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OT24 Otolaryngology
Rhinosinusitis
Toronto Notes 2019
Diagnosis
• history
• directexam
• allergytesting
Treatment
• education:identificationandavoidanceofallergen
• nasalirrigationwithsaline
• antihistamines(e.g.diphenhydramine,fexofenadine)
• oraldecongestants(e.g.pseudoephedrine,phenylpropanolamine)
• topicaldecongestant(mayleadtorhinitismedicamentosa)
• othertopicals:steroids(fluticasone),disodiumcromoglycate,antihistamines,ipratropiumbromide • oralsteroidsifsevere
• desensitizationbyallergenimmunotherapy
Vasomotor Rhinitis
Definition
• neurovasculardisorderofnasalparasympatheticsystem(vidiannerve)affectingmucosalbloodvessels • nonspecificreflexhypersensitivityofnasalmucosa
Etiology
■ temperature change
■ alcohol, dust, smoke
■ stress, anxiety, neurosis
■ endocrine: hypothyroidism, pregnancy, menopause
■ parasympathomimetic drugs
■ beware of rhinitis medicamentosa: reactive vasodilation due to prolonged use (>5 d) of nasal drops
and sprays (Dristan®, Otrivin®)
Clinical Features
• chronicintermittentnasalobstruction,variesfromsidetoside • rhinorrhea: thin, watery
• mucosaandturbinates:swollen
• nasalallergymustberuledout
Treatment
• eliminationofirritantfactors
• parasympatheticblocker(Atrovent®nasalspray)
• steroids(e.g.beclomethasone,fluticasone)
• surgery(oftenoflimitedlastingbenefit):electrocautery,cryosurgery,lasertreatment,orremovalof
inferior or middle turbinates
• vidianneurectomy(rarelydone)
• symptomaticreliefwithexercise(increasedsympathetictone)
Rhinosinusitis
Definition
• inflammationofthemucosalliningofthesinusesandnasalpassages
Pathogenesis of Rhinosinusitis
• ostialobstructionordysfunctionalciliapermitstagnantmucousand,consequently,infection
• allsinusesdraintoacommonprechamberunderthemiddlemeatuscalledtheosteomeatalcomplex
Classification
• acute:<4wk
• subacute:4-8wk • chronic:>8-12wk