Acquired Disorders of the Nose Flashcards
What is the most common etiology for epistaxis in children?
Nose picking
One should consider asking an adolescent with epistaxis about which type of illicit drug usage?
Cocaine
Name six possible etiologies for epistaxis in the child/adolescent.
Nose picking, trauma, foreign bodies, neoplasms (nasopharyngeal carcinomata, rhabdomyosarcoma, and lymphomata), coagulopathy, and drug use (cocaine).
In which patients with epistaxis should hematologic and coagulation studies be ordered?
If the epistaxis continues to recur or is difficult to correct, perform laboratory evaluation, fully evaluate the nasal passages, and look for other causes of epistaxis.
What is a nasal polyp?
Nasal polyps are benign tumors that form in the nasal passages and are usually due to chronically inflamed nasal mucosa.
If you find nasal polyps in a child <12 years of age, what diagnosis should you consider first?
Cystic fibrosis
Name four conditions associated with nasal polyps in children.
Cystic fibrosis, chronic sinusitis, allergic rhinitis, and Aspirin-exacerbated respiratory disease (AERD).
What are the features of Aspirin-associated respiratory disease (AERD)?
AERD is diagnosed in patients who have (1) asthma and chronic sinusitis with nasal polyposis and (2) acute respiratory tract reactions to ingestion of aspirin and other COX-1 inhibitors.
What is an effective treatment for nasal polyps?
Nasal steroids are quite effective for many polyps, especially in children with cystic fibrosis. Surgically remove polyps if they do not respond to steroids and cause symptomatic obstruction, recurrent sinus infection, or nasal deformity.
What additional workup should be performed in patients who are found to have nasal fractures?
Check all patients for associated injury of the cervical spine, orbits, maxillae, and teeth. Order X-rays as needed based on physical exam findings.
When should an ophthalmology or neurology consult be ordered in a patient who presents with nasal fracture?
If the patient has diplopia, decreased visual acuity, or any sensory or motor defects.
What are some potential complications of an untreated nasal septal hematoma?
A nasal septal hematoma can potentially compromise the septal blood supply, resulting in septal perforation, saddle-nose deformity, or abscess formation.
What diagnosis should be suspected in a patient found to have a swollen, fluctuant, and tender nasal septum?
Nasal septal hematoma.
What prophylactic antibiotic should be prescribed for a patient found to have a nasal septal hematoma?
After the hematoma is drained, the patient should be started on Clindamycin until culture results are available to narrow therapy.
What are the typical pathogens associated with nasal septal hematoma/abscess?
S. aureus, H. influenzae, and S. pneumoniae.
