1、復旦大學耳鼻喉資料 MiteMoldPollenCatAntigens for allergic rhinitis變應性鼻炎的病因學 內在因素遺傳因素：有家族史者較無家族史者發病危險高倍母系第對染色體長臂段 外在因素（環境因素）：基因表達受非遺傳因素影響。對孿生兒，同時有AR 癥狀者為 易感個體在一定環境條件作用下才發病變應原與致敏靶細胞表面變應原與致敏靶細胞表面IgEIgE結合結合致敏靶細胞脫粒、釋放、合成生物活性介質致敏靶細胞脫粒、釋放、合成生物活性介質肥大細胞肥大細胞儲備的介質儲備的介質新合成的介質新合成的介質組胺組胺緩激肽緩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

2、 D2毛細血管擴張、通透性增加，腺體分泌增多毛細血管擴張、通透性增加，腺體分泌增多 嗜酸嗜酸/ /堿性粒細胞堿性粒細胞哮喘鼻炎鼻炎發病機制發病機制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

3、后滴漏鼻后滴漏Diagnosis：1、History（allergen exposure, hypersensitivity, 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 syndr

4、ome, NARES3、Hyperreflectory rhinitis4、Acute rhinitisComplications：1、Allergic sinusitis2、Asthma3、Secretory otitis media 4、Allergic pharyngolaryngitisTreatment：1、Avoidance2、Drugs1）Antihistamines2）Corticosteroids3）Sodium cromoglycate(SCG) Cromolyn sodium4）Anticholinergic agents5）Vasoconstrictor sympast

5、homimetics3、Hyposensitization4、Others：Traditional Chinese medicine, laser, operationNasal Polyp & Nasal PolyposisEtiology：mutilfactors 1.allergic；2.chronic inflammation Pathology：highly swelled connective tissue. Predominant eosinophilic cells infiltrate. Lymphatic cells, neutrophils, basophils, mas

6、t cells.Polyp in maxillary sinus（L），polyp in middle meatus（R）Symptoms & Sign：persistent 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.Dif

7、ferential Diagnosis： Papilloma inverted，angiofibroma of nasopharynx，malignant tumor of nasal cavity，meningoencephaloceleTreatment：1、conservative treatmentcorticosteroids 2、surgical treatmentPolyps（above），papilloma（below）papilloma（L），MT of nasal cavity （R）SinusitisAcute suppurative sinusitisFeatures

8、of sinus anatomy：1、small ostia of the sinuses； 2、continuative mucosa between nasal cavity 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

9、cough)2、Local factors：Sinus diseases；Infective focus of eripheral organs，Direct infection；Nasal tampon (packing)；Rapid change of atmospheric pressure ABS主要病原體：肺炎鏈球菌和嗜血流感桿菌主要病原體：肺炎鏈球菌和嗜血流感桿菌SAHP. Otolaryngol Head Neck Surg. 2004;130:1-45.20-43%22-35%Anaerobes 0-9%Staphylococcus aureus 0-8%Other bacte

10、ria 4%Moraxella catarrhalisOther streptococci 3-9%2-10%S. pneumoniae成人Acute bacterial rhinosinusitis (ABS)病因H. influenzae兒童Acute bacterial rhinosinusitis (ABS)病因ABS主要病原體：肺炎鏈球菌、嗜血流感桿菌和卡他莫拉菌主要病原體：肺炎鏈球菌、嗜血流感桿菌和卡他莫拉菌H.influenzae15-20%S.pneum 25-30%Sterile 20-35%Anaerobes 2-5%S.pyogenes 2-5%M.catarrhalis

11、15-20%Otolaryngol Head Neck Surg. 2004;130:1-45.Symptoms & Signs：General symptoms：Malaise, fever.Local symptoms: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

12、 cheek, upper alveolus on the affected side.Ethmoidal painover bridge of the nose & inner canthus behind the eye. 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：Hist

13、ory，Signs, Anterior rhinoscopy, Nasal endoscopy, Radiological examination, Puncture and irrigation of maxillary sinusTreatment：Eradicate causes，keep drainage；control infection and prevent complications1、General treatment：take rest，antibiotics，antihistamine (if necessary )2、Local treatment3、Body drai

14、nage4、Physical therapy5、 Puncture and irrigation of maxillary sinusMaxillary sinus puncture and irragationChronic suppurative sinusitisEtiology：AcuteChronicSymptoms & Signs：General:Local： rhinorrhea, nasal obstruction, headache, hyposmia, vision disorderDiagnosis：1、History；2、Examination：anterior rhi

15、noscopy, nasal endoscopy3、Radiological examination：CT or MRI4、Puncture and irrigation of sinusNormal image of nasal endoscopyMaxillary 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