过敏性鼻炎的诊断和治疗学习资料课件.ppt

1、Nasal mucosal hyperreactive rhinopathyAllergic 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.MiteMoldPollenCatAntigens for allergic rhinit

2、is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变应原与致敏靶细胞表面IgEIgE结合结合致敏靶细胞脱粒、释放、合成生物活性介质致敏靶细胞脱粒、释放、合成生物活性介质肥大细胞肥大细胞储备的介质储备的介质新合成的介质新合成的介质组胺组胺缓激肽缓激肽白三烯白三烯血小板活化因子血小板活化因子 前列腺素前列腺素D D2毛细血管扩张、通透性增加，腺体分泌增多毛细血管扩张、通透性增加，腺体分泌增多 嗜酸嗜酸/碱性粒细胞碱性

3、粒细胞哮喘鼻炎鼻炎发病机制发病机制Pathology：Type allergy Allergic inflammation:Predominant T cells&eosinophilic cells infiltrate.Symptoms&Signs：Nasal irritation and ichingrecurrent attacks of paroxysmal sneezing copious watery rhinorrheanasal obstruction鼻后滴漏鼻后滴漏Diagnosis：1、History（allergen exposure,hypersensitivity,

4、family history）2、Examination3、Skin test:skin prick test 4、IgE antibody，Serum total IgE、special IgE5、Nasal provocation or nasal chanllenge testsDifferential Diagnosis：1、Vastomotor rhinitis 2、Nonallergic rhinitis with eosinophilia syndrome,NARES3、Hyperreflectory rhinitis4、Acute rhinitisComplications：1

5、、Allergic sinusitis2、Asthma3、Secretory otitis media 4、Allergic pharyngolaryngitisTreatment：1、Avoidance2、Drugs1）Antihistamines2）Corticosteroids3）Sodium cromoglycate(SCG)Cromolyn sodium4）Anticholinergic agents5）Vasoconstrictor sympasthomimetics3、Hyposensitization4、Others：Traditional Chinese medicine,l

6、aser,operationNasal Polyp&Nasal PolyposisEtiology：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：pe

7、rsistent nasal obstruction，close nasal sound，hyposmia,rhinorrhea,snore,“frog nose”Antrochoanal polypAntrochoanal polypDiagnosis：Anterior rhinoscopy：translucent,soft,smooth masses.Endoscopy,X-ray and CT scanner.Differential Diagnosis：Papilloma inverted，angiofibroma of nasopharynx，malignant tumor of n

8、asal cavity，meningoencephaloceleTreatment：1、conservative treatmentcorticosteroids 2、surgical treatmentPolyps（above），papilloma（below）papilloma（L），MT of nasal cavity（R）SinusitisAcute suppurative sinusitisFeatures of sinus anatomy：1、small ostia of the sinuses；2、continuative mucosa between nasal cavity

9、and sinuses；3、contiguous of the ostia；4、location of the astia and features of the sinuses.Frontal Sinus Ethmoid SinusMaxillary SinusEtiology：1、General factors:Poor general health(influenza,measles,whooping cough)2、Local factors：Sinus diseases；Infective focus of eripheral organs，Direct infection；Nasa

10、l 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 catarrhalisOther streptococci 3-9%2-10%S.pneumoniae成人Acute bacterial rhinosinusit

11、is(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主要病原体：肺炎链球菌、嗜血流感杆菌和卡他莫拉菌H.influenzae15-20%S.pneum 25-30%Sterile 20-35%Anaerobes 2-5%S.pyogenes 2-5%M.catarrhalis15-20%Otolaryngol Head Neck Surg.2004;130:1-45.Symptoms&Signs：General symptoms：Malaise,fever.Local sy

12、mptoms:1）Nasal obstruction sustained,with hyposmia2）Suppurative rhinorrhea,streaky with blood,foul smell(odontogentic)3）headach or local acheAntral painfrom inner canthus downwards across the cheek,upper alveolus on the affected side.Ethmoidal painover bridge of the nose&inner canthus behind the eye

13、.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 sinusTre

14、atment：Eradicate causes，keep drainage；control infection and prevent complications1、General treatment：take rest，antibiotics，antihistamine(if necessary)2、Local treatment3、Body drainage4、Physical therapy5、Puncture and irrigation of maxillary sinusMaxillary sinus puncture and irragationChronic suppurati

15、ve sinusitisEtiology：AcuteChronicSymptoms&Signs：General:Local：rhinorrhea,nasal obstruction,headache,hyposmia,vision disorderDiagnosis：1、History；2、Examination：anterior rhinoscopy,nasal endoscopy3、Radiological examination：CT or MRI4、Puncture and irrigation of sinusNormal image of nasal endoscopyMaxill

16、ary sinusitispus in the middle meatus Maxillary sinusitis(R)Sphenoid sinusitispus in the sphenoethmoidal recessSphenoid sinusitisPansinusitisPansinusitisTreatment：1、Intranasal medications：Corticosteroid，Vasoconstrictor sympasthomimetics 2、Puncture and irrigation of maxillary sinus 3、Displacement met

17、hodfrontal sinusitis,ethmoidal sinusitis,sphenoidal sinusitis,pansinusitis 4、Surgerytraditional sinus surgeryFunctional Endoscopic Sinus Surgery(FESS)Ostiometal complex OMCFunctional Endoscopic Sinus Surgery(FESS)复习与思考：复习与思考：1、鼻腔外侧壁的解剖结构及其与临床的关系如何？2、变应性鼻炎有何临床表现，应与哪些疾病相鉴别？3、如何诊断鼻窦炎？4、鼻息肉应与哪些疾病相鉴别?5、上颌窦穿刺术有何临床意义？