Common Conditions of the Nose Flashcards
How does the nose warm and humidify the air?
Turbinates direct air flow
Which sinuses drain to the middle meatus?
Maxillary
Frontal
Anterior ethmoids
Which sinuses drain to the superior meatus?
Sphenoid
Posterior ethmoids
What are common nasal symptoms?
Blockage Congestion Rhinorrhoea Sneezing Irritation Post-nasal drip Loss of olfaction Epistaxis Facial pressure/pain
What symptoms arise from pathology affecting the orbits and lacrimal system?
Blockage of nasolacrimal apparatus > epiphora
Diplopia
- Due to displacement of axis of globe
- Ophthalmoplegia due to mechanical restrction of extra-ocular muscles
When can you get a raccoon eye?
Base of skull fracture
Procedures around nose
What symptoms arise from pathology affecting the base of the skull?
CSF rhinorrhoea
Mechanial restriction of airflow to olfactory region/neurological deficit > change in smell
Frontal lobe lesion > change in cerebral function
How can you detect CSF rhinorrhoea?
Doulbe ring sign on blotting paper
Measure
- Glucose
- Beta-2 transferrin = gold standard
What symptoms arise from pathology affecting the oral cavity and teeth?
Dental pain
Discharge through oro-antral fistula
What can cause the formation of an oro-antral fistula?
Traumatic tooth extraction
Chronic infections
What symptoms arise from pathology affecting the post-nasal space and auditory tube?
Nasal obstruction
Middle ear effusion
Why do persisting unilateral middle ear effusions need further investigation?
Rule out post-nasal tumours
What is Horner’s syndrome?
Miosis
Anhydrosis
Ptosis
What can Horner’s syndrome be a sign for?
Gastric tumours, and others
What is the significance of aspirin intolerance in nasal pathology?
Samter’s triad
- Aspirin intolerance
- Asthma
- Nasal polyps
What features of history are important in nasal pathology?
Smoking Drug Hx Aspirin intolerance Asthma Allergic Hx Age FHx - ENT cancers
In which lung condition are polyps common?
Cystic fibrosis
What is rhinitis?
Inflammation of nasal mucosa
What are the causative groups of rhinitis?
Allergic Infectious Occupational Drug induced Hormonal Idiopathic
What is intermittent allergic rhinitis?
Less than 4 days/week or <4 weeks
What is persistent allergic rhinits?
More than 4 days/week for >4 weeks
What are the symptoms of allergic rhinitis?
Clear rhinorrhoea
Nasal blockage
+/- itching of nose
Sneezing
What is the management for mild intermittent allergic rhinitis?
Oral/local non-sedative H1 blocker
Intra-nasal/oral decongestant
Allergen and irritant avoidance
What is the management for moderate-severe intermittent allergic rhinitis?
Oral/local non-sedative H1 blocker Intra-nasal/oral decongestant Allergen and irritant avoidance Intra-nasal steroid Local cromone
What is the management for persistent allergic rhinitis?
Oral/local non-sedative H1 blocker Intra-nasal/oral decongestant Allergen and irritant avoidance Intra-nasal steroid Local cromone Consider immunotherapy
What is rhinitis medicamentosa?
Inflammation of nasal mucosa secondary to prolonged alpha agonist topical medications
What are the symptoms of rhinitis medicamentosa?
Clear rhinorrhoea
Marked nasal congestion > obstruction > progressively less well controlled by topical medication
What is infectious rhinitis called?
Rhinosinusitis
What are the symptoms of viral rhinosinusitis?
Less than 10 days
Rhinorrhoea
Blockage
Itching
What are the common causes of viral rhinosinusitis?
Rhinovirus
What is the duration of symptoms for acute non-viral rhinosinusitis?
Symptoms increase after 5 days
Last >10 days
Less than 12 weeks
What is the usual duration of rhinosinusitis?
Less than 2 weeks
What are the common symptoms of rhinosinusitis?
Clear/purulent rhinorrhoea Nasal congestion/obstruction Sneezing Nasal irritation Epiphora
What is the most common site of anterior epistaxis?
Anterior septum - confluence of multiple vessels
How is anterior epistaxis controlled?
Direct pressure
Where is posterior epistaxis most commonly felt?
Dripping down back of throat
What is the common artery that bleeds in posterior epistaxis?
Sphenopalatine
How is posterior epistaxis controlled?
Nasal packing - usually kept in for 1-2 days
How is a nasal fracture confirmed?
No indication for imaging unless suspecting
- Other facial fractures
- Skull base disruption
- Central signs
What raises your suspicion of a skull base fracture?
Mechanism of injury CSF rhinorrhoea/othorrhoea Raccoon eyes Battles sign Haemotympanum Subconjunctival haemorrhage with no posterior margin
If left untreated, what can a septal haematoma progress to?
Septal abscess > cartilage destruction > saddle nose deformity
What is the management of a septal haematoma?
Immediate ENT referral for
- Drainage of haematoma
- Possible nasal bone manipulation
What are the likely bacterial organisms that cause acute rhinosinusitis?
Upper respiratory tract pathogens
- Streptococcus pneumoniae
- Haemophilus influenzae
- Moraxella catarrhalis
What are symptoms of orbital spread of the infection from the paranasal sinuses?
Eye pain and swelling
Double vision
Ophthalmoplegia
What is an initial sign of increased intra-orbital pressure?
Red-green colour vision disturbance
What is the management for chronic rhinosinusitis?
Nasal steroid spray
- Mainstay of therapy
Saline nasal douche
Abx if purulent
What bacteria cause chronic rhinosinusitis?
Similar to acute rhinosinusitis
Staphylococcus aureus
Anaerobes
What is FESS?
Functional Endoscopic Sinus Surgery
What is the aim of FESS?
To open sinuses and return them to premorbid functioning state
Allows medical therapy to enter
