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Learning Objectives
The student will be able to distinguish the acute and chronic forms of rhinitis and sinusitis in terms of their etiologies, histologic appearance, and resolution.
The student will be able to enumerate the common neoplastic diseases of the sinuses and nasopharynx and the frequency of benign versus malignant growth.
The student will be able to describe the range of disease types and severities that may involve the larynx, including the vocal chords and upper trachea, and when neoplastic, the likelihood of their progression to malignancy and metastasis.
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Given their proximity to the environment, it is not surprising that the nasal cavities, sinuses, oropharynx, and trachea are all sites for infectious, inflammatory, and neoplastic diseases. As detailed in Chaps. 2 and 10, much of the lung's conducting zone is well constructed to warm, humidify, and cleanse the inspiratory gas stream while maintaining physical barriers to aspiration events during eating, drinking, and speech. This chapter will focus on diseases that bear directly on respiratory function and pulmonary medicine rather than provide a compendium of all illnesses that might properly be considered the clinical domain of otolaryngology. Students are encouraged to consult adjoining chapters in this book for more specific details regarding anatomical landmarks, histologic configurations, and regional host defense mechanisms.
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DISEASES OF THE NOSE, SINUSES, AND NASOPHARYNX
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Infections and Inflammatory Processes
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Inflammatory diseases are the most common disorders of the nose and its accessory paranasal sinuses. Rhinitis, or inflammation of the nasal mucosa, may be either infectious or allergic in its etiology. Nasal and sinus infections are usually viral in origin, particularly with adenoviruses, echoviruses, and rhinoviruses. Macroscopically, the affected areas appear red and swollen and may express copious watery exudates, all of which narrow or occlude nasal air passages and increase dynamic upper airway resistance. The histologic presentation is of respiratory mucosal edema, often with inflammatory cell infiltrates. Secondary bacterial infections are common in this setting, in which case neutrophilic influx and purulence are prominent. Uncomplicated cases of acute rhinitis normally resolve in 5-7 days in the immunocompetent host, although sequential infection of deeper airways can occur. As for viral and bacterial infections of the lung parenchyma, treatment options for rhinitis vary from curative to palliative depending upon the pathogen.
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Allergic rhinitis, or hay fever, is caused by IgE-mediated reactions to any of the numerous allergens that are known to affect specific individuals. As many as 20% of the American public is affected by such seasonal disease, with the most common irritants as in asthma being plant pollens, fungi, animal dander, and insect droppings (Chap. 21). In such settings, there is also marked mucosal edema and redness of the affected nasal passages, while histologically the inflammatory infiltrates are often distinctly eosinophilic in composition. Nasal polyps are focal, usually non-neoplastic protrusions that commonly arise in ...