NasalmucosalhyperreactiverhinopathyAllergicRhinitis(AR)Perennial~(PAR),Seasonal~(SAR)（Pollinosis）Morbidity:10%~20%Inhalantallergens——dustmite,housedust,pollen,fungi,animaldanders,cockroach；Foodallergens——milk,eggs,fishandshrimp,meat,vegetables,fruits.Nasalmucosalhyperreactiverh

MiteMoldPollenCatAntigensforallergicrhinitis

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(fā)病危險高２～６倍母系第１１對染色體長臂ｑ段外在因素（環(huán)境因素）：基因表達受非遺傳因素影響。７０００對孿生兒，同時有AR癥狀者為２１％易感個體在一定環(huán)境條件作用下才發(fā)病變應性鼻炎的病因學內在因素──遺傳因素：有家族史者較無家變應原與致敏靶細胞表面IgE結合致敏靶細胞脫粒、釋放、合成生物活性介質肥大細胞儲備的介質新合成的介質組胺緩激肽白三烯血小板活化因子前列腺素D2毛細血管擴張、通透性增加，腺體分泌增多

嗜酸/堿性粒細胞哮喘鼻炎發(fā)病機制變應原與致敏靶細胞表面IgE結合致敏靶細胞脫粒、釋放、合成生過敏性鼻炎的診斷和治療學習資料課件過敏性鼻炎的診斷和治療學習資料課件過敏性鼻炎的診斷和治療學習資料課件過敏性鼻炎的診斷和治療學習資料課件過敏性鼻炎的診斷和治療學習資料課件Pathology：Typeallergy

Allergicinflammation:PredominantTcells&eosinophiliccellsinfiltrate.Pathology：Symptoms&Signs：NasalirritationandichingrecurrentattacksofparoxysmalsneezingcopiouswateryrhinorrheanasalobstructionSymptoms&Signs：鼻后滴漏鼻后滴漏Diagnosis：1、History（allergenexposure,hypersensitivity,familyhistory）2、Examination3、Skintest:skinpricktest4、IgEantibody，SerumtotalIgE、specialIgE5、NasalprovocationornasalchanllengetestsDiagnosis：DifferentialDiagnosis：1、Vastomotorrhinitis2、Nonallergicrhinitiswitheosinophiliasyndrome,NARES3、Hyperreflectoryrhinitis4、AcuterhinitisDifferentialDiagnosis：Complications：1、Allergicsinusitis2、Asthma3、Secretoryotitismedia4、AllergicpharyngolaryngitisTreatment：1、AvoidanceComplications：2、Drugs1）Antihistamines2）Corticosteroids3）Sodiumcromoglycate(SCG)Cromolynsodium4）Anticholinergicagents5）Vasoconstrictorsympasthomimetics3、Hyposensitization4、Others：TraditionalChinesemedicine,laser,operation2、DrugsNasalPolyp&NasalPolyposisEtiology：mutilfactors1.allergic；2.chronicinflammationPathology：highlyswelledconnectivetissue.Predominanteosinophiliccellsinfiltrate.Lymphaticcells,neutrophils,basophils,mastcells.NasalPolyp&NasalPolyposisPolypinmaxillarysinus（L），polypinmiddlemeatus（R）Symptoms&Sign：persistentnasalobstruction，closenasalsound，hyposmia,rhinorrhea,snore,“frognose”Polypinmaxillarysinus（L），poAntrochoanalpolypAntrochoanalpolyp過敏性鼻炎的診斷和治療學習資料課件AntrochoanalpolypAntrochoanalpolypDiagnosis：Anteriorrhinoscopy：translucent,soft,smoothmasses.Endoscopy,X-rayandCTscanner.DifferentialDiagnosis：Papillomainverted，angiofibromaofnasopharynx，malignanttumorofnasalcavity，meningoencephaloceleTreatment：1、conservativetreatment——corticosteroids2、surgicaltreatmentDiagnosis：Polyps（above），papilloma（below）Polyps（above），papilloma（below）papilloma（L），MTofnasalcavity（R）papilloma（L），MTofnasalcavitSinusitisAcutesuppurativesinusitisFeaturesofsinusanatomy：1、smallostiaofthesinuses；2、continuativemucosabetweennasalcavityandsinuses；3、contiguousoftheostia；4、locationoftheastiaandfeaturesofthesinuses.Sinusitis過敏性鼻炎的診斷和治療學習資料課件FrontalSinus

EthmoidSinusMaxillarySinus過敏性鼻炎的診斷和治療學習資料課件Etiology：1、Generalfactors:Poorgeneralhealth(influenza,measles,whoopingcough…)2、Localfactors：Sinusdiseases；Infectivefocusoferipheralorgans，Directinfection；Nasaltampon(packing)；RapidchangeofatmosphericpressureEtiology：

ABS主要病原體：肺炎鏈球菌和嗜血流感桿菌SAHP.OtolaryngolHeadNeckSurg.2004;130:1-45.20-43%22-35%Anaerobes0-9%Staphylococcusaureus

0-8%Otherbacteria4%MoraxellacatarrhalisOtherstreptococci3-9%2-10%S.pneumoniae成人Acutebacterialrhinosinusitis(ABS)病因H.influenzaeABS主要病原體：肺炎鏈球菌和嗜血流感兒童Acutebacterialrhinosinusitis(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OtolaryngolHeadNeckSurg.2004;130:1-45.兒童AcutebacterialrhinosinusitSymptoms&Signs：Generalsymptoms：Malaise,fever.Localsymptoms:1）Nasalobstructionsustained,withhyposmia2）Suppurativerhinorrhea,streakywithblood,foulsmell(odontogentic~)3）headachorlocalacheSymptoms&Signs：Antralpain——frominnercanthusdownwardsacrossthecheek,upperalveolusontheaffectedside.Ethmoidalpain——overbridgeofthenose&innercanthusbehindtheeye.Frontalpain——forehead,periodicity,persistforanhourortowaftergettingupinthemorning,andclearduringtheafternoon.Sphenoidalpain——occipitalorverticalheadache.Antralpain——frominnercanthuDiagnosis：History，Signs,Anteriorrhinoscopy,Nasalendoscopy,Radiologicalexamination,PunctureandirrigationofmaxillarysinusDiagnosis：Treatment：Eradicatecauses，keepdrainage；controlinfectionandpreventcomplications1、Generaltreatment：takerest，antibiotics，antihistamine(ifnecessary)2、Localtreatment3、Bodydrainage4、Physicaltherapy5、

PunctureandirrigationofmaxillarysinusTreatment：Eradicatecauses，keeMaxillarysinuspunctureandirragationMaxillarysinuspunctureandiChronicsuppurativesinusitisEtiology：Acute——ChronicSymptoms&Signs：General~:Local~：rhinorrhea,nasalobstruction,headache,hyposmia,visiondisorderChronicsuppurativesinusitisDiagnosis：1、History；2、Examination：anteriorrhinoscopy,nasalendoscopy3、Radiologicalexamination：CTorMRI4、PunctureandirrigationofsinusDiagnosis：NormalimageofnasalendoscopyNormalimageofnasalendoscopMaxillarysinusitis——pusinthemiddlemeatusMaxillarysinusitis——pusinthMaxillarysinusitis(R)Maxillarysinusitis(R)Sphenoidsinusitis——pusinthesphenoethmoidalrecessSphenoidsinusitis——pusintheSphenoidsinusitisSphenoidsinusitisPansinusitisPansinusitisPansinusitisPansinusitisTreatment：1、Intranasalmedications：Corticosteroid，Vasoconstrictorsympasthomimetics2、Punctureandirrigationofmaxillarysinus3、Displacementmethod——frontalsinusitis,ethmoidalsinusitis,sphenoidalsinusitis,pansinusitis4、Surgery——traditionalsinussurgeryFunctionalEndoscopicSinusSurgery(FESS)OstiometalcomplexOMCTreatment：FunctionalEndoscopicSinusSurgery(FESS)FunctionalEndoscopicSinusSu過敏性鼻炎的診斷和治療學習資料課件復習與思考：1、鼻腔外側壁的解剖結構及其與臨床的關系如何？2、變應性鼻炎有何臨床表現(xiàn)，應與哪些疾病相鑒別？3、如何診斷鼻竇炎？4、鼻息肉應與哪些疾病相鑒別?5、上頜竇穿刺術有何臨床意義？復習與思考：NasalmucosalhyperreactiverhinopathyAllergicRhinitis(AR)Perennial~(PAR),Seasonal~(SAR)（Pollinosis）Morbidity:10%~20%Inhalantallergens——dustmite,housedust,pollen,fungi,animaldanders,cockroach；Foodallergens——milk,eggs,fishandshrimp,meat,vegetables,fruits.Nasalmucosalhyperreactiverh

MiteMoldPollenCatAntigensforallergicrhinitis

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(fā)病危險高２～６倍母系第１１對染色體長臂ｑ段外在因素（環(huán)境因素）：基因表達受非遺傳因素影響。７０００對孿生兒，同時有AR癥狀者為２１％易感個體在一定環(huán)境條件作用下才發(fā)病變應性鼻炎的病因學內在因素──遺傳因素：有家族史者較無家變應原與致敏靶細胞表面IgE結合致敏靶細胞脫粒、釋放、合成生物活性介質肥大細胞儲備的介質新合成的介質組胺緩激肽白三烯血小板活化因子前列腺素D2毛細血管擴張、通透性增加，腺體分泌增多

嗜酸/堿性粒細胞哮喘鼻炎發(fā)病機制變應原與致敏靶細胞表面IgE結合致敏靶細胞脫粒、釋放、合成生過敏性鼻炎的診斷和治療學習資料課件過敏性鼻炎的診斷和治療學習資料課件過敏性鼻炎的診斷和治療學習資料課件過敏性鼻炎的診斷和治療學習資料課件過敏性鼻炎的診斷和治療學習資料課件Pathology：Typeallergy

Allergicinflammation:PredominantTcells&eosinophiliccellsinfiltrate.Pathology：Symptoms&Signs：NasalirritationandichingrecurrentattacksofparoxysmalsneezingcopiouswateryrhinorrheanasalobstructionSymptoms&Signs：鼻后滴漏鼻后滴漏Diagnosis：1、History（allergenexposure,hypersensitivity,familyhistory）2、Examination3、Skintest:skinpricktest4、IgEantibody，SerumtotalIgE、specialIgE5、NasalprovocationornasalchanllengetestsDiagnosis：DifferentialDiagnosis：1、Vastomotorrhinitis2、Nonallergicrhinitiswitheosinophiliasyndrome,NARES3、Hyperreflectoryrhinitis4、AcuterhinitisDifferentialDiagnosis：Complications：1、Allergicsinusitis2、Asthma3、Secretoryotitismedia4、AllergicpharyngolaryngitisTreatment：1、AvoidanceComplications：2、Drugs1）Antihistamines2）Corticosteroids3）Sodiumcromoglycate(SCG)Cromolynsodium4）Anticholinergicagents5）Vasoconstrictorsympasthomimetics3、Hyposensitization4、Others：TraditionalChinesemedicine,laser,operation2、DrugsNasalPolyp&NasalPolyposisEtiology：mutilfactors1.allergic；2.chronicinflammationPathology：highlyswelledconnectivetissue.Predominanteosinophiliccellsinfiltrate.Lymphaticcells,neutrophils,basophils,mastcells.NasalPolyp&NasalPolyposisPolypinmaxillarysinus（L），polypinmiddlemeatus（R）Symptoms&Sign：persistentnasalobstruction，closenasalsound，hyposmia,rhinorrhea,snore,“frognose”Polypinmaxillarysinus（L），poAntrochoanalpolypAntrochoanalpolyp過敏性鼻炎的診斷和治療學習資料課件AntrochoanalpolypAntrochoanalpolypDiagnosis：Anteriorrhinoscopy：translucent,soft,smoothmasses.Endoscopy,X-rayandCTscanner.DifferentialDiagnosis：Papillomainverted，angiofibromaofnasopharynx，malignanttumorofnasalcavity，meningoencephaloceleTreatment：1、conservativetreatment——corticosteroids2、surgicaltreatmentDiagnosis：Polyps（above），papilloma（below）Polyps（above），papilloma（below）papilloma（L），MTofnasalcavity（R）papilloma（L），MTofnasalcavitSinusitisAcutesuppurativesinusitisFeaturesofsinusanatomy：1、smallostiaofthesinuses；2、continuativemucosabetweennasalcavityandsinuses；3、contiguousoftheostia；4、locationoftheastiaandfeaturesofthesinuses.Sinusitis過敏性鼻炎的診斷和治療學習資料課件FrontalSinus

EthmoidSinusMaxillarySinus過敏性鼻炎的診斷和治療學習資料課件Etiology：1、Generalfactors:Poorgeneralhealth(influenza,measles,whoopingcough…)2、Localfactors：Sinusdiseases；Infectivefocusoferipheralorgans，Directinfection；Nasaltampon(packing)；RapidchangeofatmosphericpressureEtiology：

ABS主要病原體：肺炎鏈球菌和嗜血流感桿菌SAHP.OtolaryngolHeadNeckSurg.2004;130:1-45.20-43%22-35%Anaerobes0-9%Staphylococcusaureus

0-8%Otherbacteria4%MoraxellacatarrhalisOtherstreptococci3-9%2-10%S.pneumoniae成人Acutebacterialrhinosinusitis(ABS)病因H.influenzaeABS主要病原體：肺炎鏈球菌和嗜血流感兒童Acutebacterialrhinosinusitis(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OtolaryngolHeadNeckSurg.2004;130:1-45.兒童AcutebacterialrhinosinusitSymptoms&Signs：Generalsymptoms：Malaise,fever.Localsymptoms:1）Nasalobstructionsustained,withhyposmia2）Suppurativerhinorrhea,streakywithblood,foulsmell(odontogentic~)3）headachorlocalacheSymptoms&Signs：Antralpain——frominnercanthusdownwardsacrossthecheek,upperalveolusontheaffectedside.Ethmoidalpain——overbridgeofthenose&innercanthusbehindtheeye.Frontalpain——forehead,periodicity,persistforanhourortowaftergettingupinthemorning,andclearduringtheafternoon.Sphenoidalpain——occipitalorverticalheadache.Antralpain——frominnercanthuDiagnosis：History，Signs,Anteriorrhinoscopy,Nasalendoscopy,Radiologicalexamination,PunctureandirrigationofmaxillarysinusDiagnosis：Treatment：Eradicatecauses，keepdrainage；controlinfectionandpreventcomplications1、Generaltreatment：takerest，antibiotics，antihistamine(ifnecessary)2、Localtreatment3、Bodydrainage4、Physicaltherapy5、

PunctureandirrigationofmaxillarysinusTreatment：Eradicatecauses，keeMaxillarysinuspunctureandirragationMaxillarysinuspunctureandiChronicsuppurativesinusitisEtiology：Acute——ChronicSymptoms&Signs：General~:Local~：rhinorrhea,