鼻窦炎-过敏性鼻炎-鼻息肉

SinusitisRhinosinusitis鼻窦炎的重要影响

严重的社会经济问题每年16%的成年人患鼻窦炎1是花费最大的前10位健康问题之一21996年:2700万次门诊和急诊3每年直接花费为$35亿4

，总损失超过65亿美元占抗生素应用第5位5

占儿童应用抗生素处方量的9%占成年人抗生素处方量的21%1.BrookI.AnnOtolRhinolLarynogl.2000;182(suppl):2-20.2.GoetzelRZetal.JOccupEnvironMed.2003;45:5-14.3.KalinerMAetal.OtolaryngolHeadNeckSurg.1997;116:S1–S20.4.RayNFetal.JAllergyClinImmunol.1999;103:408-414.5.SinusandAllergyHealthPartnership.OtolaryngolHeadNeckSurg.2004;130:1–44在美国每年11200万天误工5900万天活动受限2000万天卧床是初级医疗保健咨询的最常见原因之一1,2可以导致严重的并发症，降低病人的生活质量，降低工作效率1-41. BrooksIetal.AnnOtolRhinolLaryngol.2000;182(suppl):2–20.2. LaurierCetal.Pharmacoeconomics.1999;15:97–113.3. DykewiczMS.JAllergyClinImmunol.2003;111:S520–S529.4. MuchaSM,BaroodyFM.CurrOpinAllergyClinImmunol.2003;3:33-38.鼻窦炎的重要影响

儿童和成人每年分别约有3~8次和2~3次病毒性上呼吸道感染约0.5%~2%形成继发性急性细菌性鼻窦炎美国每年有2000万个急性细菌性鼻窦炎病例按此估计，中国每年至少有1亿个急性细菌性鼻窦炎病例AhnJetal.InternationalSocietyofPharmacoeconomicOutcomesResearch2002.PosterPIN14(PROMPTstudy).急性细菌性鼻窦炎的重要影响

Infact,onclinicalground,CRSappearstobeacontinuousspectrumofillnessrangingfromchronicinfectiousrhinosinusitistorelativelypurenoninfectiousinflammation

(JAllergyImmunol2000;106;213-7)“Rhinosinusitisis

agroupofdisorders

characterizedbyinflammationofthemucosaofthenoseandtheparanasalsinuses.”(OtO–HeadandNeckSurgery,2004,131,s1-s62)CRS—一个复杂的疾病５个学术组织

TheAmericanAcademyAsthmaandImmunologyTheAmericanAcademyofOtolaryngologyTheAmericanAcademyofOtolaryngology–HeadandNeckSurgeryTheAmericanCollegeofAllergy,AsthmaandImmunologyTheAmericanRhinologicSociety30位学者中80%学者认同的观点

Rhinosinusitis:Establishingdefinitionsfor

clinicalresearch

andpatientcare(OTO–HNS,2004，131,s1-s62)CRS—权威的综述(2004)欧洲过敏和临床免疫学会（EAACI）组织专家小组发表

“EuropeanPositionPaperonRhinosinusitisandNasalPolyps(EP3OS)”－200515位专家参与编写全书88页652篇参考文献受到耳鼻咽喉科及其它有关学科专家和临床医生的认可(Rhinology,2005,Supplement18:1-88)EuropeanPositionPaperon

RhinosinusitisandNasalPolyps---EP3OS

,2005版编辑小组在2006年对该文献进行了补充和修改25位来自世界各地的鼻和变态反应专家参与编写综述了1112篇文献全书139页W.Fokkens(Chair)V.Lund(Co-Chair)J.Mullol,C.BachertP.HelllingsM.HolmstromN.JonesNoamCohenL.KalogjeraD.KennedyM.KowalskiD.PassaliH.StammbergerP.StiernaM.HytönenL-M.KlossekG.ScaddingB.NaclerioE.MeltzerM.DesrosiersH.RiechelmannD-Y.WangEuropeanPositionPaperon

RhinosinusitisandNasalPolyps，EP

3

OS，2007版编辑小组在2012年对该文献进行了补充和修改57位来自世界各地的鼻和变态反应专家参与编写综述了2000多篇文献全书200多页W.Fokkens(Chair)V.Lund(Co-Chair)J.Mullol,C.BachertP.HelllingsM.HolmstromN.JonesNoamCohenL.KalogjeraD.KennedyM.KowalskiD.PassaliH.StammbergerP.StiernaM.HytönenL-M.KlossekG.ScaddingB.NaclerioE.MeltzerM.DesrosiersH.RiechelmannD-Y.WangEuropeanPositionPaperon

RhinosinusitisandNasalPolyps，EP

3

OS，2012版AcuteRhinosinusitisFeaturesofsinusanatomy：1、smallostiaofthesinuses；

2、continuativemucosabetweennasalcavityandsinuses；

3、contiguousoftheostia；

4、locationoftheostiaandfeaturesofthesinuses.AcutesinusitisEtiology：

1、viralinfection2、Bacteriainfection

3、Localanatomicfactor4、allergy5、otherdiseases；

Infectionofperipheralorgans，

Directinfection；

nasaltampon(packing)；

rapidchangeofatmosphericpressure

AcutesinusitisSymptoms&Sign：General~：fever，discomfort.Local~:1）Nasalobstruction2）Suppurativerhinorrhea,streakywithblood,foul

smell(odontogentic~)3）hyposmia4）headachorlocalacheMaxillarysinusitis——Ethmoidalsinusitis——Frontalsinusitis——Sphenoidalsinusitis——5）nasalexaminationAcutesinusitisDiagnosis：

-History，-Anteriorrhinoscopy,-Nasalendoscopy,-Radiologicalexamination,-PunctureandirrigationofmaxillarysinusAcutesinusitisTreatment：1、Medicaltreatment：

-antibiotics，

-localcorticosteroid

-mucolytics

-anti-allergy(ifnecessary)2、othertreatment

-drainage

-antralirrigation

-physicaltherapy

3、surgery，forseverecomplicationAcutesinusitisAcutesinusitisChronicRhinosinusitis（CRS）鼻粘膜粘液纤毛系统被重视病因问题CRS—炎症并非总与窦口阻塞有关急性鼻窦炎的反复发作窦口阻塞炎症反应CRS病理生理认识的进步CRS的可能病因EtiologyofCRSBacterialinfectionInflammationbymultiplefactorsfungiBacterialsuperantigenbiofilmAnatomicalabformityothersSymptoms&Sign：General~；Local~：nasalobstructionrhinorrhea,hyposmia,headacheothersChronicsinusitisDiagnosis：

1、History；2、Examination：

anteriorrhinoscopy,

nasalendoscopy3、Radiologicalexamination：

CTor

MRI4、PunctureandirrigationofsinusChronicsinusitisChronicsinusitis:DiagnosisNormalimageofnasalendoscopyMaxillarysinusitis——pusinthemiddlemeatus

Sphenoidsinusitis——pusinthesphenoethmoidalrecessAllergicFungalSinusitisFungalballTreatment：1、Intranasalmedications：Corticosteroid2、long-termmacrolide3、mucolytics4、Vasoconstrictorsympsthomimetics5、Punctureandirrigationofmaxillarysinus、

Displacementmethod——frontalsinusitis,

ethmoidalsinusitis,sphenoidalsinusitis,pansinusitis6、Surgery——traditionalsinussurgery

FunctionalEndoscopicSinusSurgery(FESS)

ChronicsinusitisFunctionalEndoscopicSinusSurgery(FESS)AllergicrhinitisIschronicnasalmucosainflammation,mediatedbyIgE,inducedbyinflammatorymediatorderivedfromkindsofimmunologic-active,pro-inflammatory,andcytokinesAllergicrhinitisEpideminologyofallergicrhinitisPrevalence:10-25%Increaserapidlyinthepastdecades

（ARIAreport）ARIA2001ARIA2008ARIA(AllergicRhinitisanditsImpactonAsthma)2001年与WHO合作37位作者55个组织,其中亚洲有:HongkongcollegeofENT.JapanRhinologySocietyKoreanRhinologySocietyMalaysionsocityofoto-HasPhilippineENTSocietySingaporeENTSocietyThaiRhinologySociety2776篇参考文献187页JallergyandClinicalImmunology2001,108,s147-s33443ARIAPocketGuide:

52Translations52种文字Morbidity:10%Inhalantallergens——dustmite,housedust,

pollen,fungi,animaldanders,cockroach；Foodallergens——milk,eggs,fishandshrimp,

meat,vegetables,fruits.Pathology：Typeallergy

Allergicinflammation:PredominantTcells&eosinophiliccellsinfiltrate.AllergicRhinitis(AR)AllergenmitedanderpollenLeatherClassificationofAROldClassification:

Perennial~(PAR),

Seasonal~(SAR)（Pollinosis）

NewWHO-ARIA间歇性症状发生的天数※<4天/周※或病程<4周持续性症状发生的天数※>4天/周※和病程>4周轻度睡眠正常日常活动、体育和娱乐正常工作、学习正常无令人烦恼的症状中-重度下列一项或多项不能正常睡眠日常活动、体育锻炼、娱乐等受影响不能正常工作或学习有令人烦恼的症状Symptoms&Signs：

1,nasalirritationandiching,

2,recurrentattacksofparoxysmalsneezing,

3,nasalobstruction

4,wateryrhinorrhea.AllergicRhinitis(AR)Diagnosis：1、history（atleast2of4mainsymptoms，morethanhalfday，atleast4of7days）

2、examination

3、skintest:skinpricktest

4、IgEantibody：SerumtotalIgE、specialIgE5、nasalprovocationornasalchallengetestsAllergicRhinitis(AR)DifferentialDiagnosis：1、vastomotorrhinitis2、nonallergicrhinitiswitheosinophiliasyndrome,3、coldair-inducingrhinitis4、hyperreflectoryrhinitis5、endocrinerhinitis6、acuterhinosinusitisAllergicRhinitis(AR)Complications：1、asthma2、allergicsinusitis,pharyngitis,laryngitis3、secretoryotitismedia4、sleepingdisordersAllergicRhinitis(AR)Treatment：1、Allergenavoidance2、Drugs1）Antihistamines2）Corticosteroids3）Vasoconstrictorsympsthomimetics4）Anticholinergicagents5）Sodiumcromoglycate(SCG)Cromolynsodium3、Hyposensitization4、Others：TraditionalChinesemedicine,

laser,operation

educationAllergicRhinitis(AR)轻度间歇性轻度持续性中/重度间歇性中/重度持续性避免接触变应原免疫治疗

鼻用

(<10days)或口服减冲剂色甘酸钠口服或鼻用无嗜睡作用抗组胺过敏性鼻炎的治疗

(ARIA)鼻用激素NasalPolyp&NasalPolyposis慢性鼻-鼻窦炎的分型CRS分成伴有鼻息肉的CRS和不伴鼻息肉伴有鼻息肉的CRS(CRSwNP)20％不伴鼻息肉的CRS(CRSsNP)80%

Etiology：multi-factors:

-micro-environmentaltheoryofmiddlemeatus-allergic-aspirinsensitive-chronicinflammationNasalPolyp&NasalPolyposisPathology：-highlyswelledconnectivetissue.-Predominanteosinophiliccellsinfiltrate.-Lymphaticcells,-neutrophils,-basophils,-mastcells.NasalPolyp&NasalPolyposisSymptom