Rhinitis

Question 1

What is Rhinitis?

Answer 1

Nasal inflammation

Question 2

What is Allergic Rhinitis?

Answer 2

Hay fever

=> Caused by allergens:

• Hay
• Pollen
• Dust
• Animal hair
• Mold spores

Question 3

What type of hypersensitivity reaction is Allergic Rhinitis?

Answer 3

Type I hypersensitivity

Question 4

How is Allergic Rhinitis categorised?

Answer 4

Seasonal => symptoms occur same time ever year
Perennial => symptoms occur throughout the year
Occupational => symptoms occur by allergens at work place

Question 5

What are the clinical features of Allergic Rhinitis?

Answer 5

• Sneezing
• Bi-lateral nasal obstruction
• Clear nasal discharge
• Post-nasal drip
• Nasal pruritis

Question 6

What is the pathophysiology of Allergic Rhinitis?

Answer 6

=> Type I Hypersensitivity

• Dendritic cells engulf allergen and present to T cell
• T cell activate and release cytokines which stimulate b cells
• B cells release specific IgE antibodies that bind to mast cells
• Upon re-exposure, IgE antibodies on mast cells cross link and cause degranulation, releasing histamines

=> Action of histamines:

• vasodilation of capillaries
• increased permeability of vessel wall

Question 7

What are the investigations in suspected Allergic Rhinitis?

Answer 7

Skin prick test

Question 8

What is the management of Allergic Rhinitis?

Answer 8

• Allergy avoidance
• Mild to moderate symptoms require oral or intranasal anti-histamines
• Moderate to severe persistent symptoms or when initial drug fails requires intranasal corticosteroids
• Oral corticosteroids given for important life events

Question 9

What are Nasal Polyps?

Answer 9

• Overgrowth of epithelial cells which form a bump along the nasal cavity

Question 10

In which sinuses do Nasal Polyps most likely form?

Answer 10

Ethmoid and maxillary sinus

Question 11

What are the clinical features of Nasal Polyps?

Answer 11

• Hyperplasia of epithelial cells lining the sinuses
• May cause obstruction of air flow and mucus drainage
• This means pathogens linger in nasal cavity, causing infection
• Infection leads to mucosal swelling, worsening airway obstruction

Question 12

What are the investigations in suspected Nasal Polyps?

Answer 12

=> Nasal Endoscopy

Gold standard

Question 13

What is the management of Nasal Polyps?

Answer 13

• Shrink them through the use of nasal spray steroids

=> Incases of unresponsiveness to steroids due to high eosinophil count:
- Endoscopic sinus surgery

Repeat treatments whenever polyps return