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1、Inflammtory diseases of nasal cavityDepartment of Otolaryngology, Affiliated Ninth People s Hospital of Shanghai Jiaotong University, School of Medicine Wang PeihuaChronic rhinitischronic rhinitischronic rhinitis 4 weeks4 weekscause of disease: : 1. systemic factors:systemic dieases, malnutrition, e
2、ndocrine disturbance, immunodeficiency 2. local factor: acute rhinitis, nasal sinusitis, anatomic abnormalities, some naristillaes 3. occupational and environmental factorsChronic rhinitischronic simple rhinitis Inflammatory cell infiltration without mucosal hyperplasia chronic hypertrophic rhinitis
3、 mucosal and submucosal extensive fibroplasiaChronic rhinitisSymptoms of chronic simple rhinitisSymptoms of chronic simple rhinitis : :1.1.Nasal obstruction: intermittent, Nasal obstruction: intermittent, alternativealternative2.2.Nasal discharge: mucusNasal discharge: mucus，mucopurulencemucopurulen
4、ce3.3.Others Others Examination :Examination :1.1.Mucous hyperemia, swelling of inferior Mucous hyperemia, swelling of inferior turbinate, sensitive to turbinate, sensitive to amidephrineamidephrine2.2.Viscous nasal dischargeViscous nasal discharge Chronic rhinitisTreatmentTreatment: remove the caus
5、es of : remove the causes of dieasesdieases, , recuperate ventilation of nasal cavity.recuperate ventilation of nasal cavity. 1 1. . etilogicaletilogical treatment treatment 2 2. local treatment. local treatment (1)(1)amidephrineamidephrine (2) (2)block therapyblock therapy (3) (3)acupuncture therap
6、yacupuncture therapy ( (4)Chinese medicine4)Chinese medicineChronic rhinitisSymptoms of chronic hypertrophic rhinitisSymptoms of chronic hypertrophic rhinitis1.1.Nasal obstruction: persistentNasal obstruction: persistent2.2.Nasal discharge: mucusNasal discharge: mucus，mucopurulence(notmucopurulence(
7、not too much) too much)3.3.Closed Closed rhinolaliarhinolalia, tinnitus, headache, dizziness, tinnitus, headache, dizziness Examination :Examination :1.1.Nasal Nasal mucomembranousmucomembranous thickening and hyperplasia, thickening and hyperplasia, 2.2.Swelling of inferior turbinate and turbinate
8、bone, Swelling of inferior turbinate and turbinate bone, insensitive to insensitive to amidephrineamidephrineTreatment:Treatment: 1. Conservative therapy -1. Conservative therapy -sclerosingsclerosing agent, laser and agent, laser and microwave.microwave.2. partial inferior 2. partial inferior turbi
9、nectomyturbinectomyMain points of identificationMain points of identification鼻塞鼻塞鼻塞鼻塞 间歇性（冬季、夜间、静坐时明显，间歇性（冬季、夜间、静坐时明显，间歇性（冬季、夜间、静坐时明显，间歇性（冬季、夜间、静坐时明显，持续性持续性持续性持续性 夏季白天、运动时减轻或消失）；夏季白天、运动时减轻或消失）；夏季白天、运动时减轻或消失）；夏季白天、运动时减轻或消失）；两侧交替性两侧交替性两侧交替性两侧交替性 鼻涕鼻涕鼻涕鼻涕 略多，粘液性略多，粘液性略多，粘液性略多，粘液性 多，粘液性或粘脓性，不易擤出多，粘液性或粘脓
10、性，不易擤出多，粘液性或粘脓性，不易擤出多，粘液性或粘脓性，不易擤出 嗅觉减退嗅觉减退嗅觉减退嗅觉减退 不明显不明显不明显不明显可有可有可有可有 闭塞性鼻音闭塞性鼻音闭塞性鼻音闭塞性鼻音无无无无有有有有头痛、头昏头痛、头昏头痛、头昏头痛、头昏可有可有可有可有常有常有常有常有咽干、咽痛咽干、咽痛咽干、咽痛咽干、咽痛可有可有可有可有常有常有常有常有耳鸣、耳闭塞感耳鸣、耳闭塞感耳鸣、耳闭塞感耳鸣、耳闭塞感无无无无可有可有可有可有前鼻孔镜所见前鼻孔镜所见前鼻孔镜所见前鼻孔镜所见下鼻甲粘膜肿胀表面光滑，暗红色下鼻甲粘膜肿胀表面光滑，暗红色下鼻甲粘膜肿胀表面光滑，暗红色下鼻甲粘膜肿胀表面光滑，暗红色 下鼻
11、甲粘膜肥厚暗红色，表面光下鼻甲粘膜肥厚暗红色，表面光下鼻甲粘膜肥厚暗红色，表面光下鼻甲粘膜肥厚暗红色，表面光 滑或不平，或呈结节状、桑椹状滑或不平，或呈结节状、桑椹状滑或不平，或呈结节状、桑椹状滑或不平，或呈结节状、桑椹状或分叶状，鼻甲骨可肥大或分叶状，鼻甲骨可肥大或分叶状，鼻甲骨可肥大或分叶状，鼻甲骨可肥大下鼻甲探针触诊下鼻甲探针触诊下鼻甲探针触诊下鼻甲探针触诊柔软，有弹性，轻压时有凹陷，探针柔软，有弹性，轻压时有凹陷，探针柔软，有弹性，轻压时有凹陷，探针柔软，有弹性，轻压时有凹陷，探针有硬实感，轻压时无凹陷，但不有硬实感，轻压时无凹陷，但不有硬实感，轻压时无凹陷，但不有硬实感，轻压时无凹陷
12、，但不移去后立即恢复移去后立即恢复移去后立即恢复移去后立即恢复立即恢复立即恢复立即恢复立即恢复对对对对1 12 2麻黄麻黄麻黄麻黄粘膜收缩明显，下鼻甲缩小粘膜收缩明显，下鼻甲缩小粘膜收缩明显，下鼻甲缩小粘膜收缩明显，下鼻甲缩小粘膜不收缩或轻微收缩，下鼻甲粘膜不收缩或轻微收缩，下鼻甲粘膜不收缩或轻微收缩，下鼻甲粘膜不收缩或轻微收缩，下鼻甲素的反应素的反应素的反应素的反应大小无明显改变大小无明显改变大小无明显改变大小无明显改变治疗治疗治疗治疗非手术治疗非手术治疗非手术治疗非手术治疗一般宜手术治疗一般宜手术治疗一般宜手术治疗一般宜手术治疗 慢性单纯性鼻炎慢性单纯性鼻炎慢性肥厚性鼻炎慢性肥厚性鼻炎 A
13、llergic rhinitisAllergic rhinitisAllergic disorder of nasal mucosa. Allergic disorder of nasal mucosa. Allergic disorder of nasal mucosa. Allergic disorder of nasal mucosa. RhinocnesmusRhinocnesmusRhinocnesmusRhinocnesmus, , , , sneezingsneezingsneezingsneezing, , , , hypersecretionhypersecretionhyp
14、ersecretionhypersecretion, swelling , swelling , swelling , swelling and distension of nasal mucosa.and distension of nasal mucosa.and distension of nasal mucosa.and distension of nasal mucosa.Development of allergic rhinitis is correlated Development of allergic rhinitis is correlated Development o
15、f allergic rhinitis is correlated Development of allergic rhinitis is correlated with heredity and environment. with heredity and environment. with heredity and environment. with heredity and environment. internal cause: internal cause: atopyatopy. . external cause: indoor/outdoor contaminants. exte
16、rnal cause: indoor/outdoor contaminants. external cause: indoor/outdoor contaminants. external cause: indoor/outdoor contaminants. Pathogenesis :Pathogenesis :Pathogenesis :Pathogenesis : Type I allergic reaction which has Type I allergic reaction which has Type I allergic reaction which has Type I
17、allergic reaction which has correlation with cytokines, correlation with cytokines, correlation with cytokines, correlation with cytokines, intercellular intercellular intercellular intercellular adhesion molecule-1adhesion molecule-1adhesion molecule-1adhesion molecule-1, , , , neuropeptideneuropep
18、tideneuropeptideneuropeptide. . . .ARIA Classification 季节性季节性 常年性常年性 间歇性间歇性 间歇性间歇性 持续性持续性 持续性持续性 中重度中重度 轻度轻度 中重度中重度 轻度轻度 中重度中重度 轻度轻度 中重度中重度 轻度轻度Lanzhou Conference，2004Main kind of allergens：DermatophagoidesDermatophagoidesDermatophagoidesDermatophagoides pteronyssinuspteronyssinuspteronyssinuspteron
19、yssinus and and and and its dead body, spawn, dischargeits dead body, spawn, dischargeits dead body, spawn, dischargeits dead body, spawn, dischargePollens, fungal sporesPollens, fungal sporesPollens, fungal sporesPollens, fungal sporesExuviae and feathers of animalsFoods Foods Foods Foods Chemical
20、substanceChemical substanceChemical substanceChemical substanceAllergic rhinitis -cascade reactionAllergic rhinitis -cascade reactionClin Drug Invest 2005; 25 (3): 153-164Allergic rhinitisClinical manifestationClinical manifestationSymptomsSymptoms： sneezing, nasal discharge, sneezing, nasal dischar
21、ge, rhinocnesmusrhinocnesmus, nasal obstruction , nasal obstruction Allergic Salute Allergic Salute（Linea Linea NasalisNasalis） Allergic Shiner Allergic ShinerExaminationExamination：nasal mucosal nasal mucosal edema(palloredema(pallor, gray-, gray-blue, blue, kermesinuskermesinus) ) Secretions(Secre
22、tions(serosityserosity or or seromucusseromucus) ) Swelling of inferior turbinateSwelling of inferior turbinate HyposmiaHyposmia Itching of eye, palate, earItching of eye, palate, earAllergic rhinitis1.1.Specific skin tests:Specific skin tests: Prick Test & Prick Test & IntracutaneousIntracutaneous
23、Test Test2. Nasal Provocation Test 2. Nasal Provocation Test ：Identify allergenIdentify allergenAfford supports to skin testAfford supports to skin testTest one allergen for one time Test one allergen for one time Potential riskPotential risk Allergic rhinitisTreatment To advoid allergensPharmacothe
24、rapyImmunotherapyOthers:laser, radiofrequency ablation , surgery and so on. Treatment to AR (ARIA)PharmacotherapyLocal application of corticosteroid hormone is the first choice（WHO 1994 2001 WHO 1994 2001 WHO 1994 2001 WHO 1994 2001 ） e.g.e.g. BeclometasoneBeclometasone DipropionateDipropionate, , f
25、luticasonefluticasone, , budesonidebudesonide, , momestasonemomestasone furoatefuroate. . combinationcombination：antihistaminicsantihistaminics, , peroralperoral corticosteroids, corticosteroids, mastocytemastocyte inhibitor, inhibitor, antileukotrieneantileukotriene Directions of corticosteroid nas
26、al spray:Directions of corticosteroid nasal spray:persistent ARpersistent AR：decrease progressively to minimum decrease progressively to minimum maintenance dosemaintenance doseintermittent ARintermittent AR：use it 1 month before the period of use it 1 month before the period of onset, for 3-4 years
27、.onset, for 3-4 years. coryzacoryza professionalisprofessionalis：long-term uselong-term useCauses of treatment failure: anatomic abnormality, sinusitis, polyps, fugus and so on.Effect to rhinitisEffect to rhinitis喷嚏喷嚏喷嚏喷嚏流涕流涕流涕流涕鼻塞鼻塞鼻塞鼻塞鼻痒鼻痒鼻痒鼻痒眼症状眼症状眼症状眼症状鼻内色酮鼻内色酮鼻内色酮鼻内色酮口服减充血药口服减充血药口服减充血药口服减充血药鼻内减
28、充血药鼻内减充血药鼻内减充血药鼻内减充血药抗胆碱能药抗胆碱能药抗胆碱能药抗胆碱能药抗白三烯药抗白三烯药抗白三烯药抗白三烯药口服口服口服口服H1H1抗组胺抗组胺抗组胺抗组胺药药药药鼻内鼻内鼻内鼻内H1H1抗组胺抗组胺抗组胺抗组胺药药药药鼻内糖皮质激素鼻内糖皮质激素鼻内糖皮质激素鼻内糖皮质激素Van Cawenberge P, et al.Eropean Academy of Allergology and Clinical Immnology. Allergy, 2000;55(2):p116-34Immunotherapy Immunotherapy Indication :ARIA mult
29、istep therapy (、 grade)MethodMethod：1.1.Specific allergic vaccines, Specific allergic vaccines, allergic allergic ploypeptideploypeptide vaccines, vaccines, research on allergic generesearch on allergic gene2.2.Non-specific Non-specific immunotherapy(Timmunotherapy(T cell cell and cytokines)and cyto
30、kines) vasomotor rhinitisvasomotor rhinitis Nonspecific stimulus induced Nonspecific stimulus induced neurogenicneurogenic inflammation of nasal mucosa.inflammation of nasal mucosa.Cause of disease: mental stress, anxiety, Cause of disease: mental stress, anxiety, change of environment temperature,
31、change of environment temperature, endocrine disorderendocrine disorderPathologyPathology: : neurogenicneurogenic inflammation mediated inflammation mediated by neurotransmitters.by neurotransmitters.vasomotor rhinitisClinical manifestation: similar with Clinical manifestation: similar with AR.AR.Na
32、sal obstructionNasal obstructionSneezing Sneezing RhinorrheaRhinorrheavasomotor rhinitisExamination : Examination : Chronic congestion of nasal mucosa, dark red or pallor.Diagnosis :Diagnosis : 1. nasal symptom 1h1. nasal symptom 1h 2. skin test (-)2. skin test (-) 3. 3. nasal smear: nasal smear: eo
33、sinophileeosinophile granulocyte granulocyte / / neutrophilicneutrophilic granulocyte(-) granulocyte(-) 4. eliminate 4. eliminate medicamentousmedicamentous rhinitis rhinitisvasomotor rhinitisTreatmentChief method: pharmacotherapy. Nasal mucosal edema and severe sneezing-Nasal mucosal edema and seve
34、re sneezing-antihistaminicsantihistaminicsNasal obstructiondecongestant Nasal obstructiondecongestant naristillaenaristillae corticosteroid nasal spray corticosteroid nasal sprayNNasal asal serous serous dischargedischargeanticholinergicsanticholinergics e.g. 0.03e.g. 0.03 ipratropiumipratropium bromide bromideSensitive Sensitive to to temperature temperature and and dust/sneezing dust/sneezing frequently-laser, frequently-laser, radiofrequency radiofrequency ablation ablation , , microwaves and so onmicrowaves and so on
