过敏性鼻炎的诊断和治疗.ppt

Nasal mucosal hyperreactive rhinopathy Allergic 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 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: Predominant T cells & eosinophilic cells infiltrate.,Symptoms & Signs： Nasal irritation and iching recurrent attacks of paroxysmal sneezing copious watery rhinorrhea nasal obstruction,鼻后滴漏,Diagnosis： 1、History（allergen exposure, hypersensitivity, family history） 2、Examination 3、Skin test: skin prick test 4、IgE antibody，Serum total IgE 、special IgE 5、Nasal provocation or nasal chanllenge tests,Differential Diagnosis： 1、Vastomotor rhinitis 2、Nonallergic rhinitis with eosinophilia syndrome, NARES 3、Hyperreflectory rhinitis 4、Acute rhinitis,Complications： 1、Allergic sinusitis 2、Asthma 3、Secretory otitis media 4、Allergic pharyngolaryngitis Treatment： 1、Avoidance,2、Drugs 1）Antihistamines 2）Corticosteroids 3）Sodium cromoglycate(SCG) Cromolyn sodium 4）Anticholinergic agents 5）Vasoconstrictor sympasthomimetics 3、Hyposensitization 4、Others：Traditional Chinese medicine, laser, operation,Nasal Polyp & Nasal Polyposis Etiology：mutilfactors 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 sound，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，meningoencephalocele Treatment：1、conservative treatmentcorticosteroids 2、surgical treatment,Polyps（above），papilloma（below）,papilloma（L），MT of nasal cavity （R）,Sinusitis Acute suppurative sinusitis Features of sinus anatomy： 1、small ostia of the sinuses； 2、continuative mucosa between nasal cavity and sinuses； 3、contiguous of the ostia； 4、location of the astia and features of the sinuses.,Frontal Sinus,Ethmoid Sinus Maxillary 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)； 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. influenzae,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 hyposmia 2） Suppurative rhinorrhea, streaky with blood, foul smell(odontogentic) 3）headach 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 afternoon. 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 complications 1、General treatment：take rest，antibiotics，antihistamine (if necessary ) 2、Local treatment 3、Body drainage 4、Physical therapy 5、 Puncture and irrigation of maxillary sinus,Maxillary sinus puncture and irragation,Chronic suppurative sinusitis Etiology：AcuteChronic Symptoms & Signs： General: Local： rhinorrhea, nasal obstruction, headache, hyposmia, vision disorder,Diagnosis： 1、History； 2、Examination：anterior rhinoscopy, nasal endoscopy 3、Radiological examination：CT or MRI 4、Puncture and irrigation of sinus,Normal image of nasal endoscopy,Maxillary sinusitispus in the middle meatus,Maxillary sinusitis(R),Sphenoid sinusitispus in the sphenoethmoidal 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,