medical and surgical treatment of chronic rhinitis慢性鼻炎的醫(yī)療和外科治療課件

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1、TheMedicalandSurgicalTreatmentofChronicRhinitisR.Moulton-Barrett,MDDefinationofChronicRhinitissymptomsof:nasalcongestionrhinorrhoeaanosmiasneezingoritchynoselasting>3monthsinoneyear40millionpeopleinUSA50%seekmedicaladvise50%allergicinorigin6milliondollarsspentondeconges

2、tants/yr.PhysiologyofNasalCongestion3portions:vestibulerespiratory(92%byarea:120sqcm's)andolfactoryFlow:Inspiratory-laminar,aboveinferiorturbinateExpiratory-circum-laminartoparanasalsinusesVestibule:1/3nasalresistance(byacousticrhinometryandMRI)NasalValve:2/3'stotalnasa

3、lresistance(0.72cm2)themostnarrowportionofthenasalcavityAnatomyoftheInferiorTurbinateNerve:Post-ganglionicpterygopalatineganglionfibresInfPostLatbranchofGreaterPalatineNerveArtery:Singlebranchofsphenopalatinearteryenters1-1.5cm'sfromposteriorsuperiorbonetravelsanteriorl

4、yalongsuperiorperiosteumSwelling:40%ofblood:throughspongysubmucosalvenoustissuecontainingsmallvesselswithleakybasementmembranes60%ofthebloodpassesthrougha/vshunts:Sympatheticdependent-reducescanoverdrivebyparasympathetics+engorgesnothistaminesensitiveAcousticRhinometrya

5、ssessescross-sectionalareaandgeometry(experimental)Hilberg1989PosteriorRhinometryResistance=Pressure/Flow:disputedintermsofvalueMyrindN,1980.Measurementofnasalairwayresistance-isitonlyforarticlewriters.ClinicalOtolaryngol5:161-163.MeasurementofNasalResistanceDynamicvari

6、ationinnasalresistanceSite:anterior-superiorleadingedgeHydrostaticpresssure:positionalNervousinnervation:nasalcycle(sympathetictone)Inflammatoryprocess:chronicrhinitisDrugmanipulation:vasoconstriction:35%

7、andindependentPhysiologyofRhinorrhoeaSerous&MucoserousGlandsparasympatheticandhistaminedependentinducewithmethacholine'challenge'test50-100cilia/cellbeatsmucusposteriorlyat0.3-1cm/minuteadropofsaccarin:tastein20minutes,ifdelayed:performmicroscopyruleoutimmotileciliaSnee

8、zingandItchingHistaminerelated:releasedbymastcellseosinophils&mostimportantlybasophilcellsSuccessoftherapy:ant