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1、Nasal mucosal hyperreactive rhinopathyAllergic Rhinitis (AR)Perennial(PAR), Seasonal(SAR) （Pollinosis）Morbidity: 10%20%Inhalant allergensdust mite, house dust, pollen, fungi, animal danders, cockroach；Food allergensmilk, eggs, fish and shrimp, meat, vegetables, fruits.,Mite,Mold,Pollen,Cat,Antigens
2、for allergic rhinitis,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倍母系第对染色体长臂段 外在因素（环境因素）：基因表达受非遗传因素影响。对孪生儿，同时有AR 症状者为 易感个体在一定环境条件作用下才发病,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,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,嗜酸/碱性粒细胞,哮喘,鼻炎,发病机制,Pathology：Type allergy Allergic inflammation: Predom
3、inant T cells & eosinophilic cells infiltrate.,Symptoms & Signs：Nasal irritation and ichingrecurrent attacks of paroxysmal sneezing copious watery rhinorrheanasal obstruction,鼻后滴漏,Diagnosis：1、History（allergen exposure, hypersensitivity, family history）2、Examination3、Skin test: skin prick test 4、IgE
4、antibody，Serum total IgE 、special IgE5、Nasal provocation or nasal chanllenge tests,Differential Diagnosis：1、Vastomotor rhinitis 2、Nonallergic rhinitis with eosinophilia syndrome, NARES3、Hyperreflectory rhinitis4、Acute rhinitis,Complications：1、Allergic sinusitis2、Asthma3、Secretory otitis media 4、Alle
5、rgic pharyngolaryngitisTreatment：1、Avoidance,2、Drugs1）Antihistamines2）Corticosteroids3）Sodium cromoglycate(SCG) Cromolyn sodium4）Anticholinergic agents5）Vasoconstrictor sympasthomimetics3、Hyposensitization4、Others：Traditional Chinese medicine, laser, operation,Nasal Polyp & Nasal PolyposisEtiology：m
6、utilfactors 1.allergic；2.chronic inflammation Pathology：highly swelled connective tissue. Predominant eosinophilic cells infiltrate. Lymphatic cells, neutrophils, basophils, mast cells.,Polyp in maxillary sinus（L），polyp in middle meatus（R）,Symptoms & Sign：persistent nasal obstruction，close nasal sou
7、nd，hyposmia, rhinorrhea, snore, “frog nose”,Antrochoanal polyp,Antrochoanal polyp,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，meningoencephaloce
8、leTreatment：1、conservative treatmentcorticosteroids 2、surgical treatment,Polyps（above），papilloma（below）,papilloma（L），MT of nasal cavity （R）,SinusitisAcute suppurative sinusitisFeatures of sinus anatomy：1、small ostia of the sinuses； 2、continuative mucosa between nasal cavity and sinuses；3、contiguous
9、of the ostia；4、location of the astia and features of the sinuses.,Frontal Sinus,Ethmoid SinusMaxillary Sinus,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)；
10、Rapid change of atmospheric pressure,ABS主要病原体：肺炎链球菌和嗜血流感杆菌,SAHP. Otolaryngol Head Neck Surg. 2004;130:1-45.,20-43%,22-35%,Anaerobes 0-9%,Staphylococcus aureus 0-8%,Other bacteria 4%,Moraxella catarrhalis,Other streptococci 3-9%,2-10%,S. pneumoniae,成人Acute bacterial rhinosinusitis (ABS)病因,H. influenz
11、ae,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.,Symptoms & Signs：General symptoms：Malaise, fever.Local symptoms:1）Nasal obstruction sustained, with hyposmia2） Suppurative rhinorrhea, streaky with blood, foul smell(odontogentic)3）head
12、ach or local ache,Antral painfrom inner canthus downwards across the cheek, upper alveolus on the affected side.Ethmoidal painover bridge of the nose & inner canthus behind the eye. Frontal painforehead, periodicity, persist for an hour or tow after getting up in the morning, and clear during the af
13、ternoon.Sphenoidal painoccipital or vertical headache.,Diagnosis：History，Signs, Anterior rhinoscopy, Nasal endoscopy, Radiological examination, Puncture and irrigation of maxillary sinus,Treatment：Eradicate causes，keep drainage；control infection and prevent complications1、General treatment：take rest
14、，antibiotics，antihistamine (if necessary )2、Local treatment3、Body drainage4、Physical therapy5、 Puncture and irrigation of maxillary sinus,Maxillary sinus puncture and irragation,Chronic suppurative sinusitisEtiology：AcuteChronicSymptoms & Signs：General:Local： rhinorrhea, nasal obstruction, headache,
15、 hyposmia, vision disorder,Diagnosis：1、History；2、Examination：anterior rhinoscopy, nasal endoscopy3、Radiological examination：CT or MRI4、Puncture and irrigation of sinus,Normal image of nasal endoscopy,Maxillary sinusitispus in the middle meatus,Maxillary sinusitis(R),Sphenoid sinusitispus in the sphe
16、noethmoidal recess,Sphenoid sinusitis,Pansinusitis,Pansinusitis,Treatment：1、Intranasal medications：Corticosteroid， Vasoconstrictor sympasthomimetics 2、Puncture and irrigation of maxillary sinus 3、Displacement methodfrontal sinusitis, ethmoidal sinusitis, sphenoidal sinusitis, pansinusitis 4、Surgerytraditional sinus surgeryFunctional Endoscopic Sinus Surgery(FESS) Ostiometal complex OMC,Functional Endoscopic Sinus Surgery(FESS),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？,
