Diseases of nose and paranasal sinuses Flashcards
Folliculitis of nasal vestibule
presence of inflammation (staphylococcal infection) within the wall and ostia of the hair follicle, creating a follicular-based pustule.
Clinical features of Folliculitis and furunculitis of nasal vestibule
pain and sensitivity to pressure, followed by redness and swelling of the tip of the nose and/or nasal ala and the upper lip.
treatment of Folliculitis and furunculitis of nasal vestibule
local antibiotic creams if a furuncle is forming — oral or i.v. antibiotics are administered.
rhinosinusitis
inflammation of the paranasal sinuses and nasal cavity
Rhinosinusitis s characterised by two or more symptoms name them
One of them should be either nasal blockage (obstruction, congestion) or nasal discharge in adults (anterior or posterior nasal drip), respectively, or a cough in children.
Another symptom is facial pain (pressure) and/or reduction (loss) of smell
Endoscopic signs of rhinosinusitis
polyps or mucopurulent discharge primarily from the middle meatus
and/or oedema (mucosal obstruction) primarily in the middle meatus must be present
Acute vs chronic rhinosinusitis
acute, lasting more than 10 days and less than 12 weeks with complete resolution of the symptoms. Chronic rhinosinusitis lasts more than 12 weeks without complete resolution of the symptoms.
Acute rhinosinusitis can be divided into several subgroup name them
subgroups: Common cold/acute rhinosinusitis
Acute post-viral rhinosinusitis
Acute bacterial rhinosinusitis
Acute post-viral rhinosinusitis
defined as an increase of symptoms after 10 days with less than 12 weeks of duration
Onee must have at least one of these features of Acute bacterial rhinosinusitis
Discoloured discharge and purulent exudate in the nasal cavity
Severe local pain (with unilateral predominance)
Fever (38°C or higher)
Elevated erythrocyte sedimentation rate/CRP
“Double sickening” – deterioration after an initial milder phase of illness
Aetilogy of Acute bacterial rhinosinusitis
after a course of viral sinusitis.
Typical pathogens include Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Staphylococcus aureus
Treatment in adult patients. Supportive therapy for acute rhinosinusitis
analgesics/ antipyretics for pain and fever,
intranasal saline irrigation,
short-term use of intranasal steroids,
especially in patients with allergic rhinitis, and topical nasal decongestant
The following risk factors for antibiotic resistance should be considered for an appropriate choice of antibiotics
age older than 65 years, antibiotic use within the past 1 month, immunocompromised host, and presence of medical comorbidities.
Treatment in children Acute bacterial rhinosinusitis
. Intranasal steroids
antibiotics in the empiric treatment
Allergic rhinitis
nasal inflammation caused by allergic reaction to airborne allergens and is an extremely common condition
Clinical features of Allergic rhinitis
rhinorrhoea,
sneezing,
pruritus,
and conjunctivitis.
The mucosa of the nasal turbinates may be swollen and have a pale, bluish-grey colour.
Some patients may have predominant erythema of the mucosa.
Thin, watery secretions are frequently associated with allergic rhinitis,
Possible complications of Allergic rhinitis
otitis media, Eustachian tube dysfunction, acute sinusitis, and chronic sinusitis
Allergic rhinitis can be associated with a number of comorbid conditions
asthma,
atopic dermatitis,
and nasal polyps
DX of Allergic rhinitis
clinically on the basis of a history and rhinoscopic examination and/or skin testing
Treatment of allergi rhinitis
three major categories of treatment: environmental control measures and allergen avoidance,
pharmacological management (antihistamines, decongestants,
intranasal steroids and cromolyns),
and immunotherapy
Pseudoephedrine: function and SEs
(oral or intranasal) is used to relieve congestion. If overused, it causes severe rebound congestion, leading to rhinitis medicamentosa
Chronic sinusitis is almost always accompanied by
Chronic sinusitis is almost always accompanied by concurrent nasal airway inflammation and is often preceded by rhinitis symptom
CRS is associated with
asthma and allergic rhinitis.
Clinical features of CRS
nasal obstruction,
discharge,
hyposmia,
cough,
congestion
and postnasal drip
functional endoscopic sinus surgery (FESS
This involves visualisation of the nasal cavity and sinuses using rigid endoscopy. The surgeon removes any tissues that are blocking the drainage of the affected sinus. This can improve sinus drainage and ventilation and help to restore normal function to the sinuses
Nasal polyps Definition
an end result of varying disease processes in the nasal cavity.
benign, semi-transparent nasal lesions
arise from the mucosa of the nasal cavity or from one or more of the paranasal sinuses, often at the outflow tract of the sinuses
Polyp development has been linked to
chronic inflammation, autonomic nervous system dysfunction, allergy, and genetic predisposition
Clinical features of polyps
nasal airway obstruction, postnasal drainage, dull headaches noring, hyposmia and rhinorrhoea obstructive sleep symptoms and chronic mouth breathing
treatment of polyps
Corticosteroids are the treatment of choice, either topically or systemically. Surgical intervention (FESS) is required for patients with multiple polyposis or chronic rhinosinusitis who fail maximum medical therapy
Osteomyelitis (“Pott’s puffy tumour”)
frontal rhinosinusitis resulting in a subperiostal abscess.
Clinical features of osteomyelitis
prominent frontal swelling
Osteomyelitis treatment
drain the abscess and responsible paranasal sinuses,
remove the infected bone, and
direct a six-week regimen of intravenous antibiotics
Aetiology of Orbital complications in children
Streptococcus and Staphylococcus
Aetiology of Orbital complications in adults
Streptococcus pneumoniae,
Haemophilus influenzae,
and Moraxella catarrhalis usually affect adult patients
A classification scheme that categorises the various forms of orbital complications of rhinosinusitis and triages them in increasing severity
preseptal cellulitis,
orbital cellulitis,
subperiosteal abscess,
orbital abscess, and
cavernous sinus thrombosis
Nasal papilloma may be caused by
tissue injury
Inverted papillomas are
nasal tumours that originate in the mucous membrane of the nasal cavity and paranasal sinuses. They tend to invert into the underlying connective tissue stroma, which differs from other types of papillomas
most common presenting symptom of patients with inverted papillomas + other symptoms
Unilateral nasal obstruction
epistaxis, nasal discharge, epiphora, and facial pain.
Physical examination in Dx of inverted papilloma
unilateral polypoidal mass filling the nasal cavity and causing nasal obstruction
Morphology of inverted papillomas
Papillomas have an irregular, friable appearance, and they often bleed when touched.
Septal haematoma is
The accumulation of blood between the perichondrium and septal cartilage.
Aetiology of Septal haematoma
It is caused by trauma to the external nose or septum. Blunt nasal trauma can lead to elevation of the mucoperichondrium/mucoperiosteum from the underlying cartilage/bone.
A haematoma forms in the newly created perichondrial/periosteal space on one or both sides
Aetiology of septal abscess
. Infection of the haematoma
After septal surgery
Sx of Septal haematoma and septal abscess
Increasing nasal obstruction,
tenderness, and pain.
If an abscess forms, pain increases, and the patient complains of
headache, fever, and redness of the bridge of the nose
Tx of Septal haematoma and septal abscess
Urgent drainage is indicated for all nasal septal haematomas.
Needle aspiration under topical anaesthesia can be performed and systemic antibiotics should then be administered.
To drain the haematoma or abscess, incise the mucosa over the area of greatest fluctuance without incising cartilage. D
Local causes of epistaxis
Environmental influences
Foreign body
Idiopathic
Infection
Trauma
Tumour
Systemic causes of epistaxis
Anticoagulants
Endocrine
Haematological diseases
Hereditary haemorrhagic telangiectasia (Osler`s disease)
Hypertension
Types of epistxis
Anterior
Posterior
The most common site of bleeding in epistaxis
anterior nasal septum (90% of cases) due to its rich blood suppl
an anastomotic network of vessels located on the anterior cartilaginous septum
Kiesselbach plexus, or Little’s area
Kiesselbach plexus, or Little’s area blood supply origins
internal carotid artery and the external carotid artery
Complications of posterior epistaxis
present a greater risk of airway compromise, aspiration of blood, and greater difficulty controlling bleeding.
Treatemnt of epistaxis
Cauterisation
anaesthetic-vasoconstrictor solution
chemical cauterisation using a silver nitrate stick
Thermal cauterisation is reserved for more aggressive bleeding
Anterior nasal packing
to stop anterior bleeding, the nasal cavity should be packed with ribbon gauze impregnated with petroleum jelly/Vaseline
Posterior nasal packing
passing a catheter through one nostril, through the nasopharynx, and out the mouth
double balloon devices that have separate anterior and posterior balloons.
Surgical epistaxis intervention
Endonasal ligation of the sphenopalatine artery or the internal maxillary artery usually controls the bleeding
Clinical features of choanal atresia
Unilateral choanal atresia t presents as a unilateral nasal discharge until later childhood or even adulthood.
Bilateral atresia, on the other hand, almost always presents as a respiratory emergency and is apparent at birth
Dx. of choanal atresia
inability to pass a feeding catheter at least 3 cm through the nose into the nasopharynx.
In addition, direct observation with nasal endoscopy and
CT scanning are essential to determine the type of obstruction
Treatment of choanal atresia
Immediate management of bilateral atresia involves training the infant to breathe through the mouth with the aid of an indwelling oral appliance; a plastic oropharyngeal airway may be placed temporarily
A nasal foreign body should be suspected in all cases of
unilateral childhood rhinorrhoea.
The most common signs and symptoms of foreign bodies
nasal obstruction,
foetor,
unilateral rhinorrhoea
and bleeding
