過敏性鼻炎的診斷和治療學(xué)習(xí)資料課件

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(yīng)性鼻炎的病因?qū)W

內(nèi)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(yīng)性鼻炎的病因?qū)W內(nèi)在因素──遺傳因素：有家族史者較無家變應(yīng)原與致敏靶細胞表面IgE結(jié)合致敏靶細胞脫粒、釋放、合成生物活性介質(zhì)肥大細胞儲備的介質(zhì)新合成的介質(zhì)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(yīng)原與致敏靶細胞表面IgE結(jié)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(xué)習(xí)資料課件過敏性鼻炎的診斷和治療學(xué)習(xí)資料課件過敏性鼻炎的診斷和治療學(xué)習(xí)資料課件過敏性鼻炎的診斷和治療學(xué)習(xí)資料課件過敏性鼻炎的診斷和治療學(xué)習(xí)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(xué)習(xí)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(xué)習(xí)資料課件FrontalSinus

EthmoidSinusMaxillarySinus過敏性鼻炎的診斷和治療學(xué)習(xí)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(xué)習(xí)資料課件復(fù)習(xí)與思考：1、鼻腔外側(cè)壁的解剖結(jié)構(gòu)及其與臨床的關(guān)系如何？2、變應(yīng)性鼻炎有何臨床表現(xiàn)，應(yīng)與哪些疾病相鑒別？3、如何診斷鼻竇炎？4、鼻息肉應(yīng)與哪些疾病相鑒別?5、上頜竇穿刺術(shù)有何臨床意義？復(fù)習(xí)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(yīng)性鼻炎的病因?qū)W

內(nèi)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(yīng)性鼻炎的病因?qū)W內(nèi)在因素──遺傳因素：有家族史者較無家變應(yīng)原與致敏靶細胞表面IgE結(jié)合致敏靶細胞脫粒、釋放、合成生物活性介質(zhì)肥大細胞儲備的介質(zhì)新合成的介質(zhì)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(yīng)原與致敏靶細胞表面IgE結(jié)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(xué)習(xí)資料課件過敏性鼻炎的診斷和治療學(xué)習(xí)資料課件過敏性鼻炎的診斷和治療學(xué)習(xí)資料課件過敏性鼻炎的診斷和治療學(xué)習(xí)資料課件過敏性鼻炎的診斷和治療學(xué)習(xí)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(xué)習(xí)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(xué)習(xí)資料課件FrontalSinus

EthmoidSinusMaxillarySinus過敏性鼻炎的診斷和治療學(xué)習(xí)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,