04/19/2304/19/23 Professor Sameer BafaqeehProfessor Sameer Bafaqeeh 11

Non Allergic RhinitisNon Allergic Rhinitis

Prof. Sameer Bafaqeeh, M.D.Prof. Sameer Bafaqeeh, M.D.University Professor University Professor

in Rhinology & Rhinoplastyin Rhinology & Rhinoplasty

04/19/2304/19/23 Professor Sameer BafaqeehProfessor Sameer Bafaqeeh 22

04/19/2304/19/23 Professor Sameer BafaqeehProfessor Sameer Bafaqeeh 33

Vasomotor RhinitisVasomotor Rhinitis

Symptoms : Symptoms : as Perennial Allergic Rhinitisas Perennial Allergic Rhinitis

Paroxsysmal courseParoxsysmal course Local Finding: Local Finding:

Livid, pale nasal mucosa.Livid, pale nasal mucosa. Profuse watery secretionProfuse watery secretion Nasal turbinates swollenNasal turbinates swollen

04/19/2304/19/23 Professor Sameer BafaqeehProfessor Sameer Bafaqeeh 44

Vasomotor RhinitisVasomotor RhinitisPathogenesisPathogenesis Neurovascular Neurovascular

disorderdisorder No specific No specific

antibodiesantibodies Nonspecific Nonspecific

reflex reflex hypersensitivityhypersensitivity

Caused by Caused by various various influencesinfluences

04/19/2304/19/23 Professor Sameer BafaqeehProfessor Sameer Bafaqeeh 55

Vasomotor RhinitisVasomotor RhinitisPathogenesisPathogenesis Change of temperature or humidityChange of temperature or humidity Alcohol , dust, smoke, mechanical Alcohol , dust, smoke, mechanical

irritation, stress, anxiety neurosis, irritation, stress, anxiety neurosis, endocrine disorders, rhinitis of endocrine disorders, rhinitis of pregnancy.pregnancy.

Drugs: (e.g., antihypertensive agents Drugs: (e.g., antihypertensive agents as reserpine or beta-blockers, oral as reserpine or beta-blockers, oral contraceptives)contraceptives)

Drug abuse: (imidazoline & catechol Drug abuse: (imidazoline & catechol derivatives, clomethiazole, etc.)derivatives, clomethiazole, etc.)

04/19/2304/19/23 Professor Sameer BafaqeehProfessor Sameer Bafaqeeh 66

Vasomotor RhinitisVasomotor RhinitisDiagnosisDiagnosis

Typical historyTypical history Negative Negative

allergen testsallergen tests No elevated IgE No elevated IgE

in the secretionin the secretion

04/19/2304/19/23 Professor Sameer BafaqeehProfessor Sameer Bafaqeeh 77

Vasomotor RhinitisVasomotor RhinitisDifferential diagnosisDifferential diagnosis

Allergic RhinitisAllergic Rhinitis

Foreign body in the NoseForeign body in the Nose

Common ColdCommon Cold

04/19/2304/19/23 Professor Sameer BafaqeehProfessor Sameer Bafaqeeh 88

Vasomotor RhinitisVasomotor RhinitisConservative TretmentConservative Tretment Elimination of irritant factorsElimination of irritant factors AntihistaminesAntihistamines Nasal decongestant dropsNasal decongestant drops Oral decongestant drugsOral decongestant drugs Steroids (e.g., Steroids (e.g.,

beclomethasone)beclomethasone) Metabolic & endocrine Metabolic & endocrine

systemssystems SedativesSedatives Imidazoline preparationsImidazoline preparations (Potential for habituation)(Potential for habituation)

04/19/2304/19/23 Professor Sameer BafaqeehProfessor Sameer Bafaqeeh 99

Vasomotor RhinitisVasomotor RhinitisSurgical TreatmentSurgical Treatment Turbinate surgery Turbinate surgery

Electrocautery,cryElectrocautery,cryosurgery, laserosurgery, laser

Correction of Correction of anatomical anatomical deformitydeformity

ConchotomyConchotomy Parasympathetic Parasympathetic

nasal fibers nasal fibers divisionsdivisions

(Pterygoid canal n., (Pterygoid canal n., vidian n., greater vidian n., greater petrosal n.) petrosal n.) M.C.F.M.C.F.

04/19/2304/19/23 Professor Sameer BafaqeehProfessor Sameer Bafaqeeh 1010

Vasomotor RhinitisVasomotor RhinitisPrognosisPrognosis UncertainUncertain

Suddenly Suddenly improvesimproves

Resistant to Resistant to treatmenttreatment

04/19/2304/19/23 Professor Sameer BafaqeehProfessor Sameer Bafaqeeh 1111

Rhinitis Sicca AnteriorRhinitis Sicca AnteriorSymptomsSymptoms

Dryness Dryness IrritationIrritation Crusts Crusts

formationformation Nasal bleedingNasal bleeding

04/19/2304/19/23 Professor Sameer BafaqeehProfessor Sameer Bafaqeeh 1212

Rhinitis Sicca AnteriorRhinitis Sicca AnteriorPathogenesisPathogenesis

Anterior nasal Anterior nasal mucosa injurymucosa injury DustDust Nose pickingNose picking Extremes of Extremes of temperaturetemperature

04/19/2304/19/23 Professor Sameer BafaqeehProfessor Sameer Bafaqeeh 1313

Rhinitis Sicca AnteriorRhinitis Sicca AnteriorDiagnosisDiagnosis

Nasal septum is dryNasal septum is dry Mucosal surface is:Mucosal surface is:

Raw, roughened, & granular.Raw, roughened, & granular. Crustation Crustation ulcerationulceration

Septal perforationSeptal perforation

04/19/2304/19/23 Professor Sameer BafaqeehProfessor Sameer Bafaqeeh 1414

Rhinitis Sicca AnteriorRhinitis Sicca AnteriorDifferential DiagnosisDifferential Diagnosis

Chemical injury Chemical injury

(Chromium workers)(Chromium workers) Iatrogenic septal Iatrogenic septal

perforationperforation TraumaTrauma LupusLupus LeprosyLeprosy syphilissyphilis

04/19/2304/19/23 Professor Sameer BafaqeehProfessor Sameer Bafaqeeh 1515

Rhinitis Sicca AnteriorRhinitis Sicca AnteriorTreatmentTreatment

Nasal ointmentsNasal ointments Septal Septal

perforation perforation closureclosure

04/19/2304/19/23 Professor Sameer BafaqeehProfessor Sameer Bafaqeeh 1616

Chronic RhinitisChronic Rhinitis

Irritation Or InflammationIrritation Or Inflammation Hypertrophied Nasal Hypertrophied Nasal

MucosaMucosa Hyperemia & edemaHyperemia & edema True tissue hypertrophyTrue tissue hypertrophy

04/19/2304/19/23 Professor Sameer BafaqeehProfessor Sameer Bafaqeeh 1717

Chronic RhinitisChronic RhinitisSYMPTOMSSYMPTOMS

Nasal obstructionNasal obstruction Tough, Stringy, Colorless Tough, Stringy, Colorless

secretions (rarely purulent)secretions (rarely purulent) Post nasal catarrhPost nasal catarrh Rhinolalia clausa &EpiphoraRhinolalia clausa &Epiphora 22ndnd dacryocystitis dacryocystitis 22ndnd pharyngitis pharyngitis

04/19/2304/19/23 Professor Sameer BafaqeehProfessor Sameer Bafaqeeh 1818

Chronic RhinitisChronic RhinitisSYMPTOMSSYMPTOMS Fatigue ,sleeplessnessFatigue ,sleeplessness Unsteady or woozy feelingUnsteady or woozy feeling Headache Headache Feeling of pressure in the headFeeling of pressure in the head

Psychological & physical well-Psychological & physical well-being lossbeing loss

04/19/2304/19/23 Professor Sameer BafaqeehProfessor Sameer Bafaqeeh 1919

Chronic RhinitisChronic RhinitisPathogenesisPathogenesis Recurrent inflammationRecurrent inflammation SinusitisSinusitis Enlarged adenoidEnlarged adenoid Nasopharyngeal tumorNasopharyngeal tumor VMR & Side effects of drugsVMR & Side effects of drugs Tobacco, smoke, dust, chemicals, acquired Tobacco, smoke, dust, chemicals, acquired

toxins, temperature extremes , humiditytoxins, temperature extremes , humidity Pregnancy, menstruation, menopausePregnancy, menstruation, menopause Endocrine disturbancesEndocrine disturbances Heart &circulatory diseasesHeart &circulatory diseases Infective allergy “late-type allergy”Infective allergy “late-type allergy”

04/19/2304/19/23 Professor Sameer BafaqeehProfessor Sameer Bafaqeeh 2020

Chronic RhinitisChronic RhinitisDiagnosisDiagnosis Long-standing diseaseLong-standing disease History of toxinsHistory of toxins Dark red &bluish-violet swelling Dark red &bluish-violet swelling

turbinateturbinate Narrowed or obstructed nasal Narrowed or obstructed nasal

cavitycavity Nasal decongestedNasal decongested

04/19/2304/19/23 Professor Sameer BafaqeehProfessor Sameer Bafaqeeh 2121

Chronic RhinitisChronic RhinitisDiagnosisDiagnosis

Granular Granular nodular surfacenodular surface

(Micro-polyps) (Micro-polyps) nasal polypinasal polypi

Mulberry-like massesMulberry-like masses

04/19/2304/19/23 Professor Sameer BafaqeehProfessor Sameer Bafaqeeh 2222

Chronic RhinitisChronic RhinitisDifferential diagnosisDifferential diagnosis

SinusitisSinusitis Foreign bodiesForeign bodies Specific infectionsSpecific infections Adenoidal hypertrophyAdenoidal hypertrophy wegener’s granulomawegener’s granuloma allergy allergy TumorsTumors

04/19/2304/19/23 Professor Sameer BafaqeehProfessor Sameer Bafaqeeh 2323

Chronic RhinitisChronic RhinitisConservative TreatmentConservative Treatment

Treatment of etiological agents Treatment of etiological agents Drug overuse controlledDrug overuse controlled Endocrinologic investigationEndocrinologic investigation Environment & occupationEnvironment & occupation Symptomatic treatment by Symptomatic treatment by

decongestant nose dropsdecongestant nose drops

(Not in long term)(Not in long term)

04/19/2304/19/23 Professor Sameer BafaqeehProfessor Sameer Bafaqeeh 2424

Chronic RhinitisChronic RhinitisSurgical TreatmentSurgical Treatment Reduction of the inferior turbinate by Reduction of the inferior turbinate by

sclerosing agents, cryoprobe, or the sclerosing agents, cryoprobe, or the laser.laser.

-Electrocoagulation-Electrocoagulation multiple, multiple, localized scars in N.M.localized scars in N.M.

-Cryosurgery-Cryosurgerypartial obliterationpartial obliteration -CO2 or argon laser-CO2 or argon lasermucosal scars mucosal scars

(evaporation or coagulation)(evaporation or coagulation) Turbinectomy or mucotomyTurbinectomy or mucotomy turbinoplastyturbinoplasty

04/19/2304/19/23 Professor Sameer BafaqeehProfessor Sameer Bafaqeeh 2525

Pregnancy RhinitisPregnancy Rhinitis

Nasal swelling Nasal swelling & obstruction& obstruction

22ndnd hafe of hafe of pregnancypregnancy

Resolve after Resolve after deliverydelivery

04/19/2304/19/23 Professor Sameer BafaqeehProfessor Sameer Bafaqeeh 2626

Rhinitis MedicamentosaRhinitis Medicamentosa

Reversible or irreversible Reversible or irreversible damaged mucosa caused by damaged mucosa caused by topically or systemically applied topically or systemically applied drugs:-drugs:-

Hyper-plastic RhinitisHyper-plastic Rhinitis Dryness of the nasal mucosaDryness of the nasal mucosa Toxic RhinopathyToxic Rhinopathy

04/19/2304/19/23 Professor Sameer BafaqeehProfessor Sameer Bafaqeeh 2727

Rhinitis MedicamentosaRhinitis MedicamentosaHyperplastic RhinitisHyperplastic Rhinitis

Mucosal swellingMucosal swelling Acetylsalicylic acidAcetylsalicylic acid Oral contraceptivesOral contraceptives Guanethidine , hydantoin , Guanethidine , hydantoin ,

estrogens, paraamino-salicylic acid, estrogens, paraamino-salicylic acid, phenothiazine, rauwolfia phenothiazine, rauwolfia preparations, preparations,

Beta-blocking drugsBeta-blocking drugs Tetraethyl ammoniumTetraethyl ammonium

04/19/2304/19/23 Professor Sameer BafaqeehProfessor Sameer Bafaqeeh 2828

Rhinitis MedicamentosaRhinitis Medicamentosa

Dryness of the Nasal MucosaDryness of the Nasal Mucosa Atropine, belladonna preparatiosAtropine, belladonna preparatios CorticosteroidsCorticosteroids Imidazoline, or catecholamine Imidazoline, or catecholamine

derivativesderivatives

04/19/2304/19/23 Professor Sameer BafaqeehProfessor Sameer Bafaqeeh 2929

Rhinitis MedicamentosaRhinitis MedicamentosaToxic RhinopathyToxic Rhinopathy

#Vasoactive subsances#Vasoactive subsances Adrenalin or imidazoline derivatives Adrenalin or imidazoline derivatives

as privine, nasivine...as privine, nasivine... Habituation Habituation R.M. R.M. Autonomic vascular regulation Autonomic vascular regulation

failurefailure O mucosal damage O mucosal damage Local or systemic decongestantLocal or systemic decongestant Acute intoxication in infants Acute intoxication in infants

& small children& small children

04/19/2304/19/23 Professor Sameer BafaqeehProfessor Sameer Bafaqeeh 3030

Atrophic RhinitisAtrophic Rhinitis& Ozena& Ozena

Atrophic rhinitis+ foul smell Atrophic rhinitis+ foul smell = = OzenaOzena

Mainly in womenMainly in women At pubertyAt puberty Flattened Flattened

& broad Face& broad Face

04/19/2304/19/23 Professor Sameer BafaqeehProfessor Sameer Bafaqeeh 3131

Atrophic RhinitisAtrophic Rhinitisclinical presentationclinical presentation Greenish–yellow or Greenish–yellow or

brownish-black crustsbrownish-black crusts Wide nasal cavityWide nasal cavity Atrophic mucosa & dry:Atrophic mucosa & dry: Subepithelial layer fibrosisSubepithelial layer fibrosis Fetid secretion &crusts (Ozena)Fetid secretion &crusts (Ozena) Anosmia & social problemAnosmia & social problem Nasal obstructionNasal obstruction Mucosal changes in ph., la., & tr.,Mucosal changes in ph., la., & tr.,

04/19/2304/19/23 Professor Sameer BafaqeehProfessor Sameer Bafaqeeh 3232

Atrophic RhinitisAtrophic RhinitisPathogenesisPathogenesis Unknown but is multifactorialUnknown but is multifactorial Common in orientals than in whites than in Common in orientals than in whites than in

blacksblacks Geographic concentrationGeographic concentration Abnormally wide nasal cavityAbnormally wide nasal cavity Mucosal atrophy& bony nasal skeleton.Mucosal atrophy& bony nasal skeleton. M.G. & S.N.F. degenerateM.G. & S.N.F. degenerate Respiratory epith.Respiratory epith. sq. metaplasia sq. metaplasia Destroyed mucociliary cleaning systemDestroyed mucociliary cleaning system Bacterial proteolysis decomposed the thick Bacterial proteolysis decomposed the thick

& gluey secretions& gluey secretions

04/19/2304/19/23 Professor Sameer BafaqeehProfessor Sameer Bafaqeeh 3333

22ndnd Atrophic Rhinitis Atrophic Rhinitis

Nasal TraumaNasal Trauma Extensive surgeryExtensive surgery Occupational exposure to:-Occupational exposure to:-

Glass, wood, asbestos, etc.Glass, wood, asbestos, etc.

04/19/2304/19/23 Professor Sameer BafaqeehProfessor Sameer Bafaqeeh 3434

Atrophic RhinitisAtrophic RhinitisDiagnosisDiagnosis

Gluey, dry, greenish-yellow Gluey, dry, greenish-yellow secretions & crustssecretions & crusts

wide nasal cavity wide nasal cavity & very small turbinates & very small turbinates

Foul-smelling crusts in OzenaFoul-smelling crusts in Ozena

04/19/2304/19/23 Professor Sameer BafaqeehProfessor Sameer Bafaqeeh 3535

Atrophic RhinitisAtrophic RhinitisDifferential DiagnosisDifferential Diagnosis

Atrophic rhinitis with fetor (ozena)Atrophic rhinitis with fetor (ozena) Tumors of the Nose & SinusesTumors of the Nose & Sinuses Purulent Rhinitis & SinusitisPurulent Rhinitis & Sinusitis Rhinolith & foreign bodyRhinolith & foreign body Gumma due to stage III SyphilisGumma due to stage III Syphilis Nasal diphtheria &Nasal Nasal diphtheria &Nasal

TuberculosisTuberculosis glandersglanders

04/19/2304/19/23 Professor Sameer BafaqeehProfessor Sameer Bafaqeeh 3636

Atrophic RhinitisAtrophic RhinitisConservative TreatmentConservative Treatment

Nasal douchingNasal douching Alkaline nasal lotionAlkaline nasal lotion Greasy ointmentsGreasy ointments Oily nasal drops, emulsions , or Oily nasal drops, emulsions , or

ointments, ?! Vitamin Aointments, ?! Vitamin A Steam inhalationsSteam inhalations Osmotic Powders :DextroseOsmotic Powders :Dextrose

04/19/2304/19/23 Professor Sameer BafaqeehProfessor Sameer Bafaqeeh 3737

Atrophic RhinitisAtrophic RhinitisOperative TreatmentOperative Treatment

Bolstering of the Nasal Bolstering of the Nasal MucosaMucosa

(Cartilage or Bone chips)(Cartilage or Bone chips)

Median DisplacementMedian Displacement of of the lateral nasal wall by the lateral nasal wall by internal rotation of the internal rotation of the mobilized lateral nasal wallmobilized lateral nasal wall

04/19/2304/19/23 Professor Sameer BafaqeehProfessor Sameer Bafaqeeh 3838

Nasal DiphtheriaNasal Diphtheria

Children older than 6 monthsChildren older than 6 months

04/19/2304/19/23 Professor Sameer BafaqeehProfessor Sameer Bafaqeeh 3939

Nasal Tuberculosis Nasal Tuberculosis

LupusLupus

Exudative Ulcerative Exudative Ulcerative mucosal Tuberculosismucosal Tuberculosis

04/19/2304/19/23 Professor Sameer BafaqeehProfessor Sameer Bafaqeeh 4040

Stage 1 : infection from Stage 1 : infection from instrumentsinstruments

Stage 11 : very rareStage 11 : very rare Stage 111 : more commonStage 111 : more common

Nasal SyphilisNasal Syphilis

04/19/2304/19/23 Professor Sameer BafaqeehProfessor Sameer Bafaqeeh 4141

GlandersGlanders

SosoSoso

04/19/2304/19/23 Professor Sameer BafaqeehProfessor Sameer Bafaqeeh 4242

BlastomycosisBlastomycosis

04/19/2304/19/23 Professor Sameer BafaqeehProfessor Sameer Bafaqeeh 4343

RhinosporidiosisRhinosporidiosis

04/19/2304/19/23 Professor Sameer BafaqeehProfessor Sameer Bafaqeeh 4444

Other MycosesOther Mycoses

04/19/2304/19/23 Professor Sameer BafaqeehProfessor Sameer Bafaqeeh 4545

Wegener’s GranulomatosisWegener’s Granulomatosis

04/19/2304/19/23 Professor Sameer BafaqeehProfessor Sameer Bafaqeeh 4646

Lethal Midline GranulomaLethal Midline Granuloma

04/19/2304/19/23 Professor Sameer BafaqeehProfessor Sameer Bafaqeeh 4747

The 3The 3ndnd Riyadh RiyadhComprehensive InternationalComprehensive International

Rhinoplasty CourseRhinoplasty Course21 April – 24 April 200821 April – 24 April 2008

King Saud University King Saud University HospitalsHospitals

-King Abdul-Aziz University Hospital-King Abdul-Aziz University Hospital

44thth Floor Floor

-King Kalid University Hospital -King Kalid University Hospital

Anatomy DepartmentAnatomy Department

Prof. Sameer Prof. Sameer BafaqeehBafaqeeh

-Chairman of Organizing Committee-Chairman of Organizing Committee

-ENT Department-ENT Department

-King Abdul-Aziz University Hospital-King Abdul-Aziz University Hospital