Non Allergic Rhinitis Prof. BAFAQEEH

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Non Allergic Rhinitis Prof. BAFAQEEH Powered By Docstoc
					            Non Allergic Rhinitis

                 Prof. Sameer Bafaqeeh, M.D.
                      University Professor
                  in Rhinology & Rhinoplasty



5/16/2012           Professor Sameer Bafaqeeh   1
5/16/2012   Professor Sameer Bafaqeeh   2
            Vasomotor Rhinitis

             Symptoms :
              as Perennial Allergic Rhinitis
             Paroxsysmal course

             Local Finding:
              Livid, pale nasal mucosa.
               Profuse watery secretion
               Nasal turbinates swollen

5/16/2012          Professor Sameer Bafaqeeh   3
            Vasomotor Rhinitis
            Pathogenesis
               Neurovascular
                disorder
               No specific
                antibodies
               Nonspecific
                reflex
                hypersensitivity
               Caused by
                various
                influences

5/16/2012            Professor Sameer Bafaqeeh   4
            Vasomotor Rhinitis
            Pathogenesis
               Change of temperature or humidity
               Alcohol , dust, smoke, mechanical
                irritation, stress, anxiety neurosis,
                endocrine disorders, rhinitis of
                pregnancy.
               Drugs: (e.g., antihypertensive agents
                as reserpine or beta-blockers, oral
                contraceptives)
               Drug abuse: (imidazoline & catechol
                derivatives, clomethiazole, etc.)

5/16/2012            Professor Sameer Bafaqeeh      5
            Vasomotor Rhinitis
            Diagnosis


               Typical history
               Negative
                allergen tests
               No elevated IgE
                in the secretion




5/16/2012            Professor Sameer Bafaqeeh   6
            Vasomotor Rhinitis
            Differential diagnosis
               Allergic Rhinitis

               Foreign body in the Nose

               Common Cold




5/16/2012            Professor Sameer Bafaqeeh   7
            Vasomotor Rhinitis
            Conservative Tretment
               Elimination of irritant factors
               Antihistamines
               Nasal decongestant drops
               Oral decongestant drugs
               Steroids (e.g.,
                beclomethasone)
               Metabolic & endocrine
                systems
               Sedatives
               Imidazoline preparations
                 (Potential for habituation)

5/16/2012              Professor Sameer Bafaqeeh   8
            Vasomotor Rhinitis
            Surgical Treatment
             Turbinate surgery
              Electrocautery,cry
              osurgery, laser
             Correction of
              anatomical
              deformity
             Conchotomy
             Parasympathetic
              nasal fibers
              divisions
             (Pterygoid canal n.,
              vidian n., greater
              petrosal n.)
              M.C.F.
5/16/2012            Professor Sameer Bafaqeeh   9
            Vasomotor Rhinitis
            Prognosis
               Uncertain

               Suddenly
                improves

               Resistant to
                treatment



5/16/2012            Professor Sameer Bafaqeeh   10
            Rhinitis Sicca Anterior
            Symptoms

               Dryness
               Irritation
               Crusts
                formation
               Nasal bleeding


5/16/2012           Professor Sameer Bafaqeeh   11
            Rhinitis Sicca Anterior
            Pathogenesis
               Anterior nasal mucosa injury
               Dust
               Nose picking
               Extremes of temperature




5/16/2012           Professor Sameer Bafaqeeh   12
            Rhinitis Sicca Anterior
            Diagnosis
               Nasal septum is dry
               Mucosal surface is:
                Raw, roughened, & granular.
               Crustation ulceration
                Septal perforation




5/16/2012           Professor Sameer Bafaqeeh   13
            Rhinitis Sicca Anterior
            Differential Diagnosis
                Chemical injury
                  (Chromium workers)
                Iatrogenic septal
                 perforation
                Trauma
                Lupus
                Leprosy
                syphilis
5/16/2012          Professor Sameer Bafaqeeh   14
            Rhinitis Sicca Anterior
            Treatment


               Nasal ointments
               Septal
                perforation
                closure




5/16/2012            Professor Sameer Bafaqeeh   15
            Chronic Rhinitis


               Irritation Or Inflammation
               Hypertrophied Nasal
                Mucosa
               Hyperemia & edema
               True tissue hypertrophy



5/16/2012           Professor Sameer Bafaqeeh   16
            Chronic Rhinitis
            SYMPTOMS
               Nasal obstruction
               Tough, Stringy, Colorless
                secretions (rarely purulent)
               Post nasal catarrh
               Rhinolalia clausa &Epiphora
               2nd dacryocystitis
               2nd pharyngitis

5/16/2012           Professor Sameer Bafaqeeh   17
            Chronic Rhinitis
            SYMPTOMS
               Fatigue ,sleeplessness
               Unsteady or woozy feeling
               Headache
               Feeling of pressure in the head

               Psychological & physical well-
                being loss

5/16/2012            Professor Sameer Bafaqeeh    18
            Chronic Rhinitis
            Pathogenesis
               Recurrent inflammation
               Sinusitis
               Enlarged adenoid
               Nasopharyngeal tumor
               VMR & Side effects of drugs
               Tobacco, smoke, dust, chemicals, acquired
                toxins, temperature extremes , humidity
               Pregnancy, menstruation, menopause
               Endocrine disturbances
               Heart &circulatory diseases
               Infective allergy “late-type allergy”
5/16/2012             Professor Sameer Bafaqeeh         19
            Chronic Rhinitis
            Diagnosis
               Long-standing disease
               History of toxins
               Dark red &bluish-violet swelling
                turbinate
               Narrowed or obstructed nasal
                cavity
               Nasal decongested

5/16/2012            Professor Sameer Bafaqeeh     20
            Chronic Rhinitis
            Diagnosis
                Granular nodular surface
                (Micro-polyps) nasal polypi




               Mulberry-like masses
5/16/2012            Professor Sameer Bafaqeeh   21
            Chronic Rhinitis
            Differential diagnosis
               Sinusitis
               Foreign bodies
               Specific infections
               Adenoidal hypertrophy
               wegener’s granuloma
               allergy
               Tumors

5/16/2012           Professor Sameer Bafaqeeh   22
            Chronic Rhinitis
            Conservative Treatment

               Treatment of etiological agents
               Drug overuse controlled
               Endocrinologic investigation
               Environment & occupation
               Symptomatic treatment by
                decongestant nose drops
                (Not in long term)
5/16/2012            Professor Sameer Bafaqeeh    23
            Chronic Rhinitis
            Surgical Treatment
              Reduction of the inferior turbinate by
               sclerosing agents, cryoprobe, or the
               laser.
             -Electrocoagulation multiple,
               localized scars in N.M.
             -Cryosurgerypartial obliteration
             -CO2 or argon lasermucosal scars
               (evaporation or coagulation)
             Turbinectomy or mucotomy
             turbinoplasty

5/16/2012           Professor Sameer Bafaqeeh       24
            Pregnancy Rhinitis


               Nasal swelling
                & obstruction
               2nd hafe of
                pregnancy
               Resolve after
                delivery



5/16/2012            Professor Sameer Bafaqeeh   25
            Rhinitis Medicamentosa

             Reversible or irreversible
              damaged mucosa caused by
              topically or systemically applied
              drugs:-
             Hyper-plastic Rhinitis

             Dryness of the nasal mucosa

             Toxic Rhinopathy



5/16/2012          Professor Sameer Bafaqeeh      26
            Rhinitis Medicamentosa
            Hyperplastic Rhinitis
                Mucosal swelling
               Acetylsalicylic acid
               Oral contraceptives
               Guanethidine , hydantoin ,
                estrogens, paraamino-salicylic acid,
                phenothiazine, rauwolfia
                preparations,
               Beta-blocking drugs
               Tetraethyl ammonium
5/16/2012             Professor Sameer Bafaqeeh        27
            Rhinitis Medicamentosa

                 Dryness of the Nasal Mucosa
               Atropine, belladonna preparatios
               Corticosteroids
               Imidazoline, or catecholamine
                derivatives




5/16/2012           Professor Sameer Bafaqeeh   28
            Rhinitis Medicamentosa
            Toxic Rhinopathy
                   #Vasoactive subsances
               Adrenalin or imidazoline derivatives
                as privine, nasivine...
               Habituation  R.M.
               Autonomic vascular regulation
                failure O mucosal damage
               Local or systemic decongestant
               Acute intoxication in infants
                & small children
5/16/2012            Professor Sameer Bafaqeeh         29
            Atrophic Rhinitis
            & Ozena
               Atrophic rhinitis+ foul smell
                = Ozena
               Mainly in women
               At puberty
               Flattened
                & broad Face


5/16/2012            Professor Sameer Bafaqeeh   30
            Atrophic Rhinitis
            clinical presentation
               Greenish–yellow or
                brownish-black crusts
               Wide nasal cavity
               Atrophic mucosa & dry:
               Subepithelial layer fibrosis
               Fetid secretion &crusts (Ozena)
               Anosmia & social problem
               Nasal obstruction
               Mucosal changes in ph., la., & tr.,

5/16/2012            Professor Sameer Bafaqeeh        31
            Atrophic Rhinitis
            Pathogenesis
               Unknown but is multifactorial
               Common in orientals than in whites than in
                blacks
               Geographic concentration
               Abnormally wide nasal cavity
               Mucosal atrophy& bony nasal skeleton.
               M.G. & S.N.F. degenerate
               Respiratory epith. sq. metaplasia
               Destroyed mucociliary cleaning system
               Bacterial proteolysis decomposed the thick
                & gluey secretions

5/16/2012             Professor Sameer Bafaqeeh          32
            2nd Atrophic Rhinitis


             Nasal Trauma
             Extensive surgery

             Occupational exposure to:-

             Glass, wood, asbestos, etc.




5/16/2012         Professor Sameer Bafaqeeh   33
            Atrophic Rhinitis
            Diagnosis
             Gluey, dry, greenish-yellow
              secretions & crusts
                 wide nasal cavity
              & very small turbinates
             Foul-smelling crusts in Ozena




5/16/2012         Professor Sameer Bafaqeeh   34
            Atrophic Rhinitis
            Differential Diagnosis
               Atrophic rhinitis with fetor (ozena)
               Tumors of the Nose & Sinuses
               Purulent Rhinitis & Sinusitis
               Rhinolith & foreign body
               Gumma due to stage III Syphilis
               Nasal diphtheria &Nasal
                Tuberculosis
               glanders
5/16/2012            Professor Sameer Bafaqeeh    35
            Atrophic Rhinitis
            Conservative Treatment
               Nasal douching
               Alkaline nasal lotion
               Greasy ointments
               Oily nasal drops, emulsions , or
                ointments, ?! Vitamin A
               Steam inhalations
               Osmotic Powders :Dextrose

5/16/2012            Professor Sameer Bafaqeeh     36
                Atrophic Rhinitis
                Operative Treatment

                Bolstering of the Nasal
                 Mucosa
                (Cartilage or Bone chips)

               Median Displacement of
                the lateral nasal wall by
                internal rotation of the
                mobilized lateral nasal wall
5/16/2012             Professor Sameer Bafaqeeh   37
            Nasal Diphtheria

               Children older than 6 months




5/16/2012           Professor Sameer Bafaqeeh   38
            Nasal Tuberculosis

             Lupus


                      Ulcerative
             Exudative
             mucosal Tuberculosis



5/16/2012        Professor Sameer Bafaqeeh   39
            Nasal Syphilis

               Stage 1 : infection from
                instruments
               Stage 11 : very rare
               Stage 111 : more common




5/16/2012           Professor Sameer Bafaqeeh   40
            Glanders

               Soso




5/16/2012          Professor Sameer Bafaqeeh   41
            Blastomycosis




5/16/2012        Professor Sameer Bafaqeeh   42
            Rhinosporidiosis




5/16/2012        Professor Sameer Bafaqeeh   43
            Other Mycoses




5/16/2012        Professor Sameer Bafaqeeh   44
            Wegener’s Granulomatosis




5/16/2012         Professor Sameer Bafaqeeh   45
            Lethal Midline Granuloma




5/16/2012        Professor Sameer Bafaqeeh   46
             The 3nd Riyadh
             Comprehensive International

             Rhinoplasty Course
             21 April – 24 April 2008
            King Saud University
              Hospitals
            -King Abdul-Aziz University Hospital
             4th Floor
            -King Kalid University Hospital
             Anatomy Department


               Prof. Sameer
               Bafaqeeh
            -Chairman of Organizing Committee
            -ENT Department
            -King Abdul-Aziz University Hospital




5/16/2012                         Professor Sameer Bafaqeeh   47

				
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