Perenial Allergic Rhinosinusitis and OMM

Transcription

1 Perenial Allergic Rhinosinusitis and OMM Robert Hostoffer, DO Devi Jhaveri, DO

2 Allergic Symptoms Sinus Pressure Nasal Congestion Rhinorrhea Post Nasal Drainage

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7 Physical Examination Findings That Suggest Rhinitis General Constitutional symptoms suggest allergic rhinitis. Mouth versus nose breathing is a symptom of chronic congestion. Eyes Allergic shiners (i.e., dark areas under the eyes) suggest allergic rhinitis. Conjunctivitis suggests allergic rhinitis. Ears Air fluid levels can suggest chronic congestion. Nose A deviated or perforated septum and polyps are structural causes of rhinitis. Purulent or bloody discharge can be a sign of sinusitis. Fiberoptic visualization can detect structural causes of rhinitis. Mouth Enlarged tonsils and pharyngeal postnasal discharge are associated with nonallergic rhinitis. Neck Lymphadenopathy suggests an infectious cause of rhinitis. Chest Allergic or atopic disease (e.g., asthma) supports the diagnosis of allergic rhinitis. Skin Allergic or atopic disease (e.g., eczema) supports the diagnosis of allergic rhinitis.

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15 Review Sinus Anatomy

16 Osteopathic considerations

17 Sinus Consideration Autonomic stimulation Mucous drainage Lymphatic drainage

18 Autonomic Stimulation

19 Sympathetic Innervation of the Head and Neck T1-T4

20 Parasympathetic Innervation of Head and Neck Cr Nerves III, VII, IX, X

21 Chapman Reflexes Chapman's reflexes are localized to consistent anatomic landmarks Smooth Firm bead Small 2-3mm in diameter when found alone Discretely palpable or grouped in irregular patches

22 Chapman Reflexes Etiology Over-stimulation of the sympathetic nervous system Resulting in a concentration of ionized fluid.

23 Chapman Reflexes: A viscerosomatic reflex mechanism that has diagnostic and therapeutic significance. a neurolymphatic gangliform contraction that blocks lymphatic drainage, causing inflammation in tissues distal to the blockage, and causes both viseral and somatic tissures to suffer.

24 Chapman Reflexes Eye, Ear, Nose, Throat and Neck: Anterior Middle Ear: Superior Medial Clavicle Nasal Sinus: Inferior Medial Clavicle Pharynx: inferior sternoclavicular joint Tonsils: 1 st ICS, just lateral to the sternum Retina, Conjunctiva: Lateral upper humerous Neck: Medial upper humerous

25 Posterior points

26 Mucous Drainage

27 Muco-ciliary movement

28 Sinus Effleurage To effleurage is to move in a stroking massage movement to move lymphatic fluids. Excessive mucus production, and decrease of ciliary motility can all be modified using effleurage. Effleurage will promote lymphatic drainage in both allergic or infective pathology. Effleurage of the anterior cervical chain towards each lymphatic duct and ultimately the heart will eventually promote health.

29 Positioning The patient is supine. With repetitive strokes, the thumbs are brought across the frontal maxillary sinuses from medial to lateral finishing at a point near the ear lobes. The thumbs should be used to milk the lymphatic fluid down the anterior aspect of the sternocleidomastoid muscle belly along the anterior cervical lymphatic chain towards the heart. Repeat this technique for complete drainage.

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33 Lymphatic Drainage

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35 Mandibular Drainage of Galbreath A passive soft tissue technique is used to induce jaw motion to create increased drainage of middle ear and tonsillar areas via the eustachian tube and lymphatics. This technique can be used for chronic otitis media.

36 Positioning The patient is supine and the doctor is behind patient, while stabilizing the head and placing traction on the mandible. With a pumping action, the fascia of the Eustachian tube via the mandible is brought anteriorly and medially across the face a short distance, multiple times on each side of the head. The procedure is done for 30 seconds on each side for up to three times a day.

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38 Ear Pull Technique A gentle bilateral ear pull will help mobilize the underlying fascia and the temporal bones. The physician will notice that one side may be less mobile and may require longer to feel a release. The side that is more medial often correlates with an internally rotated temporal bone.

39 Positioning The patient is supine. The doctor is behind the patient. A gentle force is applied to the bilateral pinnae until the pinnae becomes more mobile. The earpull is helpful in infants but may not be useful in children that are moving around.

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41 Continue lymphatic drainage caudad Thoracic Inlet release Rib Raising Redoming of thoracoabdominal diaphragm

42 Innervation Table Organ/System Parasympathetic Sympathetic Ant. Chapman's Post. Chapman's EENT Cr Nerves (III, VII, IX, T1-T4 T1-4, 2 nd ICS Suboccipital Heart X) Vagus (CN X) T1-T4 T1-4 on L, T3 sp process Respiratory Vagus (CN X) T2-T7 T2-3 3 rd & 4 th ICS T3-5 sp Esophagus Vagus (CN X) T2-T8 --- process --- Foregut Vagus (CN X) T5-T9 (Greater Splanchnic) Stomach Vagus (CN X) T5-T9 (Greater Splanchnic) 5 th -6 th ICS on T6-7 on L Liver Vagus (CN X) T5-T9 (Greater Splanchnic) L Rib 5 on R T5-6 Gallbladder Vagus (CN X) T5-T9 (Greater Splanchnic) Rib 6 on R T6 Spleen Vagus (CN X) T5-T9 (Greater Splanchnic) Rib 7 on L T7 Pancreas Vagus (CN X) T5-T9 (Greater Splanchnic), T9- T12 (Lesser Splanchnic) Rib 7 on R T7 Midgut Vagus (CN X) Thoracic Splanchnics (Lesser) Small Intestine Vagus (CN X) T9-T11 (Lesser Splanchnic) Ribs 9-11 T8-10 Appendix T12 Tip of 12 th Rib T11-12 on R Hindgut Pelvic Splanchnics (S2- Lumbar (Least) Splanchnics Ascending Colon 4) Vagus (CN X) T9-T11 (Lesser Splanchnic) R T10-11 Transverse Colon Vagus (CN X) T9-T11 (Lesser Splanchnic) hip Near Knees --- Descending Colon Pelvic Splanchnic (S2-4) Least Splanchnic L hip T12-L2 Colon & Rectum Pelvic Splanchnics (S2-4) T8-L