Disorders Of Nose + Paranasal Sinuses Flashcards
Acute sinusitis :
Diseases
- Acute viral/BACTERIAL rhinosinusitis
- Nasal Vestibulitis / S. Aureus nasal colonization
- Invasive fungal sinusitis
Acute Bacterial Rhinosinusitis:
Path
- Ostemeatal complex obstruction (sinus pore)
* Impaired mucocilliary clearance
Acute Bacterial Rhinosinusitis:
Top 4 bugs
S. PNEUMONIA
H. INFLUENZA
M. Catarrhalis
S. Aureus
also anaerobe, strep, fungus
Acute Bacterial Rhinosinusitis:
Etiology
Specific to community
Acute Bacterial Rhinosinusitis:
Presentation
Purulent discharge Facial pain/pressure Nasal obstruction Acute s/s onset Min 10 days
W/ cough, malaise, fever, headache
Dx Sinusitis:
2 major S/S
Or
1 major 2 minor S/S
Acute Bacterial Rhinosinusitis:
Tx
NSAID
Oral/nasal decongestants
(Pseudoeph/ oxymetazoline)
Intranasal corticosteroids 5 days
Systemic oral ABX (amoxi, TM-SLF)Sinusitis
Acute vs. Chronic
Acute - <4 weeks
Chronic - >12 weeks
Chronic sinusitis
DX
>12 weeks Objective (PE) evidence - mucosal inflammation \+ 2/4 signs: *Nasal mucupurulent drainage *Nasal obstruction/cong *Facial pain/pressure *Smell loss (kids - cough)
Chronic Sinusitis :
Etiology
Children + adults
Chronic sinusitis:
Tx
No cure
- Intranasal saline
- Topical/systemic steroid
- ABX (topical/syst) - Amoxi-clav or clinda (allergy)
- Antileukotriene (Montelukast)
- Surgery - AFRS
- refer - refractory
Allergic rhinitis:
Etiology
1/6 - 1/2 americans
Allergic Rhinitis :
Path
Exposure airborne allergen
Immune response
Cells - proinflammatory mediators
Allergic rhinitis
Cause - early spring
Tree pollens
Allergic rhinitis :
Spring/summer
Grass pollens
Late summer
Weed pollens
Allergic rhinitis
Cause - Throughout year
Fungi
Household allergens
Allergic rhinitis :
Cause - occupational
Seed dusts, woods, furs, latex, flour, psyllium …
allergic rhinitis:
Present
Clear rhinorrhea Sneezing Tearing, eye inflame Pruritis Ass S/S : cough, bronchospasm, eczematous dermatitis PE: PALE TURBINATES
Allergic Rhinitis:
Tx
AVOID ALLERGEN Intranasal steroid Antihistimine Antileukotrenes Ipatroprium Immunotherapy
Epistaxis:
Etiology
Before age 10
From age 45-65
Epistaxis:
Path
Trauma Dryness FB Rhinitis Intranasal steroid Bleeding disorder
Epistaxis :
Hx - remember
Attempts at control Prior episodes Trauma/surgery Meds/ herbs Bleeding problems
Epistaxis:
Dx
IF uncertain about etiology or prolonged:
CBC
Crossmatch/type
Epistaxis:
Tx - initial tamponade
Lean forward
Blow nose
Spray decongestant
Pinch 15 mins
Epistaxis:
Tx - further treatment
Topical 4% cocaine Gelatin/collagen sponge Cautery Fibrin glue Nasal packing
Epistaxis:
Nasal tampon
ENT w/in 24-48 hrs
ABX
Nose FB :
etiology
Children 2-4 y/o
Noticed by caregiver
FB Nose:
Presentation
Unilateral nasal discharge Halitosis Epistaxis Septal perf Ingestion/Aspiration of FB
FB Nose:
FB location
Nasal floor/inferior turb
Anterior superior middle turb
FB Nose:
Tx
5 mins before, topical anesthetic/vasoconstrictor Positive pressure Balloon Forceps Suction
Nasal polyps :
Etiology
Allergic rhinitis patient
Nasal Polyps:
Tx
Intranasal corticosteroid 1-3 months
Oral corticosteroids 6 day
Surgery
Nasal trauma, PE see septum perf….
EMERGENCY
