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Diseases Of Nose​

  1. Rhinitis and Sinusitis
  1. As the lining epithelium of the nose and paranasal sinuses are continuous with each other, inflammatory process tends to involve the two together
  2. Etiology
  1. Pathophysiology
Fig: Release of mediators from mast cell when challenged by allergic or non-specific stimuli.
Specific allergic stimulus (IgE – mediated) Non specific stimuli
  Weather changes (Temp-humidity)
Emotional stimuli
Viral infections
Air pollution
Increased vascular permeability and vasodilatation Change in smooth muscle tone Hyperactivity
Tissue oedema   Increased secretion
Nasal blockage Bronchospasm Rhinorrhoea
Table: Both allergic and non-specific stimuli act on mast cells or blood basophils releasing several mediators substances responsible for symptomatology of allergy.
  1. Structural :- DNS, Hypertrophic turbinates
  2. Other :-Occupation , drug - induced , irritants, food
  1. Allergic Rhinitis
1. Type
  1. Perennial
  2. Seasonal  
  3. Occupational
    1. Features:-                           
      1. Itching                
      2. sneezing      
      3. profuse  
      4. watery discharge
      5. concomitant coughing & wheezing
      6. genetic predisposition - skin allergies/asthma
    2. Signs:-                  
      1. Nasal mucosa pale, boggy hypertrophic esp. over turbinates
      2. May appear bluish
      3. Discharge : watery and mucoid
      4. Ear: otitis media with effusion
      5. Pharynx: granules
      6. Larynx: Oedema of the vocal cords, hoarseness
    3.  Investigation :-
      1. Blood tests:- TLC, DLC (increased eosinophil count)
      2. Nasal smear-eosinophils
      3. Skin tests :-to identify the allergen
      4. Skin tests
      5. P.S :- Prick test : preferred over the other since the other two are less reproducible, more dangerous & many false positive results
      6. RAST (Radioallergosorbent Test)
  2. Serum IgE measurement in vitro
  1. Complications
    1. Recurrent sinusitis because of obstruction to the sinus ostia
    2. Nasal polypi
    3. Serous otitis media
    4. Orthodontic problems and other ill-effects of prolonged mouth breathing especially in children.
    5. Bronchial asthma. Patients of nasal allergy have four times more risk of developing bronchial asthma.
  2. Treatment                   
    1. Avoidance of allergens
    2. Treatment with drugs
    3. A Anti allergic
    4. B Corticosteroids -form the mainstay of treatment as nasal spray
    5. Steam inhalation/nasal douching
    6. Immunotherapy
    7. [decreases the formation of IgE ] [increase the titre of IgG ]
    8. In case of polyps, polypectomy may be required.

Extra Edge. Samter’s triad consists of nasal polypi, bronchial asthma and aspirin sensitivity.



Extra Edge: Most common sinusitis is seen in Maxillary but in children most commonly involved



MCQ: Most common allergen causing rhinitism is house duct

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