nasal and laryngeal examination - world allergy organization and manageing... · “normal”nasal...
TRANSCRIPT
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Nasal and Laryngeal Examination
Michael Kaliner, MD
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Fashionable Nose?
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The End
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Outline
• Nasal Anatomy
• Larynx
• Nasal Histology
• Primary Symptoms
– Sneezing
– Pruritus (please note spelling, not pruritis)
– Congestion
– Secretions
• Concepts of treatment
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The Functions of the Nose
• Nasal airway
• Olfaction
• Taste
• Humidification of inspired air
• Filtration of inspired air
• Warming of inspired air
• Muco-ciliary clearance of trapped particulates
• Local host defenses
– Antibody secretion (lgA)
– Mucus secretion with anti-infective activities (lysozyme)
• Resonance
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Nasal Septum
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Inferior Turbinate
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Middle Turbinate
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Middle Turbinate
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Olfactory Nerve
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Olfactory epithelium
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Normal Sinuses
Source: MD Consult Online. Available at http://www.mdconsult.com. Retrieved October
1, 2001.
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Sinuses, turbinates and spaces,
including the osteomeatal complex
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Anatomy & physiology
Coronal Axial
Ethmoid sinus
Frontal sinuses
RADIOGRAPHIC ANATOMY OF THE PARANASAL SINUSES
Maxillary sinus
Sphenoid sinus Anterior ethmoid
Posterior ethmoid
Sphenoid sinus
Anterior Posterior
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Uvula ring
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Eustachian Tube
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Larynx
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Laryngo-Pharyngeal Reflux
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What’s Next?
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Symptoms and Triggers Associated
With the Most Common Types of Rhinitis
Symptoms
• Seasonal allergic rhinitis
– Nasal congestion
– Watery rhinorrhea
– Repetitive sneezing
– Pruritus- eyes, nose, throat
– Watery eyes
• Perennial allergic rhinitis
– Stuffiness/congestion
– Postnasal drip
– Rhinorrhea
• Perennial nonallergic rhinitis
– Stuffiness/congestion
– Rhinorrhea
– Postnasal drip
Triggers
• Seasonal allergic rhinitis
– Pollen
• Perennial allergic rhinitis
– Dust mites
– Animal dander
– Mold
• Perennial nonallergic rhinitis
– Strong odors
– Changes in temperature,
humidity, barometric pressure
– Alcoholic beverages
– Emotional stress
– Air pollutants, smoke
Triggers
• Seasonal allergic rhinitis
– Pollen
• Perennial allergic rhinitis
– Dust mites
– Animal dander
– Mold
• Perennial nonallergic rhinitis
– Strong odors
– Changes in temperature,
humidity, barometric pressure
– Alcoholic beverages
– Emotional stress
– Air pollutants, smoke
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“Normal” Nasal Congestion
• Nasal Cycle
– Reciprocal obstruction of alternate nostrils
– Occurs in 21%-80% of individuals
• Supine position
– Increase in nasal airway resistance
– Reduced ability of the nose to condition air
– Lateral recumbent position may exaggerate response
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Mechanism of Congestion
• Engorgement of
capacitance vessels in
nasal mucosa
• Inflammatory mucosal
edema
• Mucus hypersecretion
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Rhinorrhea
• Increased glandular secretions
• Edema fluid from increased vascular
permeability
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The Epithelial Lining Fluid
2 layers:
• An aqueous periciliary fluid
– Remains stationary for extended period of
time
• A mucous layer that floats on top of the
periciliary fluid
– Replaced by ciliary action every 15 min
• Saccharine time test = cilia move fluid 1 cm/min
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Congestion in Rhinitis
• Increased vascular permeability
– Mucosal edema
– Vasodilation
– Anatomical abnormality
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Sneezing and Pruritus
• Stimulation of sensory nerves
• Trigeminal reflex
– Bright lights
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Allergic Cascade
IgE