media 4、Allergic pharyngolaryngitis Treatment： 1、Avoidance

16. 2、Drugs 1）Antihistamines 2）Corticosteroids 3）Sodium cromoglycate(SCG) Cromolyn sodium 4）Anticholinergic agents 5）Vasoconstrictor sympasthomimetics 3、Hyposensitization 4、Others：Traditional Chinese medicine, laser, operation

17. Nasal Polyp & Nasal Polyposis Etiology：mutilfactors 1.allergic；2.chronic inflammation Pathology：highly swelled connective tissue. Predominant eosinophilic cells infiltrate. Lymphatic cells, neutrophils, basophils, mast cells.

18. Symptoms & Sign：persistent nasal obstruction，close nasal sound，hyposmia, rhinorrhea, snore, “frog nose” Polyp in maxillary sinus（L），polyp in middle meatus（R）

19. Antrochoanal polyp

21. Antrochoanal polyp

22. Diagnosis： Anterior rhinoscopy：translucent, soft, smooth masses. Endoscopy, X-ray and CT scanner. Differential Diagnosis： Papilloma inverted，angiofibroma of nasopharynx，malignant tumor of nasal cavity，meningoencephalocele Treatment：1、conservative treatment——corticosteroids 2、surgical treatment

23. Polyps（above），papilloma（below）

24. papilloma（L），MT of nasal cavity （R）

25. Sinusitis Acute suppurative sinusitis Features of sinus anatomy： 1、small ostia of the sinuses； 2、continuative mucosa between nasal cavity and sinuses； 3、contiguous of the ostia； 4、location of the astia and features of the sinuses.

27. Frontal Sinus Ethmoid Sinus Maxillary Sinus

28. Etiology： 1、General factors: Poor general health (influenza, measles, whooping cough…) 2、Local factors： Sinus diseases； Infective focus of eripheral organs， Direct infection； Nasal tampon (packing)； Rapid change of atmospheric pressure

29. 成人Acute bacterial rhinosinusitis (ABS)病因 ABS主要病原体：肺炎链球菌和嗜血流感杆菌 Staphylococcus aureus 0-8% Other bacteria 4% Anaerobes 0-9% S. pneumoniae Other streptococci 3-9% 20-43% 2-10% Moraxella catarrhalis 22-35% H. influenzae SAHP. Otolaryngol Head Neck Surg. 2004;130:1-45.

30. 儿童Acute bacterial rhinosinusitis (ABS)病因 • ABS主要病原体：肺炎链球菌、嗜血流感杆菌和卡他莫拉菌 Otolaryngol Head Neck Surg. 2004;130:1-45.

31. Symptoms & Signs： General symptoms： Malaise, fever. Local symptoms: 1）Nasal obstruction sustained, with hyposmia 2） Suppurative rhinorrhea, streaky with blood, foul smell(odontogentic~) 3）headach or local ache

32. Antral pain——from inner canthus downwards across the cheek, upper alveolus on the affected side. Ethmoidal pain——over bridge of the nose & inner canthus behind the eye. Frontal pain——forehead, periodicity, persist for an hour or tow after getting up in the morning, and clear during the afternoon. Sphenoidal pain——occipital or vertical headache.

33. Diagnosis： History， Signs, Anterior rhinoscopy, Nasal endoscopy, Radiological examination, Puncture and irrigation of maxillary sinus

34. Treatment：Eradicate causes，keep drainage；control infection and prevent complications 1、General treatment：take rest，antibiotics，antihistamine (if necessary ) 2、Local treatment 3、Body drainage 4、Physical therapy 5、Puncture and irrigation of maxillary sinus

35. Maxillary sinus puncture and irragation

36. Chronic suppurative sinusitis Etiology：Acute——Chronic Symptoms & Signs： General~: Local~： rhinorrhea, nasal obstruction, headache, hyposmia, vision disorder

37. Diagnosis： 1、History； 2、Examination：anterior rhinoscopy, nasal endoscopy 3、Radiological examination：CT or MRI 4、Puncture and irrigation of sinus

38. Normal image of nasal endoscopy

39. Maxillary sinusitis——pus in the middle meatus

40. Maxillary sinusitis(R)

41. Sphenoid sinusitis——pus in the sphenoethmoidal recess

42. Sphenoid sinusitis

43. Pansinusitis

44. Pansinusitis

45. Treatment： 1、Intranasal medications：Corticosteroid， Vasoconstrictor sympasthomimetics 2、Puncture and irrigation of maxillary sinus 3、Displacement method——frontal sinusitis, ethmoidal sinusitis, sphenoidal sinusitis, pansinusitis 4、Surgery——traditional sinus surgery Functional Endoscopic Sinus Surgery(FESS) Ostiometal complex OMC

46. Functional Endoscopic Sinus Surgery(FESS)

48. 复习与思考： 1、鼻腔外侧壁的解剖结构及其与临床的关系如何？ 2、变应性鼻炎有何临床表现，应与哪些疾病相鉴别？ 3、如何诊断鼻窦炎？ 4、鼻息肉应与哪些疾病相鉴别? 5、上颌窦穿刺术有何临床意义？