Rhinitis and Rhinosinusitis Chia-Ming Liu, M.D. April, 2015
Three factors influence normal nasal function: mucosa, innate (epithelial barrier) and adaptive (humoral & cellular) immunity, anatomy (septum, turbinate)
1. Rhinitis (nasal itching, sneezing, rhinorrhea, nasal obstruction)
1) Acute rhinitis (coryza, common cold), acute suppurative rhinitis (acute bacterial sinusitis)
2) Chronic rhinitis (allergy, vasomotor, rhinitis medicamentosa, hormonal, drug-induced, atrophic, specific infection)
Nasal obstruction: saddle nose, hump nose, twisted nose, septal deviation, septal perforation, hypertrophic inferior turbinate, nasal polyp
2. Sinusitis (rhinosinusitis, RS)
1)Acute rhinosinusitis: Stretococcus pneumoniae, Haemophilus influenza, Moraxella catarrhalis.
2) Chronic rhinosinusitis (CRS): (with nasal polyp, CRSwNP and without nasal polyp, CRSsNP)
Etiology:
a. Infection
b. Allergy, systemic diseases (DM , uremia)
c. Mechanical obstruction (septal deviation, concha bullosa)
d. Pollution
CRSwNP---diffuse inflammatory edema of sinus mucosa (eosinophilic, neutrophilic)
CRSsNP---obstruction of ostium—impair ventilation and drainage--- vicious cycle of mucosal inflammatory change
3. Nasal polyp (a result of rupture of surface epithelium and prolapse of submucosal lamina propria and the formation and growth of NP require an active remodeling of extracellular matrix (ECM) in lamina propria.)
Etiology:
a. Infection(bacteria, fungus)
b. Allergy
c. Mechanical obstruction (antrochoanal)
d. Autonomic dysfunction (devoid of vasomotor regulation)
e. Enzyme abnormality (aspirin associated)
f. mucopolysacchride abnormality (ECM remodeling, collagen, fibronectin)
g. Gene mutation (cystic fibrosis)
h. Idiopathic (natural existence)
Histopathology (multiple factors but with constant histological appearance)
Epithelium: increased goblet cells, squamous metaplasia, thickened basement membrane
Lamina propria: edematous with fibroblasts; infiltration of eosinophils, neutrophils, mast cells, plasma cells, lymphocytes ; atypical glands and immature vessels
4 Unilateral sinus lesions
a. Infection (bacteria, fungus)
b. Odontogenic (dental implant, dentigerous cyst)
c.Trauma
d. Neoplasms (malignant –SCC and benign--inverted papilloma)
e. Postopeerative cheek cyst
5. Complications
orbital Cx (preseptal cellulitis, subperiosteal abscess, orbital cellulitis, orbital abscess, cavernous sinus thrombophlebitis), mucocele, osteomyelitis, CNS Cx (cerebral abscess, meningitis), sinobronchial syndrome, focal infection.