Rhinitis and Rhinoscleroma

Acute Rhinitis

• A common cold is the most prevalent illness, typically caused by adenoviruses
• Common cold symptoms include coryza (runny nose), sneezing, nasal congestion, and mild sore throat
• Allergic rhinitis involves an IgE type I immune reaction with mast cells
• Allergic rhinitis leads to increased eosinophils in peripheral blood and nasal discharge
• Bacterial infection can be superimposed on acute viral or allergic rhinitis
• It is caused by environmental factors that injure mucosal cilia
• Organisms that cause bacterial infection are streptococci, staphylococci, or Haemophilus influenzae.
• Complications from bacterial infections include fibrous scarring, decreased vascularity, and atrophy of the epithelium/mucous glands

Rhinoscleroma

• Rhinoscleroma is a granulomatous inflammation of the upper respiratory tract
• It primarily affects the nose, but can also affect the nasopharynx, larynx, and trachea
• This condition is caused by klebsiella rhinoscleromatis, and is endemic in Egypt
• Rhinoscleroma presents as hard nodules or masses in the nasal cavity that may extend to surrounding areas
• Microscopically, it presents as chronic inflammatory cells, Mikulicz cells, and Russell bodies
• Complications include nasal obstruction, ulceration, and deformity

Epistaxis

• Epistaxis is defined as bleeding through the nose.
• The nasopharynx receives its blood supply from four arteries.
• Blood is supplied to the nose through the Kiesselbach plexus with anastomosis in anterior segment
• Damage within the Kiesselbach plexus in the nose is a common source of nosebleeds
• Epistaxis from the posterior segment of the nasopharynx can be life-threatening
• Common causes include foreign bodies, trauma, allergic rhinitis, and nasal angiofibromas (often in adolescent males)

Sinusitis

• Sinusitis is the inflammation of the paranasal sinuses
• It often extends from the nasal cavity or a dental infection
• This results in obstructed drainage outlets, accumulation of secretions, and inflammation/pain over the affected sinus
• The maxillary sinuses are frequently affected
• Infections in the sphenoid or ethmoid sinuses extend to cavernous sinus and cause complications such as cavernous sinus syndrome

Laryngitis

• Laryngitis is the acute inflammation of the larynx
• It is produced by viruses, bacteria, irritants, or overuse of voice
• Laryngitis is characterized by inflammation and edema of the vocal cords, resulting in hoarseness

Acute Epiglottitis

• Acute epiglottitis is inflammation of the epiglottis
• It can be life-threatening in young children because it inflames the epiglottis
• Predominantly caused by H. influenzae

Acute Laryngotracheobronchitis (Croup)

• Croup is an acute inflammation of the larynx, trachea, and epiglottis
• It is potentially life-threatening in infants
• Viral infections are the most frequent cause
• It's characteristics include a harsh cough and inspiratory stridor

Tumors of the Nose and Nasopharynx

• Angiofibroma is a vascular neoplasm that occurs in adolescent males
• It is commonly found in the posterior-lateral nasal wall and nasopharynx
• Angiofibroma is histologically benign but locally aggressive
• Nasopharyngeal carcinoma, formerly known as "lymphoepithelioma" is the most common
• It's found in Southeast Asia and East Africa, it's genesis is the Epstein-Barr virus
• Squamous cell carcinoma is the most common malignant nasal tumor
• Adenocarcinoma accounts for about 5% of malignant tumors of the nose and throat and includes intestinal-type and non-intestinal-type cases
• Olfactory neuroblastomas arise from the olfactory mucosa.
• Olfactory neuroblastomas tend to be found in older male patients (unlike pediatric neuroblastoma)
• These are small round blue cells set in a neurofibrillary matrix
• Plasmacytoma is an extraosseous form of plasma cell neoplasms, which produce tumors in the upper respiratory tract.
• Embryonal rhabdomyosarcoma happens often in young children
• It is an aggressive mesenchymal malignancy

Tumors of the Oropharynx

• Squamous cell carcinomas represent the majority of malignancies in the oropharynx
• A primary risk factor is high-risk human papillomavirus (HPV), commonly, type 16 in approximately 80% of cases
• Common sites for squamous cell carcinoma are the palatine and lingual tonsils
• Microscopically, these tumors are non-keratinizing squamous cell carcinomas
• HPV-positive cases occur in young, non-smokers, present in high stage, but their overall prognosis is better
• HPV-negative cases are usually in tobacco smokers or alcohol abusers, and have a poor prognosis

Tumors of the Larynx

• Singer’s nodule is a small, benign laryngeal polyp
• This is usually induced by chronic irritation, such as heavy cigarette smoking, and excessive use of the voice
• It is usually localized to the true vocal cords
• Squamous papilloma is a benign neoplasm usually around the true vocal cords
• Though benign, they may rarely undergo malignant change
• It is usually due to low-risk HPV infections (types 6 and 11)
• Juvenile laryngeal papillomatosis can occur in children/adolescents, and may extend into the trachea and bronchi potentially threatening the airway, and recurrence after resection is common
• Squamous cell carcinoma is the most common malignant tumor of the larynx
• It is usually seen in men older than 40 years of age
• It is often associated with both cigarette smoking and alcoholism
• The condition is usually not associated with HPV infection
• Initially present with persistent hoarseness
• Glottic carcinoma arises from the true vocal cords, is the most common laryngeal carcinoma, and has the best prognosis
• Supraglottic and subglottic carcinomas are less common and typically have a poor prognosis