Disorders of the Nose Flashcards
Definition of allergic rhinitis
- inflammation of the mucous membranes of the nose, eyes, eustachian tubes, middle ear, sinuses and pharynx
- triggered by IgE mediated response
Complications of allergic rhinitis
- Otitis media
- ETD
- Sinusitis (acute and chronic)
- impairment in quality of life
What is early response
With allergen re-exposure, the specific protein binds to the IgE on the mast cells resulting in an immediate and delayed release of inflammatory mediators (histamines) which lead to symptoms of AR
What is late response
4-10 hours after allergen exposure, you have a second release of inflammatory mediators (eosinophils), continued inflammation with persistent symptoms
Symptoms of allergic rhinitis
- rhinorrhea
- sneezing
- itching
- post nasal drip/sore throat
- nasal congestion/obstruction
- increased lacrimation/red eyes
- eye swelling
- fatigue/drowsiness
What is allergic salute?
transverse crease across the nasal bridge d/t upward rubbing of the nose
PE of nose in AR
Allergic salute
Nasal mucosa is pale and boggy
thin, watery nasal secretions
What are allergic shiners
dark, swollen, infraorbital tissue secondary to vasodilation and/pr congestion
PE of eyes in AR
conjunctiva injected and edematous with clear drainage
allergic shiners
PE of ears in AR
TM retraction, air fluid levels or bubbles
PE of throat in AR
Pharynx is generally unremarkable
DDX of allergic rhinitis
Nonallergic rhinitis syndromes
What are some diagnostic tests for allergic rhinitis
- Blood (supportive but not sensitive or specific)
i. e. Eosinophils in CBC, IgE elevation - Nasal smears (eosinophils)
- Skin testing (immediate hypersensitivity)
- RAST (radioallergosorbent test)
Allergic rhinitis treatment
- Avoidance of allergens/prevention
- pharmacologic treatment
- immunotherapy
Examples of pharmacotherapy treatment for AR
- Intranasal steroids
- antihistamines
- leukotriene antagonist
- mast cell stabilizer- Cromolyn
What are nasal polyps
-Pale, edematous, mucosally covered masses
Benign
Etiology of nasal polyps
Unknown but thought to be from chronic inflammation
What is acute sinusitis
- sinusitis of
Diagnostic criteria for acute sinusitis
Moderate symptoms for > 10 days
Cause of sinusitis
S. pneumonia
Viral sinusitis
more common than bacterial (rhinovirus, parainfluenza virus, influenza virus)
Bacterial sinusitis
Complicates only .2-2% of viral infections
- S. pneumonia and H. Influenza make up 50-60%
- Moraxella catarrhalis more common in children
Pathophysiology of acute sinusitis
- initiated by viral upper respiratory infection
- mucosal edema, decreased mucus transport and obstruction of ostiomeatal complex which leads to secretions not moving
- stagnant secretions and limited function of the nose promotes bacterial or viral overgrowth
Acute sinusitis complications
- orbital cellulitis
- osteomyelitis of facial bones
- subcutaneous abscesses
- CNS complications
- Potts puffy tumor
What is Potts puffy tumor?
Rare, life threatening
extension of frontal sinus infection resulting in frontal bone osteomyelitis and subperiosteal abscess
Signs/symptoms of acute sinusitis
- Purulent nasal discharge
- facial pain/pressure/fullness
- nasal obstruction
- fever
- halitosis (bad breath)
- dental pain
HPI acute sinusitis
- What are their symptoms and duration of symptoms
- symptomatic OTC treatment
- Ask about risk factors
- others at home or work sick
- prior nasal/sinus history
- trauma
Physical examination finding of acute sinusitis
- Fever
- purulent nasal discharge/post nasal drip
- nasal obstruction
- palpable sinus tenderness (over sinuses/upper teeth)
- swelling, erythema or edema over cheekbone or periorbital area
- transilluminate sinuses
- signs of extra sinus involvement
Distinguishing acute bacterial from viral sinusitis
- signs/symptoms lasting greater than 10 days without evidence of clinical improvement
- worsening after initial improvement
- severe symptoms with fever over 102 and purulent nasal discharge over 3-4 consecutive days
Diagnostic testing for acute sinusitis
- typically no imaging/further diagnostic test indicated
- sinus aspiration and culture is GOLD STANDARD for acute bacterial sinusitis
Symptomatic treatment of acute sinusitis
- analgesics and antipyretics
- fluids
- intranasal corticosteroids
- decongestants
- mucolytics
- intranasal saline irrigation (netipot)
What is the drug therapy for acute sinusitis?
Amoxicillin
-if allergic then bactrim
