SPECIAL SENSE

GROUP 9
Agustin Peter Jhonatan Debby Heldayani
Prasetio Deniriawati Dachi
Diwil Hirtiantinit Halawa
Dian Farisa
Dewi Pandiangan
Ditra Koneksi W.
Dina Lesfita
Djones Van E.D.
Afliana Wahyuni
Richard Gunawan Dara Maulyda Putri
Royali Alfindo Fidel Fau
Jenny Dachi
A man aged 10 years came to poly ENT general hospital with
symptoms of nasal congestion muhammadiyah, it is
experienced since the age of 5 years, sneezing found more
than 5 x / x sneeze every morning I wake up, runny nose are
also present, fluid and clear watery mucus, nasal itching
encountered, itchy eyes met.
Sometimes it is also found when the mother of the sick
sweep home carpet. This happened 3 times in a week and a
month occurred 1-2 weeks.
Rinoskopi examination results seem cavity mucosa nasi
anterior and inferior turbinate pale bluish, inferior turbinate
edema, rice pouch narrow, there is no deviation of the nasal
septum. More information allergic shiner (+) and allergic
salute (+).
What happened to the child ?
Clarification Of The Term
Rinoskopi anterior : examination of the front nose
with nasal speculum

Rice cavity mucosa : nasal lining inside

Allergic shiner : symptoms and signs on as itching of

the eyes, redness, swelling and dark blue color of the
skin under the eyes

Allergic salute : rubbing his nose due to itching

Define The Problem
Boy 10 years, complaints of nasal congestion
experienced since the age of 5 years, sneezing
found to be 5 x / x sneezing, runny nose, watery
fluid and clear, nose and itchy eyes

Encountered when the mother of the sick sweep home

carpet. This happened 3 times in a week

Examination results: rinoskopi anterior cavity mucosa

seem rice, pale bluish inferior turbinate, inferior
turbinate edema, narrow rice pouch. Allergic shiner
(+) and allergic salute (+)
Analyze Problems
The presence of allergies and the subsequent release of
inflammatory mediators

Signs of inflammation

Tehadap dust allergy

Temporary Conclusion
Male 10 years experience
allergic rhinitis
V. Learning Objective
A. Definition, Etiology And Epidemiology Of
Allergic Rhinitis
B. Classification And Risk Factors Of Allergic
Rhinitis
C. Pathophysiology And Clinical Symptoms Of
Allergic Rhinitis
D. Anamnesis, Physical Examination,
Investigation Of Allergic Rhinitis
E. Management And Prevention Of Allergic
Rhinitis
F. Complications And Prognosis Of Allergic
Rhinitis
Definition, Etiology And Epidemiology Of
Allergic Rhinitis
A. Definition
Allergic rhinitis is an inflammatory disease that is caused by an allergic
reaction in atopic patients who have previously been sensitized with the same
allergen as well as the release of a chemical mediator in the event of a repeat
exposure to the specific allergen.

B. Etiology
Inhalants allergens, which entered along with breathing air, such as house
dust, mites, epithelial fragments of fur and mushrooms.
Ingestan allergens, which entered into the gastrointestinal tract, such as
food, such as milk, eggs, chocolate, fish and shrimp
Injektan allergens, which is entered through injections or punctures, such as
penicillin or a bee sting.
Kontaktan allergens, which is entered through contact with the skin or
mucosal tissue, such as cosmetics or jewelry
C. Epidemiology

Based on the prevalence, allergic rhinitis has become a global

health problem that is found throughout the world, there are at
least 10-25% of the population with prevalence increasing so the
impact on social life, kenerja at school and work productivity. In
the United States estimated that 40 million people suffer from
allergic rhinitis, or about 20% of the population. Cumulatively
prevalence of allergic rhinitis about 15% in men and 14% in
women, varies in each country. It mungkindiakibatkan because of
geographic differences, the type and potential allergen. Allergic
rhinitis can occur in all races, its prevalence varies depending on
genetic differences, geography, environment, and the amount
populasi.Dalam to do with sex, if allergic rhinitis occurs in
childhood, the men higher than women but in future adult
prevalence is equal between men and women. Viewed in terms of
the onset of allergic rhinitis usually occurs in childhood,
adolescence and young adulthood. Reported that 40% of allergic
rhinitis occurs in childhood. In males occur between the onset of
8-11 years, however, allergic rhinitis can occur at any age.
Classification And Risk Factors Of
Allergic Rhinitis
A. Classification

It is currently used classification of allergic rhinitis based on the

recommendation of the WHO Initiative ARIA (Allergic Rhinitis and its
Impact on Asthma) in 2001, which is based on the nature of the course is
divided into:
Intermittent (sometimes): if the symptoms are less than 4 days / week
or less than 4 weeks.
Persistent / settled when symptoms more than 4 days / week and more
than 4 weeks.
As for the level of severity of the disease, allergic rhinitis is divided into:
Lightweight if not found sleep disturbances, impaired daily activities,
relaxation, exercise, learn, work and other things that annoy.
Medium-heavy if there is one or more of the above disorders
B. Risk Factors

1. family history
2. Asthma
3. High temperatures
4. Exposed to dust mites / exposure to allergens
5. Humidity
6. History hobby gardening / recreation to the
mountains
7. Cigarette smoke
8. Air pollution
9. Smell a strong scent or stimulate
Pathophysiology And Clinical
Symptoms Of Allergic Rhinitis
A. Pathophysiology

Allergic rhinitis occurs when a person inhales or exposure to allergens

(eg, pollen, dust, mold, feathers). then the body will respond produce
chemical compounds called histamine from mast cells. will react to
histamine receptors located in the airways and surrounding areas,
causing symptoms.

B. Clinical Symptoms

Typical symptoms of allergic rhinitis is the presence of repeated

sneezing attacks. Sneezing is considered pathological, if the occurrence
of more than 5 times each attack, as a result of the release of histamine.
Another symptom is the snot (rhinorrhea) were diluted and many, nasal
congestion, itchy nose and eyes, which is sometimes accompanied by
many tears out (lacrimation).
Anamnesis, Physical Examination,
Supporting examination Of Allergic Rhinitis
A. Anamnesis

Of history in patients with allergic rhinitis is common complaints

occurrence of nasal obstruction, nasal discharge, sneezing that happens
repeatedly, itching of the nose and eyes, as well as the disruption of smell

B. Physical Examination

Inspection
The outer shape of the nose note whether there is a deviation or nasal bone
depression. Is there any swelling in the nose and paranasal sinuses.

Palpation
On physical examination, palpation found:
Mucous membranes of the nose swollen, wet (sereous, shiny), turbinate
mucosa pale or purplish due to the widening of the veins (venous).
C. Supporting examination

Nasal cytology examination

Eosinophils count Blood Bank
Skin test
Management And Prevention Of
Allergic Rhinitis
A. Management

1. The most ideal therapy is the allergen causes ( avoidance) and

elimination .

2. Simptomatic
A. Drug
B. Operative
C. Immunotherapy

B. Prevention

The only way to overcome the disease, rhinitis is to avoid things that can
make a sneeze that cold air and dust. Prevention that you can do is to
avoid cold air (put on thick clothes or jacket when the weather is cold,
avoid bathing with IAR is too cold or bathing in cold weather), avoid dust
(diligent clean room, changing bed linen 1x a week, replace cotton
mattress into a foam, avoid the doll) and avoid pets
Complications And Prognosis Of
Allergic Rhinitis
A. Complications

Acute otitis media

paranasal sinusitis
Lower respiratory tract infection
Polyp
Blockage of the eustachian tube

B. Prognosis

Generally good, allergic rhinitis disease as a whole decreases with age, but
increases the possibility of suffering from bronchial asthma.
Spontaneous remission can occur as much as 15-25% over a period of 5-7 years
Patients with allergic rhinitis without complications response to treatment
have a good prognosis.
Prognosis is happening can be affected by many factors including immune
status and anatomical anomalies
Final Conclusion
Male 10 years experience allergic rhinitis (intermittent)
supporting investigation:

1. Examination of ige
2. Allergy test

Management:

1. Provision of antihistamines
loratadine (claritin)
1 tablet (10 mg), once daily
5-10 ml (1-2 teaspoons) once daily (children's formulation)

2. Nasal decongestants
efedrine, a day for children 3 mg / kg of body weight divided into 4-6
equal doses.