Allergic rhinitis, tinnitus urticaria Flashcards
What is a schwann cell tumor?
slow growing tumors that arise from the vestibular portion of CN VIII
Risk factors for acoustic neuroma
- exposure to radiation of head/neck
2. Neurofibromatosis Type 2
A patient presents with unilateral sensorineural hearing loss and tinitis. What should you suspect?
Acoustic neuroma
What do you order to diagnose an acoustic neuroma?
- Audiometry
2. MRI
Tx of acoustic neuroma.
- Surgery
- Radiation
- Observation
What is tinnitus an early indicator of?
choclear heair cell dysfunction
What differentiates the etiology of pulsatile tinnitus from other types of tinnitus?
vascular etiology.
What commonly causes tinnitis
- ototoxic meds
- presbycusis
- otosclerosis
- vestibular schwannoma
- chari malformations
- barotrauma
What should you do on exam to rule out vascular tinnitis
auscultate for bruits
What is the main goal of treatment with tinnitis?
- lessen awareness and impact quality of life
How should you treat tinnitis?
- behavioral therapies, alprazolam, masking devices
Hallmark sxs of allergic rhinitis?
paroxysms of sneezing, rhinorrhea, nasal obstruction.
What is the typical onset of AR?
< 30, peak in childhood/adolescence
What sort of immune response is present with AR?
- allergic IgE mediated
Important HPE questions when evaluating AR?
- FH of AR, asthma, eczema?
- second hand smoke exposure?
- pets, grass in/around home?
- how is this impacting your life?
What are dennie morgan lines and what condition is associated with them?
skin folds under eyes common w/ allergic conjunctivitis
A patient presents with bluish purple rings around both eyes and complains of nasal congestion and sneezing. what is this type of ecchymosis called and what is your presumptive dx?
- allergic shiners
2. allergic rhinitis
On exam of the eye, what should you find with AR
- bilateral redness of bulbar and palpebral conjunctiva
- tearing/clear discharge
- chemosis
- eyelid edema
What do you look for on inspection of turbinates on a suspected AR pt.?
pale, boggy bluish mucosa
Describe the throat in AR patients.
- post-nasal drainage evidenced by “cobblestoning”
AR is associated w/ what dissease of the ear?
OME, AOM
When doing scratch or prick skin testing, what are you looking for?
“Wheal and flare” reactions w/ in 15-20 mins.
What is the ImmunoCAP test?
detects allergen specific IgE antibodies. Less risky, less sensitive and more expensive
How should you treat AR?
- avoidance of allergens
- oral/IN antihistamines
- IN gulcocorticosteroids
- decongestants
- leukotriene receptor antagonists
How long could it take to clear animal particles?
- 3-6 months
1st generation antihistamines
- chlor-trimeton, benadryl
- alleviate sneezing, rhinorrhea, itching
- dry mouth, constipation, sedation
2nd gen antihistamines
- claritin, allegra, zyrtec
2. less sedating
antihistamine nasal sprays
H1 antagonist, rapid onset, BID
cromolyn spray
mast cell stabilizer, low efficacy, frequent dosing
Nasal steroid sprays
- more effective than oral antihistamines
- lower bioavailability w/ 2nd generation
- adverse effects: epistaxis
Leukotriene receptor antagonist
- Singulair
- less effective than nasal spray
- LTRA + 2nd generation oralantihistamine more relief than any alone
Tx of moderate to severe AR
- 1st line is glucocorticoid nasal sprays: nasonex and veramyst
- can add antihistamine spray, oral antihistamine, cromolyn spray, singulair, antihistamine/degcongestant combo
What is a good drug for pts with AR and asthma?
singulair is a good additive therapy
What can you give pregnant women w/ AR?
- claritin or zyrtec
2. rhinocort, flonase, nasonex (glucocorticoid spray)
What can you give lactating women to treat AR?
- budesonide or cromolyn + zyrtec or claritin
What triggers non-allergic rhinitis?
- autonomic responses
- stress
- sexual arousal
- perfumes
- cigarette smoke
- temperature changes
What sxs characterize non-allergic rhinitis
- nasal congestion, rhinorrhea, postnasal drainage.
NO occular/nasal itching or sneezing
Tx of non-allergic rhinitis
- ipratropium nasal spray
2. adjuncts: oral decongestants, 1st gen antihistamines
Nasal polyp tx
nasal steroid sprays
Nasal polyp sxs
nasal congestion, obstruction.
nasal polyp findings on examination
pedunculated, non-tender grey soft tissue growths associate w/ rhinitis, chronic sinusitis and asthma
what is the cause of rhinitis medicamentosa?
regular (3+ days) use of decongestant nasal spray
Tx for rhinitis medicamentosa
discontinue afrin, start nasal steroid spray
