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Non Allergic Rhinitis

Non Allergic Rhinitis. Prof. Sameer Bafaqeeh, M.D. University Professor in Rhinology & Rhinoplasty. Vasomotor Rhinitis. Symptoms : as Perennial Allergic Rhinitis Paroxsysmal course Local Finding: Livid, pale nasal mucosa.

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Non Allergic Rhinitis

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  1. Non Allergic Rhinitis Prof. Sameer Bafaqeeh, M.D. University Professor in Rhinology & Rhinoplasty Professor Sameer Bafaqeeh

  2. Professor Sameer Bafaqeeh

  3. Vasomotor Rhinitis • Symptoms : as Perennial Allergic Rhinitis • Paroxsysmal course • Local Finding: Livid, pale nasal mucosa. • Profuse watery secretion • Nasal turbinates swollen Professor Sameer Bafaqeeh

  4. Vasomotor RhinitisPathogenesis • Neurovascular disorder • No specific antibodies • Nonspecific reflex hypersensitivity • Caused by various influences Professor Sameer Bafaqeeh

  5. Vasomotor RhinitisPathogenesis • Change of temperature or humidity • Alcohol , dust, smoke, mechanical irritation, stress, anxiety neurosis, endocrine disorders, rhinitis of pregnancy. • Drugs: (e.g., antihypertensive agents as reserpine or beta-blockers, oral contraceptives) • Drug abuse: (imidazoline & catechol derivatives, clomethiazole, etc.) Professor Sameer Bafaqeeh

  6. Vasomotor RhinitisDiagnosis • Typical history • Negative allergen tests • No elevated IgE in the secretion Professor Sameer Bafaqeeh

  7. Vasomotor RhinitisDifferential diagnosis • Allergic Rhinitis • Foreign body in the Nose • Common Cold Professor Sameer Bafaqeeh

  8. Vasomotor RhinitisConservative Tretment • Elimination of irritant factors • Antihistamines • Nasal decongestant drops • Oral decongestant drugs • Steroids (e.g., beclomethasone) • Metabolic & endocrine systems • Sedatives • Imidazoline preparations (Potential for habituation) Professor Sameer Bafaqeeh

  9. Vasomotor RhinitisSurgical Treatment • Turbinate surgery Electrocautery,cryosurgery, laser • Correction of anatomical deformity • Conchotomy • Parasympathetic nasal fibers divisions (Pterygoid canal n., vidian n., greater petrosal n.) M.C.F. Professor Sameer Bafaqeeh

  10. Vasomotor RhinitisPrognosis • Uncertain • Suddenly improves • Resistant to treatment Professor Sameer Bafaqeeh

  11. Rhinitis Sicca AnteriorSymptoms • Dryness • Irritation • Crusts formation • Nasal bleeding Professor Sameer Bafaqeeh

  12. Rhinitis Sicca AnteriorPathogenesis • Anterior nasal mucosa injury • Dust • Nose picking • Extremes of temperature Professor Sameer Bafaqeeh

  13. Rhinitis Sicca AnteriorDiagnosis • Nasal septum is dry • Mucosal surface is: Raw, roughened, & granular. • Crustation ulceration Septal perforation Professor Sameer Bafaqeeh

  14. Rhinitis Sicca AnteriorDifferential Diagnosis • Chemical injury (Chromium workers) • Iatrogenic septal perforation • Trauma • Lupus • Leprosy • syphilis Professor Sameer Bafaqeeh

  15. Rhinitis Sicca AnteriorTreatment • Nasal ointments • Septal perforation closure Professor Sameer Bafaqeeh

  16. Chronic Rhinitis • Irritation Or Inflammation • Hypertrophied Nasal Mucosa • Hyperemia & edema • True tissue hypertrophy Professor Sameer Bafaqeeh

  17. Chronic RhinitisSYMPTOMS • Nasal obstruction • Tough, Stringy, Colorless secretions (rarely purulent) • Post nasal catarrh • Rhinolalia clausa &Epiphora • 2nd dacryocystitis • 2nd pharyngitis Professor Sameer Bafaqeeh

  18. Chronic RhinitisSYMPTOMS • Fatigue ,sleeplessness • Unsteady or woozy feeling • Headache • Feeling of pressure in the head • Psychological & physical well-being loss Professor Sameer Bafaqeeh

  19. Chronic RhinitisPathogenesis • Recurrent inflammation • Sinusitis • Enlarged adenoid • Nasopharyngeal tumor • VMR & Side effects of drugs • Tobacco, smoke, dust, chemicals, acquired toxins, temperature extremes , humidity • Pregnancy, menstruation, menopause • Endocrine disturbances • Heart &circulatory diseases • Infective allergy “late-type allergy” Professor Sameer Bafaqeeh

  20. Chronic RhinitisDiagnosis • Long-standing disease • History of toxins • Dark red &bluish-violet swelling turbinate • Narrowed or obstructed nasal cavity • Nasal decongested Professor Sameer Bafaqeeh

  21. Chronic RhinitisDiagnosis • Granular nodular surface (Micro-polyps) nasal polypi • Mulberry-like masses Professor Sameer Bafaqeeh

  22. Chronic RhinitisDifferential diagnosis • Sinusitis • Foreign bodies • Specific infections • Adenoidal hypertrophy • wegener’s granuloma • allergy • Tumors Biopsy Professor Sameer Bafaqeeh

  23. Chronic RhinitisConservative Treatment • Treatment of etiological agents • Drug overuse controlled • Endocrinologic investigation • Environment & occupation • Symptomatic treatment by decongestant nose drops (Not in long term) Professor Sameer Bafaqeeh

  24. Chronic RhinitisSurgical Treatment • Reduction of the inferior turbinate by sclerosing agents, cryoprobe, or the laser. -Electrocoagulation multiple, localized scars in N.M. -Cryosurgerypartial obliteration -CO2 or argon lasermucosal scars (evaporation or coagulation) • Turbinectomy or mucotomy • turbinoplasty Professor Sameer Bafaqeeh

  25. Pregnancy Rhinitis • Nasal swelling & obstruction • 2nd hafe of pregnancy • Resolve after delivery Professor Sameer Bafaqeeh

  26. Rhinitis Medicamentosa Reversible or irreversible damaged mucosa caused by topically or systemically applied drugs:- • Hyper-plastic Rhinitis • Dryness of the nasal mucosa • Toxic Rhinopathy 1 2 3 Professor Sameer Bafaqeeh

  27. Rhinitis MedicamentosaHyperplastic Rhinitis Mucosal swelling • Acetylsalicylic acid • Oral contraceptives • Guanethidine , hydantoin , estrogens, paraamino-salicylic acid, phenothiazine, rauwolfia preparations, • Beta-blocking drugs • Tetraethyl ammonium Professor Sameer Bafaqeeh

  28. Rhinitis Medicamentosa Dryness of the Nasal Mucosa • Atropine, belladonna preparatios • Corticosteroids • Imidazoline, or catecholamine derivatives Professor Sameer Bafaqeeh

  29. Rhinitis MedicamentosaToxic Rhinopathy #Vasoactive subsances • Adrenalin or imidazoline derivatives as privine, nasivine... • Habituation  R.M. • Autonomic vascular regulation failure O mucosal damage • Local or systemic decongestant • Acute intoxication in infants & small children Professor Sameer Bafaqeeh

  30. Atrophic Rhinitis& Ozena • Atrophic rhinitis+ foul smell = Ozena • Mainly in women • At puberty • Flattened & broad Face Professor Sameer Bafaqeeh

  31. Atrophic Rhinitisclinical presentation • Greenish–yellow or brownish-black crusts • Wide nasal cavity • Atrophic mucosa & dry: • Subepithelial layer fibrosis • Fetid secretion &crusts (Ozena) • Anosmia & social problem • Nasal obstruction • Mucosal changes in ph., la., & tr., Professor Sameer Bafaqeeh

  32. Atrophic RhinitisPathogenesis • Unknown but is multifactorial • Common in orientals than in whites than in blacks • Geographic concentration • Abnormally wide nasal cavity • Mucosal atrophy& bony nasal skeleton. • M.G. & S.N.F. degenerate • Respiratory epith. sq. metaplasia • Destroyed mucociliary cleaning system • Bacterial proteolysis decomposed the thick & gluey secretions Professor Sameer Bafaqeeh

  33. 2nd Atrophic Rhinitis • Nasal Trauma • Extensive surgery • Occupational exposure to:- Glass, wood, asbestos, etc. Professor Sameer Bafaqeeh

  34. Atrophic RhinitisDiagnosis • Gluey, dry, greenish-yellow secretions & crusts •  wide nasal cavity & very small turbinates • Foul-smelling crusts in Ozena Professor Sameer Bafaqeeh

  35. Atrophic RhinitisDifferential Diagnosis • Atrophic rhinitis with fetor (ozena) • Tumors of the Nose & Sinuses • Purulent Rhinitis & Sinusitis • Rhinolith & foreign body • Gumma due to stage III Syphilis • Nasal diphtheria &Nasal Tuberculosis • glanders Professor Sameer Bafaqeeh

  36. Atrophic RhinitisConservative Treatment • Nasal douching • Alkaline nasal lotion • Greasy ointments • Oily nasal drops, emulsions , or ointments, ?! Vitamin A • Steam inhalations • Osmotic Powders :Dextrose Professor Sameer Bafaqeeh

  37. Atrophic RhinitisOperative Treatment • Bolstering of the Nasal Mucosa (Cartilage or Bone chips) • Median Displacement of the lateral nasal wall by internal rotation of the mobilized lateral nasal wall Professor Sameer Bafaqeeh

  38. Nasal Diphtheria • Children older than 6 months Professor Sameer Bafaqeeh

  39. Nasal Tuberculosis • Lupus • Exudative Ulcerative mucosal Tuberculosis Professor Sameer Bafaqeeh

  40. Nasal Syphilis • Stage 1 : infection from instruments • Stage 11 : very rare • Stage 111 : more common Professor Sameer Bafaqeeh

  41. Glanders • Soso Professor Sameer Bafaqeeh

  42. Blastomycosis Professor Sameer Bafaqeeh

  43. Rhinosporidiosis Professor Sameer Bafaqeeh

  44. Other Mycoses Professor Sameer Bafaqeeh

  45. Wegener’s Granulomatosis Professor Sameer Bafaqeeh

  46. Lethal Midline Granuloma Professor Sameer Bafaqeeh

  47. The 3nd RiyadhComprehensive InternationalRhinoplasty Course21 April – 24 April 2008 King Saud University Hospitals -King Abdul-Aziz University Hospital 4th Floor -King Kalid University Hospital Anatomy Department Prof. Sameer Bafaqeeh -Chairman of Organizing Committee -ENT Department -King Abdul-Aziz University Hospital Professor Sameer Bafaqeeh

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