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Clinical physiology—ENT:

This overview explores the complex physiology of the nose, emphasizing its role in air filtration, temperature adjustment, and immune response. Key processes involving mucosal surfaces, ciliary action, and the interaction of allergens with mast cells are discussed. Additionally, the pathophysiology and clinical implications of sinusitis, including common causes like ostial obstruction and ciliary dysfunction, are examined. Prof. James Ker's expertise sheds light on conditions such as chronic sinusitis, primary ciliary dyskinesia, and their effects on respiratory health.

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Clinical physiology—ENT:

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  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 ciliarydiskinesia: • 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 • Situsinversus: Kartagener`s

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