1. Clinical physiology—ENT: Prof James Ker MBChB, MMED, MRCP, FRCP, PhD, FESC, FACC, L.Akad.SA

2. The nose: The nose presents a large mucosal surface area through the folds of the turbinates. Serves to adjust the temperature and moisture content of inhaled air. Filters out particulate material >10 ᵤm in size

3. Does this by impingement in a mucous blanket Ciliary action moves the entrapped particles toward the pharynx Entrapment of pollen in mucous blanket:

4. Digestion of the outer coat by mucosal enzymes (such as lysozymes) This releases protein allergens (10 000-40 000 molecular weight) This interaction between protein allergens and mast cells: 2 types

5. Intraepithelial and perivenular mast cells Both are sensitized with specific IgE Which Ig`s in mucous layer: IgA, E or both IgE diffuses from plasma cells IgA secreted IgE fixes to mucosal and submucosal mast cells Clinical response related to pollen dose

6. For clinical insight: Antigens Haptens Superantigens

7. Immediate hypersensitivity reactions Delayed hypersensitivity reactions Cytotoxic reactions Immune complex formation Clinical implications: Immediate vs late clinical presentations Vasculitic associations of allergic disease

8. Sinusitis: This term refers to an inflammatory condition involving one or more of the four paired structures surrounding the nasal cavities. Maxillary sinus most commonly involved Then: Ethmoid, frontal and sphenoid

9. Each sinus is lined by respiratory epithelium that produces mucus. Mucus: Transported out by ciliary action through sinus ostia and into the nasal cavity. Mucus remain sterile, despite the proximity to bacteria filled nasal passages

10. 3 physiological disturbances that lead to infective sinusitis: Obstruction of the ostia Impaired clearance of mucus due to ciliary dysfunction Immunological disturbance

11. Immunoglobulin deficiency (IgG1-4) Cystic fibrosis Primary ciliary disorders

12. Primary ciliary diskinesia: Inherited in autosomal recessive fashion Numerous defects: Structural abnormalities in dynein arms, radial spokes, microtubules. The cilia become dyskinetic and their coordinated, propulsive action is diminished Thus, bacterial clearance is impaired

13. Clinical effects: Recurrent upper and lower respiratory tract infections,such as sinusitis, otitis media, bronchitis, pneumonia Long term: Bronchiectasis Impaired motility of sperm: Infertility Situs inversus: Kartagener`s