David Martin Student #1607030 GSU 1111 Assignment #4 Prof. Craig Jones.
Assignment Prof Teti
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Nur Ikram Binti Mat Hussin
1301-1210-0189
Assignment
1) Type and etiology of acute rhinitis
Rhinitis can be divided into:1. Allergic Rhinitis
Symptomatic disorder of the nose induced by an IgE-mediated inflammation after
allergen exposure of the membranes of the nose.
2. Non Allergic Rhinitis
A. Infection
i. Virus
a) myxovirus and paramyxovirus
influenza
parainfluenza
respiratory syncytial virusb) adenovirus
c) picorna virus
enterovirus
rhinovirus
d) corona virus
ii. Bacteria
a) streptococcus
B. Metabolic Disorder
a) pregnancy
b) hiperthyroidism
C. Neoplasm
D. Vasomotor
2) Pathogenesis the spread of rhinitis into otitis media due to Eustachian tube obstruction
A. Functional : in infant and young child the tubal cartilage is lack stiffness (floppy)
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B. Mechanical
i. Intrinsic
abnormal intraluminal factor that compromised lumen of Eustachian tube :
inflammation due to infection/allergy
ii. Extrinsic
increased extramural pressure: tumor/ adenoid mass
3) pathogenesis of otitis media
i. Patient has an antecedent event (infection/allergy) that result in congestion of
respiratory mucosa of upper respiratory tract including nasopharynx and eustachian
tube
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ii. Congestion of mucosa in eustachian tube result in obstruction of the narrowest portion
of the tube (ithmus)
iii. Negative middle-ear pressure develop and followed by aspiration/reflux of pathogens
from nasopharynx into middle ear
iv. Since Eustachian tube is obstructed, drainage and clearance of middle ear effusion, due
to infection accumulate in middle ear
v. Microbial pathogen proliferate in secretions, resulting a suppurative and symptomatic
otitis media
4) type of chronic suppurative otitis media
A. inactive
no active secretion from middle ear (perforation may dry/wet)
B. active
presence of secretion from middle ear
5) Type Of Tympanometry
type A: normal
type AD: discontinuity of the hearing bone
type AS: stiffness of the hearing bone
type B: effusion in middle ear
type C: Eustachian tube dysfunctional
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6) what is ARIA
The Allergic Rhinitis and its Impact on Asthma (ARIA) initiative has been developed in
collaboration with the World Health Organization (WHO). It aims:
1. To Update Clinicians Knowledge Of Allergic Rhinitis
2. To Highlight The Impact Of Allergic Rhinitis On Asthma
3. To Provide An Evidence-Based Approach To Diagnosis
4. To Provide An Evidence-Based Approach To Treatment
5. To Provide A Stepwise Approach To The Management Of The Disease.
Allergic rhinitis is clinically defined as a symptomatic disorder of the nose induced by an IgE-mediated
inflammation after allergen exposure of the membranes of the nose.
Symptoms of allergic rhinitis include:
1. rhinorrhea2. nasal obstruction
3. nasal itching
4. sneezing
The new classification of allergic rhinitis:
1. based on duration, and is subdivided into "intermittent" or "persistent"
2. based on severity, and is subdivided into "mild" or "moderate-severe", depending on symptoms
and quality of life
Intermittent symptoms 4 weeks
Mild normal sleep normal daily activities, sport, leisure normal work and school no troublesome symptoms
Moderate-Severe (one or more items) abnormal sleep impairment of daily activities, sport, leisure problems caused at work or school troublesome symptoms
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TRIGGERS OF ALLERGIC RHINITIS
1. Allergens
A. Aeroallergens
i. The allergens present in the homeare principally mites, domestic animals, insects or are
derived from plant origin.ii. Common outdoor allergens include pollens and moulds.
B. Occupational rhinitis
C. Latex allergy
2. Pollutants
A. Indoor air pollution includes domestic allergens and indoor gas pollutants, among which
tobacco smokeis the major source.
B. Urban-type pollution is primarily of automobile origin and the principal atmospheric
pollutants include ozone, oxides of nitrogenand sulphur dioxide. These may be involved in
the aggravation of nasal symptoms in patients with either allergic rhinitis, or, in non-allergic
subjects.C. Diesel exhaustmay enhance the formation of IgE and allergic inflammation.
3. Aspirin
Aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) commonly induce rhinitis and
asthma.
The treatment of allergic rhinitisshould combine:
1. allergen avoidance (when possible)
2. pharmacotherapy
3.
immunotherapy
Stepwise treatment proposed:
1. Mild intermittent rhinitis: oral H1-antihistamines.
2. Moderate-Severe intermittent rhinitis: Intranasal beclomethasone (300-400g daily). If needed,
after a week of treatment, oral H1-antihistamines and/or a short term course of oral
corticosteroids will be added.
3. Mild persistent rhinitis: Treatment with oral H1-antihistamines or a low dose (100-200 g) of
intranasal beclomethasone will be sufficient.
4. Moderate-Severe persistent rhinitis: Intranasal beclomethasone (300-400 g daily). If
symptoms are severe, add oral H1-antihistamines and/or a short course of oral corticosteroids
at the beginning of the treatment.
Reference
1. Bluestone CD. Pediatric Otolaryngology vol I 3rded. 1996 pg. 411-598
2. Bousquet J. Pocket guide ARIA 2001