2- Nose (common conditions) Flashcards
Nasal polyps
Background
- Fleshy, benign swelling of the nasal mucosa
- Usually bilateral: common (>40 years)
- Unilateral polyps -> red flag and should raise suspicions of tumour
causes of nasal polyps
They result from chronic inflammation and are associated with:
- Chronic rhinitis
- Asthma
- Samters triad (nasal polyps, asthma and aspirin allergy)
- CF
- Eosinophilic granulomatosis with polyangiitis (Churg- Strauss)
presentation of nasal polyps
- Polyps look slightly lighter
- In this pic: Emerge out of the middle meatus (between middle and inferior turbinate’s)
- Pale or yellow in appearance/ fleshy and reddened
Symptoms
- Blocked nose and water rhinorrhoea
- Post-nasal drip
- Drip goes into the pharynx and larynx- irritation and cough
- Decrease smell and reduced taste
- Sinusitis- blockage of the sinus air cavities
- Unilateral poly +/- blood tinged secretion may suggest tumour – cancer
nasal polyp red flag
- Blocked nose and water rhinorrhoea
- Post-nasal drip
- Drip goes into the pharynx and larynx- irritation and cough
- Decrease smell and reduced taste
- Sinusitis- blockage of the sinus air cavities
- Unilateral poly +/- blood tinged secretion may suggest tumour – cancer
Management of nasal polyps
- Topical or systemic corticosteroids
- Possible surgery as last option (functional endoscopic sinus surgery)
–> Intranasal polypectomy
–> Endoscopic nasal polypectomy (when deeper in the nose or sinuses)
Rhinitis
Background
- Inflammation of the nasal mucosa lining
- Entire nasal cavity affected- bilateral
causes of rhinitis
- Simple acute infective rhinitis (viral- common cold)
- Allergic rhinitis- similar symptoms to infective rhinitis
presentation of rhinitis
- Nasal congestion
- Rhinorrhoea – runny nose
- Sneezing
- Nasal irritation
- Postnasal drip
management of rhinitis
Management
- Topical/ oral nasal antihistamines
- Topical intranasal steroids
- Nasal saline wash
sinusitis background
Inflammation of the mucous membrane of the paranasal sinuses
- Acute <3 weeks (some sources say <12 weeks)
- chronic >3 months
paranasal sinuses
- Paranasal sinuses are air filled spaces lined with resp mucosa and therefor have cilia and goblets cells – extensions of the nasal cavity
- Sinuses drain into nasal cavities via ostia’s into a meatus most commonly the middle meatus
pathophysiology of sinusitis
- Infection leads to reduced ciliary function, oedema of nasal mucosa and sinus ostia and increased nasal secretions that cant drain due to ostia blockage
- Maxillary most commonly affected due to gravity- ostia is high up
- Stagnant secretions- breeding ground for bacterial infection
causes of sinusitis
usually viral infection (URTI)
- Rhinovirus
- Parainfluenza virus
which bacteria cause sinusitis
only 3%
- Streptococcus pneumonia
- Haemophilus influenzae
presentation of sinusitis
- Coryzal symptoms- yellow sputum – recent URTI
- Facial pain- esp when looking down
- Headache
- Nasal discharge
- Loss of smell
- Nasal obstruction
- Vertigo if mucus builds up in eustachian tube
- Ear pain, tiredness
management of sinusitis
- Analgesia
- Intranasal decongestants and nasal saline
If symptoms don’t improve after 10 days
- Intranasal corticosteroids for 14 days if symptoms present for more than 10 days e.g. mometasone
- Oral abx e.g. phenoxymethylpenicillin if severe presentation
chronic sinusitis
> 3 months
causes of chronic sinusitis
- Allergies esp hay fever and environment allergies
- Nasal polyps/ Deviated septum
- Resp tract infection
investigations for chronic sinusitis
Investigations
- Nasal endoscopy
- CT scan