RHINOSINUSITIS&NASAL POLYPOSIS

Rhinosinusitis common complication AR40 % chronic sinusitis alergyAdult childrenInflamatory mucous membraneUSA incidence 18%Socioeconomic problem

Pathophysiology of Rhinosinusitis

Symptoms RhinosinusitisMajor symptomsFacial pain/pressureFacial congestion/fullnessNasal obstruction/blockageNasal discharge/ purulence/post nasal dripHyposmia/anosmiafeverMinor symptomsHeadacheFeverHalitosis FatiqueDental painCoughEarpain/pressure/fullness

RHINOSINUSITISDiagnosis :Medical historyPhysical examainationPurulent secretionPatencyt of sinus out flow tractEdemaX-ray

RHINOSINUSITIS

Medical managementNon sedating antihistamineDecongestan Intranasal steroidAntibiotics (severe)Surgycal

NASAL POLYPOSISPolyps smooth, grade like structure arise from inflamed mucosa lining pranasal sinuses.Allergy ??EosinophiliaIL 5EotaxinrantesIntranasal CorticosteroidUntreated nasal polypsRelapse preventionPost operative

POLYPOSISSmooth, grape like

Skin testnot identify all possible allergen

Local production Ig E

Prevalence polyposis in allergic rhinitis

PATHOPSHYSIOLOGY TNF a epithelial cellVCAM-1 EPITHELIAL CELLIL 1 epithelial cellEOSINOPHIL >>Migration through blood vessel wallRelease of eosinophil granule proteinAlteration of Na & Cl fluxEDEMAInjury to air way epithelial cells by allergen, virus or traumaRegeneration of airway epitheliumBasal cell hyperplasiaSquamous cell hyperplasiaGoblet cell hyperplasiaDetective CFTR migrationAnti IL 1Anti TNF aAnti VCAM 1Anti VLA 1

POLYPOSISDiagnosis :HistoryPhysical examination (RA/Endoscopy)LaboratoryX ray/ CT scan

POLYPOSISHistoryNasal congestionHyposmia/ anosmiaSneezingRhinorrhea

POLYPOSISPhysical examination Multiple/ dingleSmoothGrade-likeGelatinousCommon arise from ethmoid/ ostial region

POLYPOSISLaboratory Skin testingHistamine / Ig Epolyps fluids

X ray/ CT scan

POLYPOSISSTAGING Grade 1 : polyps do not prolaps middle turbinate (endoscopy)Grade 2 : polyps extend bellow middle turbinate (rhinoscopy anterior)Grade 3 : polyps massive

POLYPOSISGuideline for the management Primary goal : relief patient symptomsSecondary goal :Infections