Conditions of the Nose and Pananasal sinuses Flashcards
how long do viral particles remain viable on skin
up to 2 hours
how are URI viruses tranmitted
hand contact
droplet (sneezing or coughing)
close contact with infected person
what are the common URI virus families
Rhinovirus
coronavirus
adenovirus
parainfluenza
enteroviruses
respiratory synctytial virus(also influenza)
what is the incubation period for URI
24-48 hours - can be up to 8 days after exposure
how are URI’s treated
self limited - usually lasts 5-10 days - can be up to 14 days
symptomatic with OTC medications: analgesics, decongestants, antitussives,etc
what is rhinitis
inflammation of the nasal mucosa
what are the common forms of rhinitis
allergic
vasomotor
rhinitis medicamentosa
What are the treatments for allergic rhinitis
antihistamines
corticosteroids (intranasal)
intranasal anticholinergic
cromolyn
antileukotriene
immunotherapy
What is vasomotor rhinitis
increased secretion from nasal mucosa precipitated by temp or humidity, odors, light, alcohol or neurovascular imbalance
in elderly, increased sensitivity of the vidian nerve, common cause of clear rhinorrhea
tx: avoid irritant
What is rhinitis medicamentosa
rebound congestion from overuse of nasal decongestant
tx: discontinue nasal decongestant (afrin)
What is acute sinusitis/rhinosinusitis (ARS)
inflammation in nasal cavity and para-nasal sinuses
most commonly - viral infection
what are risk factors for ARS
older age
recent URI
chronic rhinitis
cigarette smoking
allergies
what is the treatment for acute bacterial sinutisits
amoxicillin-clavulanate 875mg/125mg for 10-14 days
what are the most common bacterial pathogens for actue bacterial sinusitis
S. pneumoniae, H. influenzae, M. catarrhalis, S. pyogenes, s. aureus
what is chronic sinusitis
single infection lasting > 12 weeks
what are the symptoms of chronic sinusistis
what are the symptoms of chronic sinusitis
persistent rhinorrhea, productive cough, foul breath, low grade fever, malaise, headache, facial or dental pain
what are the most likely chronic sinusitis bacteria
S. aureus, s. pneumo, and anaerobes, fungus; mixed is most likely
what is complicated acute bacterial sinutisis
URGENT referral to otolaryngologist for evaluation and diagnosis
high persistent fever > 102F
periorbital edema, inflammation or erythema
CN palsies
abdominal extra-ocular movements
severe headache, AMS or meningeal sings
What are the different types of nasal obstructions
mucosal disorders
structural disorders
what are the causes of mucosal nasal obstructions
inflammatory
infectious
medications
What is turbinate hypertrophy
inflammation of turbinates resulting in increased congestion and drainage
URI, allergic rhinitis, vasomotor rhinitis, drugs
what is the treatment of turbinate hypertrophy
treat underlying etiology - surgery is last resort
what can cause deviated septums
trauma
CT diseases
drugs - cocaine
post-surgical changes
how do we treat deviated septum
nasal endoscopy
surgery
implants
what is adenoid hypertrophy
chronic inflammation, allegies, chronic sinus symptoms
most common cause of nasal obstruction in a child
what is adenoid facies
open mouth
flattening and elongation of the midface
retraction of upper lip
narrowing of hard palate resulting in crowding of maxillary teeth
what is the most common tumor of the nasal cavity
nasal polyps
what are the treatments of nasal polyps
steroids (oral, topical or intra-polyp injections), avoid ASA, surgical excision or larger polyps, test or treat for allergies
where are FB often found within the nose
floor of nasal passage just under inferior turbinate
or
superiorly in nasal cavity just in front of middle turbinate
what are treatment options for nasal FB
fogarty catheter
katz extractor
forcepts (if you can visualize the object)
irrigation?
what is epistaxis
bloody nose
most common causes: nose picking, dryness, allergic or viral rhinitis, FB, chronic intranasal drug use, blunt trama
what are the most common types of nasal bleeds
anterior bleed at Kiesselbachs plexus
what is the treatment of anterior nose bleeds
clear clots
topical medications (oxymetazoline drops, boyette’s solution)
can add topical tranexamic acid (TXA)
direct pressure ~15 minutes
cauterize, nasal packing as needed
Wha tis the treatment of posterior nose bleeds
balloon catheters: tamponade posterior bleeding
-foley catheter, brighton balloons, simpsons balloons
arterial ligation
angiographic embolization
What is trigeminal neuralgia
rare condition W>M
paroxysmal attacks of usually intense, sharp, superficial or stabbing pain in distribution of one or more branches of fifth cranial (trigeminal) nerve
usually lasts from one to several second but may occur repetitively
