Rhinitis: Mechanism and Presentation
Inflammation of nasal mucosa
Sneezing, congestion, runny nose
What is the most common cause of rhinitis?
Allergic Rhinitis: Mechanism. What type of hypersensitivity?
Type I hypersensitivity (e.g. to pollen) Subtype of rhinitis
Allergic Rhinitis: Histology
Inflammatory infiltrate with eosinophils
What is allergic rhinitis associated with?
Asthma and eczema
Nasal polyp: Mechanism and Causes
Protrussion of edematous, inflamed nasal mucosa
Repeated rhinitis, cystic fibrosis and aspirin-intolerant asthma
What is the triad of aspirin-intolerant asthma?
Asthma, Aspirin-induced bronchospasm, nasal polyps
Seen in 10% of asthmatic adults
What is a nasopharynx angiofibroma?
benign tumor of nasal mucosa of large blood vessels and fibrous tissues, classically seen in adolescent males Present with profuse epistaxis
malignant tumor of nasopharyngeal epithelium often involves cervical lymph nodes
What is nasopharyngeal carcinoma associated with? Which population?
EBV African children and Chinese adults
Nasopharyngeal carcinoma: biopsy
pleomorphic keratin-positive epithelial cells (poorly differentiated SCC) in background of lymphocytes
Acute epiglottis: Presentation
Inflammation of epiglottis
Fever, sore throat, drooling with dysphagia, muffled voice, inspiratory stridor, risk of airway obstruction
What is the most common cause of acute epiglottis?
H. flu type b Especially in nonimmunized children
Inflammation of upper airway
Presents with hoarse, "barking" cough and inspiratory stridor
What is the most common cause of laryngotracheobronchitis?
What is a singer's nodule?
Vocal cord nodule - arise on true vocal cord
Presents with hoarseness; resolves with resting of voice
What is the cause of a vocal cord nodule?
Excessive use of vocal cord, usually bilateral
Vocal cord nodule: histology
degenerative (myxoid) connective tissue
Benign papillary tumor of vocal cord Presents with hoarseness
What is the common cause of laryngeal papilloma?
HPV 6 and 11
How are laryngeal papillomas presented in children vs adults?
Children - multiple Adults - single
Squamous cell carcinoma usually from epithelial lining of vocal cord
Presents with hoarseness, other sings include cough and stridor
Risk factors for laryngeal carcinoma
alcohol and tobacco
Rarely arise from laryngeal papilloma
What is choanal atresia?
Unilateral or bilateral bony septum between nose and pharynx
Newborn cannot breath through nose; cyanosis when breast-feeding and pink up after crying
What is the most common polyp in adults?
What test to order when a child has nasal polyps?
Sweat test to rule out cystic fibrosis
Obstructive sleep apnea: laboratory findings
Respiratory acidosis and hypoxemia
Obstructive sleep apnea: complications
Risk for developing cor pulmonale
Diagnosis for Obstructive Sleep Apnea
Polysomnography: confirmatory test that documents period of apnea during sleep
What is the most common sinus infection in adults?