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Clinical physiology—ENT:

Clinical physiology—ENT:. Prof James Ker MBChB , MMED, MRCP, FRCP, PhD, FESC, FACC, L.Akad.SA. The nose:. The nose presents a large mucosal surface area through the folds of the turbinates . Serves to adjust the temperature and moisture content of inhaled air.

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Clinical physiology—ENT:

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  1. Clinical physiology—ENT: Prof James Ker MBChB, MMED, MRCP, FRCP, PhD, FESC, FACC, L.Akad.SA

  2. The nose: • The nose presents a large mucosal surface area through the folds of the turbinates. • Serves to adjust the temperature and moisture content of inhaled air. • Filters out particulate material >10 ᵤm in size

  3. Does this by impingement in a mucous blanket • Ciliary action moves the entrapped particles toward the pharynx • Entrapment of pollen in mucous blanket:

  4. Digestion of the outer coat by mucosal enzymes (such as lysozymes) • This releases protein allergens (10 000-40 000 molecular weight) • This interaction between protein allergens and mast cells: 2 types

  5. Intraepithelial and perivenular mast cells • Both are sensitized with specific IgE • Which Ig`s in mucous layer: IgA , E or both • IgE diffuses from plasma cells • IgA secreted • IgE fixes to mucosal and submucosal mast cells • Clinical response related to pollen dose

  6. For clinical insight: • Antigens • Haptens • Superantigens

  7. Immediate hypersensitivity reactions • Delayed hypersensitivity reactions • Cytotoxic reactions • Immune complex formation • Clinical implications: • Immediate vs late clinical presentations • Vasculitic associations of allergic disease

  8. Sinusitis: • This term refers to an inflammatory condition involving one or more of the four paired structures surrounding the nasal cavities. • Maxillary sinus most commonly involved • Then: Ethmoid, frontal and sphenoid

  9. Each sinus is lined by respiratory epithelium that produces mucus. • Mucus: Transported out by ciliary action through sinus ostia and into the nasal cavity. • Mucus remain sterile, despite the proximity to bacteria filled nasal passages

  10. 3 physiological disturbances that lead to infective sinusitis: • Obstruction of the ostia • Impaired clearance of mucus due to ciliary dysfunction • Immunological disturbance

  11. Immunoglobulin deficiency (IgG1-4) • Cystic fibrosis • Primary ciliary disorders

  12. Primary ciliarydiskinesia: • Inherited in autosomal recessive fashion • Numerous defects: • Structural abnormalities in dynein arms, radial spokes, microtubules. • The cilia become dyskinetic and their coordinated, propulsive action is diminished • Thus, bacterial clearance is impaired

  13. Clinical effects: • Recurrent upper and lower respiratory tract infections,such as sinusitis, otitis media, bronchitis, pneumonia • Long term: Bronchiectasis • Impaired motility of sperm: Infertility • Situsinversus: Kartagener`s

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