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Rhinitis and Sinusitis


Rhinitis
Symptoms that cause itching, congestion, runny nose, sneezing, and nasal congestion are called rhinitis
allergic rhinitis
It is characterized by results that occur in the nose due to allergens. Associated with IgE. It often develops against pollen and house dust mites. It is the type that benefits most from antihistamines and topical corticosteroids
Seasonal allergic rhinitis
 Increase in results in spring seasons
Perennial allergic rhinitis
Consistent results throughout the year
Non-allergic rhinitis
It features negative allergy tests (prick test, specific Ig's) for a patient whose symptoms are similar to those of allergic rhinitis. It is divided into five groups
1. Idiopathic (vasomotor) rhinitis
There is a defect in the nose's intrinsic function. In case of insufficient sympathetic response to increased parasympathetic stimulation, nasal congestion and runny nose begin
2. Non-allergic rhinitis with eosinophilia (NARES)
It is the presence of more than 20% of eosinophils in a nasal swab when the skin tests are negative and the blood IgE is negative 
3. Irritative toxic rhinitis
It is a rhinitis that develops against chemical solvents and cigarette smoke. It reveals rhinitis findings by irritating the mucosa directly, not by immunological mechanisms.
4. Hormonal rhinitis
The most common form is gestational rhinitis.
5. Drug-associated rhinitis
" The most important drug-associated rhinitis is rhinitis medicamentosa. It occurs with long-term use of vasoconstrictive (oxymetazoline, xylometazoline --iliadin, otrivin) agents.
Sampte triad : In the same patient, aspirin hypersensitivity, asthma, allergic rhinitis (nasal polyp) are together.
Chronic Atrophic Rhinitis ( Ozaenae):
In some cases, Klebsiella ozaenae is the causative agent.
It is a chronic rhinitis characterized by progressive atrophy of mucous and turbinate bones, squamous epithelial metaplasia, solid secretion, drying, and malodor.
Sinusitis
Sinuses present at birth are the ethmoid and maxillary sinuses.
Ethmoid sinusitis is most common in children, and maxillary sinusitis is most common in adults.
Etiology: S. pneumoniae, H. influenzae and M. catarrhalis
Factors that predispose to sinusitis:
nasal allergy
Septum deviation
Ciliary dysfunction (immotile cilia, Kartagener's syndrome)
Adenoid hypertrophy
Rhinosinusitis Complications
Sinusitis complications are examined in 3 categories.
Orbital complications
Intracranial complications
Bone complications
Orbital complications
The most common cause is ethmoid sinusitis.
The most common causative agents are streptococci.
Preseptal cellulitis:
It is the most common complication. The most common cause is ethmoid sinusitis.
It is characterized by edema and redness of the eyelid. Eye movements are not impaired, visual acuity is not affected.
Orbital cellulitis:
Proptosis, chemosis, decreased eye movements, painful eye movements
 and diplopia.
Subperiosteal abscess:
 It is an abscess between the periosteum and the lamina papyracea.
Orbital abscess:
It happens with the progression of orbital cellulitis. It is characterized by severe exophthalmos, chemosis, and fully established ophthalmoplegia. The progression of the table can lead to blindness.
Cavernous sinus thrombus:
This complication can also be evaluated among intracranial complications.
It is characterized by chemosis, orbital pain, proptosis, and ophthalmoplegia. The most striking feature is that it can affect the opposite eye.
- Treatment: Antibiotic and abscess drainage
Intracranial Complications
a- Frontal sinusitis leads to brain complications more frequently.
b- The most common cause of complicating meningitis is Streptococcus.
pneumoniae.
Meningitis: It is the most common intracranial complication.
Epidural abscess: It is a complication of frontal sinusitis.
Subdural abscess: It is a complication of frontal sinusitis. It has a high mortality and morbidity rate.
Intracerebral abscess: It is a complication of frontal sinusitis.
venous sinus thrombosis
Bone Complications
Osteomyelitis may develop due to frontal sinusitis.
The swelling due to purulence accumulating under the periosteum is called Pott's puffy tumor.
Note
B-2-transferrin in the fluid collected in suspected CSF leakage is a highly specific protein for CSF and is the method used today for diagnosis.

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