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Clinical physiology—ENT: Prof James Ker MBChB, MMED, MRCP, FRCP, PhD, FESC, FACC, L.Akad.SA
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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
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Does this by impingement in a mucous blanket Ciliary action moves the entrapped particles toward the pharynx Entrapment of pollen in mucous blanket:
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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
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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
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For clinical insight: Antigens Haptens Superantigens
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Immediate hypersensitivity reactions Delayed hypersensitivity reactions Cytotoxic reactions Immune complex formation Clinical implications: Immediate vs late clinical presentations Vasculitic associations of allergic disease
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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
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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
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3 physiological disturbances that lead to infective sinusitis: Obstruction of the ostia Impaired clearance of mucus due to ciliary dysfunction Immunological disturbance
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Immunoglobulin deficiency (IgG1-4) Cystic fibrosis Primary ciliary disorders
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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
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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
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