Download Free Medical Nonallergic Rhinitis and Acute and Chronic Sinusitis PowerPoint Presentation

Nonallergic Rhinitis and Acute and Chronic Sinusitis PowerPoint Presentation

DOWNLOAD MEDICAL POWERPOINT PRESENTATION

About This Presentation

Description : Check out this medical presentation on Influenza (Flu), which is titled "Nonallergic Rhinitis & Acute and Chronic Sinusitis", to know about Nonallergic Rhinitis and Acute and Chronic Sinusitis.

Tags : Influenza, Flu, Nonallergic Rhinitis, Acute and Chronic Sinusitis

Published on : Jul 12, 2021 | Views : 2270 | Downloads : 0

Shareable Url :

Embed Code :

Comment

Transcript

Slide 1-

Nonallergic Rhinitis (Ch.46) Acute and Chronic Sinusitis (Ch. 47) Marilene B. Wang, MD, FACS Professor UCLA Department of Head Neck Surgery Chief of Otolaryngology VA Greater Los Angeles Healthcare System
Slide 2-

1. Nonallergic rhinitis Is more common in males Incidence increases with age May occur in conjunction with allergic rhinitis B and c All of the above
Slide 3-

2. Innervation of the nasal mucosa Parasympathetic nerves are the primary component of the efferent nasal reflex arc. Parasympathetic nerves release vasoactive intestinal peptide Parasympathetic nerves cause nasal decongestion C fibers are efferent nerves that react to pain, changes in temperature, osmolarity and irritants. All of the above
Slide 4-

3. Nasal provocation testing Can differentiate between allergic and non-allergic rhinitis Done with histamine is specifically for allergic rhinitis Done with capsaicin is specifically for nonallergic rhinitis Done with histamine causes decreased vascular permeability, sneezing, and nasal obstruction Done with methacholine leads to increased rhinorhea
Slide 5-

4. Nonallergic rhinitis with eosinophilia Occurs in response to common allergens such as dust, pollen, mold Symptoms are exacerbated by weather changes Occurs in over half of patients with nonallergic rhinitis Involves mast cells and Ig-A positive cells in the nasal mucosa Does not occur with nasal polyps
Slide 6-

5. Rhinitis of pregnancy Occurs more frequently in pregnant women who smoke Affects the majority of pregnant women Occurs in response to estrogen-induced vascular smooth muscle relaxation Severity of symptoms parallels blood progesterone levels All of the above
Slide 7-

6. Medication-induced rhinitis can be found from use of the following medications: Aspirin Oral contraceptives Amitryptiline Hydralazine All of the above
Slide 8-

7. Atrophic rhinitis Is most commonly associated with infection from Klebsiella pneumoniae Can occur after aggressive nasal surgery Is most common in young adults Results in changes in nasal mucosa from squamous epithelium to ciliated respiratory epithelium Can be treated effectively with antibiotics
Slide 9-

8. Idiopathic rhinitis Is also known as vasomotor rhinitis Occurs rarely Involves autonomic nervous system dysfunction A and c All of the above
Slide 10-

9. Diagnosing nonallergic rhinitis Requires a thorough history Requires acoustic rhinomatry Requires a sinus CT scan All of the above None of the above
Slide 11-

10. Treatment of nonallergic rhinitis a. May include nasal steroids, antihistamines, and anticholinergics b. Septoplasty and/or turbinate reduction may be of benefit c. Vidian neurectomy can provide relief of rhinorrhea d. A and c e. All of the above
Slide 12-

Acute and Chronic Sinusitis 12
Slide 13-

Major Healthcare Problem Problem One of most common healthcare problems in U.S. Over 31 million Americans affected annually 18-22 million physician office visits annually
Slide 14-

Definition of rhinosinusitis Group of disorders characterized by inflammation of the mucosa of the nose and paranasal sinuses Acute, subacute, chronic
Slide 15-

ppt slide no 15 content not found
Slide 16-

Paranasal Sinus Function Lining – pseudostratified ciliated columnar epithelium Mucous and serosanguinous glands Parasympathetic and sympathetic innervation
Slide 17-

Paranasal Sinus Function Mucous blanket renewed every 10-15 minutes Warm and humidify air Secrete immunoglobulins, interferons, inflammatory cells
Slide 18-

Paranasal Sinus Function Cilia beat 10-15 times/second Cilia function varies with environment, allergies, etc. Mucociliary system—cleanse sinus, immunoprotective Move mucous to natural ostia of sinuses
Slide 19-

ppt slide no 19 content not found
Slide 20-

Rhinosinusitis-Major factors Facial pain/pressure Nasal obstruction/blockage Nasal discharge/purulence/discolored postnasal drip
Slide 21-

Rhinosinusitis-Major factors Hyposmia/anosmia Purulence in nasal cavity on examination Fever (acute rhinosinusitis only)
Slide 22-

Rhinosinusitis-Minor factors Headache Fever Halitosis Fatigue
Slide 23-

Rhinosinusitis-Minor factors Dental pain Cough Ear pain/pressure/fullness
Slide 24-

Categories of Rhinosinusitis Acute Subacute Chronic Recurrent, acute Acute exacerbations of chronic
Slide 25-

Acute Rhinosinusitis Duration up to 4 weeks > 2 major factors 1 major factor + 2 minor factors Nasal purulence on exam
Slide 26-

Subacute Rhinosinusitis Duration 4-12 weeks >2 major factors 1 major factor + 2 minor factors, or nasal purulence on exam Complete resolution after effective medical therapy
Slide 27-

Chronic Rhinosinusitis Duration > 12 weeks History same as for subacute Facial pain does not constitute suggestive history in absence of other nasal symptoms or signs
Slide 28-

Recurrent acute >4 episodes/year + each episode last >7-10 days. Absence of intervening signs of chronic rhinosinusitis
Slide 29-

Acute exacerbations of chronic Sudden worsening of chronic rhinosinusitis Return to baseline after treatment
Slide 30-

Factors Associated with Chronic Rhinosinusitis Allergies Immunodeficiency Genetic/congenital
Slide 31-

Factors Associated with Chronic Rhinosinusitis Endocrine Neural
Slide 32-

Factors Associated with Chronic Rhinosinusitis Anatomic Neoplastic Acquired mucociliary dysfunction
Slide 33-

Associated Factors Microorganisms—viral, bacterial, fungal Noxious chemicals, pollutants, smoke Medications Trauma Surgery
Slide 34-

Microbiology of acute sinusitis (adults) S. pneum (20-43%) H. influenzae (22-35%) Strep spp. (3-9%) Anaerobes (0-9%) M. catarrhalis (2-10%) S. aureus (0-8%) Other (4%)
Slide 35-

Microbiology of acute sinusitis (children) S. pneum (25-30%) H. influenzae (15-20%) M. catarrhalis (15-20%) S. pyogenes (2-5%) Anaerobes (2-5%) Sterile (20-35%)
Slide 36-

Recommended abx for adults with acute bacterial rhinosinusitis Mild disease with no recent antimicrobial use Augmentin, Amoxicillin Vantin Ceclor Omnicef
Slide 37-

Switch if no improvement after 72 hours Tequin, Levaquin, Avelox Augmentin Combination (Amox or clinda + Suprax)
Slide 38-

Abx for acute sinusitis if PCN-allergic Bactrim Doxycycline Zithromax, Biaxin, Erythromycin Switch to quinolone if no improvement in 72 hours
Slide 39-

If recent abx use Quinolone Augmentin Clindamcin + rifampin Consider IV abx
Slide 40-

Abx for acute sinusitis in children Augmentin, Amoxicillin Vantin Ceclor Omnicef Switch if no improvement after 72 hours
Slide 41-

If PCN-allergic Bactrim Macrolide
Slide 42-

If recent abx use (children) Augmentin Rocephin Bactrim, macrolide Consider IV abx if no improvement
Slide 43-

Other symptomatic therapies Afrin for 3 days Normal saline sprays Decongestants Antihistamines ?Steroids
Slide 44-

Complications of sinusitis Periorbital cellulitis Preseptal cellulitis/abscess Orbital cellulitis Orbital abscess Cavernous sinus thrombosis
Slide 45-

Chronic rhinosinusitis Antibiotics Antihistamines Nasal steroids Normal saline irrigations Allergy evaluation +/- immunotherapy
Slide 46-

Chronic rhinosinusitis Sinus CT scan Consider anatomic factors—septal deviation, nasal polyps, concha bullosa, ostio-meatal blockage
Slide 47-

Indications for sinus surgery Nasal polyposis Anatomic blockage—deviated septum, enlarged turbinate, concha bullosa Mucocele Orbital abscess
Slide 48-

Indications for sinus surgery Fungal sinusitis—allergic vs. invasive (mucor) Tumor of nasal cavity or sinus
Slide 49-

Indications for sinus surgery Chronic, recurrent sinusitis Failure to respond to maximal medical therapy Obtain cultures
Slide 50-

ppt slide no 50 content not found
Slide 51-

ppt slide no 51 content not found
Slide 52-

ppt slide no 52 content not found
Slide 53-

ppt slide no 53 content not found
Slide 54-

ppt slide no 54 content not found
Slide 55-

ppt slide no 55 content not found
Slide 56-

ppt slide no 56 content not found
Slide 57-

ppt slide no 57 content not found
Slide 58-

ppt slide no 58 content not found
Slide 59-

ppt slide no 59 content not found
Slide 60-

ppt slide no 60 content not found
Slide 61-

ppt slide no 61 content not found
Slide 62-

Long-term management May be a lifelong disease Allergy control—antiihistamines, nasal steroids, immunotherapy Oral steroids—judiciously Antibiotics for acute exacerbations
Slide 63-

Long-term management Environmental control—avoid carpet, damp, mold, older homes, smog Saline irrigations
Slide 64-

Long-term management Alternative therapies—acupuncture, stress management, herbal remedies Pain management Multi-disciplinary effort—work with allergy, infectious disease, neurology/pain management services