8: Stuffy nose Flashcards
Which cytokines are released by mast cells after IgE causes their degranulation?
Histamine
Leukotrienes (interleukins)
What are some examples of
a) topical corticosteroids
b) anti-histamines
c) anti-cholinergics
d) decongestants
used in allergic rhinitis?
a) Beclometasone
b) Cetirizine
c) Ipratropium
d) Pseudoephedrine
Also: montelukast
What are the four core nasal symptoms?
Blocked nose
Discharge
Loss of smell
Facial pain
What are the 4 Ss of nasal symptoms?
Stuffy
Snot
Smell
Sore
What symptoms are seen in allergic nose disease?
Sneezing
Itch
Crusting
Epistaxis
What are the three steps of a nasal examination?
Examine airway patency
Examine external nose
Rhinoscopy
What should you ask the patient to do when you stick a scope up their nose?
Stop breathing
so the lens isn’t steamed up
What is another name for a nasal concha?
Turbinate
Rhinitis can be either ___ or ___.
infective
non-infective
What infection commonly results in infectious rhinitis?
URTI
Non-infectious rhinitis is further divided into ___ and ___ rhinitis.
allergic
non-allergic
What are some associated symptoms that come along with allergic rhinitis?
Sneezing
Itch
Crusty eyes
Watery eyes
What allergens cause allergic rhinitis?
Pollen
Dust mites
Pet hair
What are the two timings of allergic rhinitis?
Intermittent
Persistent
Persistent allergic rhinitis tends to be caused by allergens in your ___.
home
dust mites, cat and dog hair
What terms are used to describe the severity of allergic rhinitis?
Mild
Moderate/Severe
How allergic rhinitis is treated depends on its ___ and ___.
timing - intermittent or persistent
severity - mild or severe
Which antibody mediates allergic disease?
IgE
What is the mainstay for relieving symptoms of allergic rhinitis?
Allergen avoidance
Which drugs are used to treat allergic rhinitis?
Oral antihistamines
Inhaled steroids
+/- cromones, interleukin antagonists
Immunotherapy
What experimental treatment can be done to reduce a patient’s sensitivity to allergens?
Immunotherapy
Why would surgery be indicated for allergic rhinitis?
Chronic inflammation leading to fibrosis and loss of airway function
What nose lesions are seen alongside non-allergic rhinitis?
Nasal polyps
How may nasal polyps be treated if they are causing airway problems?
Oral steroids
then Topical steroids
then Surgery
What are the symptoms of infectious rhinosinusitis?
Blocked nose
Discharge - yellow/green
Facial pain
What causes the vast majority of infectious rhinosinusitis?
Viruses
How is infectious rhinosinusitis treated?
Supportive - analgesia and decongestion
Add antibiotic if persistent
What are some serious complications of infectious rhinosinusitis?
Cavernous sinus compression
Orbital cellulitis
Meningitis
Rheumatic fever
How is non-allergic, non-infective rhinitis treated?
Anti-muscarinics e.g ipratropium
How is allergic rhinitis investigated?
Skin PRICK test (Type I hypersensitivity)
RAST (picks up specific IgE levels)
Which type of imaging isn’t helpful in allergic rhinits?
Nasal / Sinus X-rays
What are some possible triggers for non-allergic rhinitis?
Drugs
Alcohol
How is non-allergic rhinitis managed?
Topical steroid
Antihistamines
Topical anticholinergic for vasomotor rhinitis
How is infectious rhinitis managed?
Analgesia
Decongestants
+/- Topical antibiotic
What can form between the cartilage and bone/soft tissue of the ear/nose in trauma?
Haematoma
Collapse due to necrosis (perichondrium raised off its blood supply)
What surgery can be done to repair a fractured nose?
Rhinoplasty
What type of symptom should make you seriously concerned?
Unilateral
refer them
(Bilateral / unilateral) symptoms should give you serious cause for concern.
Unilateral
