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19/02/2014, 08:20
... )wasforchildren12years
oryounger.(5‐7)Aprimarydiagnosisofacuteorchronicsinusitisaccountedfor58.7%ofallexpenditures($3.5
billion).(5‐7)Itisestimatedthat2.2billiondollarsisspentyearly
onprescription and nonprescriptionmedication.
(5‐7)About12%eachofthecostsforasthma and chronicotitismedia and eustachiantubedisorderswere
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Allergic and Non AllergicSinusitisforthePrimaryCarePhysician:
Pathophysiology,Evaluation and Treatment
CHAPTER4
ALLERGY AND SINUSDISEASE
INTRODUCTION
AccordingtotheAmericanAcademyofAllergy,Asthma, and Immunology(AAAAI),over50million
Americanssufferfromsomeformofallergiesthatgreatlyimpactstheirqualityoflifeaswellashealthcarecoststhat
areestimatedatapproximately20billiondollarsayear.(
1)Allergicrhinitisaloneisestimatedtoaffect20to30
millionAmericanseachyear and accountsforanestimated3%ofallmedicalofficevisits and ranksasthesecond
mostcommonreasonpatientsseekprofessionalhealthcare.(1)InmanygeographicareasoftheUnitedStates,
allergiesplay
asignificantroleascontributoryfactorsofsinusdiseaseaswellassecondarycauseofsinusinfections.
Itisofgreatvaluetothepractitionertounderstandtheunderlyingimmunologicfactors,availablediagnostictests
and treatments.(2‐8)
Itisespeciallyvaluableforthepractitionertobewellversedin
allergybecausemanypatientsareconfused
aboutthedifferencebetweensinusitis ... causesarevaried.Inallergicrhinitis,aninhalantallergenisthecause.Otherssuffer
frominfective
rhinitisduetoabacteriaoravirus,whilesomehavegustatoryrhinitis–triggeredbyeating.Some
commonmedicationsmaycauserhinitis(“drug‐inducedrhinitis”).Othershavearunnynosetriggeredbya
substanceintheirworkplace.Stillothersareaffectedbycoldweatherorexercise(“VasomotorRhinitis”).Whatever
the
cause,precisediagnosisisthekeytoeffectivetreatment.Fortunately,mostpatientswithchronicrunnynose
willbenefitfromsimple,targetedmedicaltreatments.(7,12‐16)
SMELL AND TASTEDYSFUNCTION
Smell and tastesensationgohandinhand.Patientswholosetheirsenseofsmellprobablyalsofindthat
foodisblandortasteless.Althoughannoying,thiscanactuallybeamoreserious ...
9
Thesinusescommunicatewiththenasalcavityvianarrowopeningscalledostia.(11)Ostiadrainintospaces
withinthenosecalledmeatiwhichareborderedbyverticallyorientedbonesknownasturbinates.Thetearduct
(naso‐lacrimalduct)drainsintotheinferiormeatus(whichisborderedbytheinferior
turbinatebone).Thisisone
reasonwhyournosedripswhenwecry.Themaxillary,frontal, and ethmoidsinusesdrainintothemiddlemeatus,
whichisborderedbythemiddleturbinatebone(FIGURE2).Someoftheethmoidsinusesalsodrainintothe
superiormeatus,whichisaspacedefined
bysuperiorturbinatebone.Whilethemaxillary,frontal, and sphenoid
sinusesaresolitary,well‐definedcompartments,theethmoidsinusis–inactuality–acollectionofseveralsmall
sinuses,structuredlikeabeehive.Itisforthisreasonthattheethmoidsinuseshavevarieddrainagepatterns.The
sphenoidsinusdrains
intothespheno‐ethmoidalrecess,locatedbetweenthesuperiorturbinatebone and thenasal
septum.(3,11,12)
Air and mucusenter and exitthesinusthroughthesinusostia.Thefunctionsofthenose and sinusesinclude
olfaction(senseofsmell),respiration, and defense.(3,11,12)
Thenose and sinusesproducemucustokeepthe
nasal and upperrespiratorypassagewaysmoist, and haveaneffectonvocalresonance.Amongtheimportant
physiologicalrolesofthesinusesarethehumidification and warmingofinspiredair, and theremovalofparticulate
matterfromthisair.Humidification and warmingof
inspiredairareaccomplishedbythewaterysecretionsofthe
serousglands,whichcanproduceupto1–2litersofsecretionsperday.
...