Disorders of the Nose Flashcards
Definition of rhinosinusitis (6)
inflammation of nose+paranasal air sinuses+2 of: -congestion/discharge -decreased smell -facial pain/pressure -cough -endoscopic signs of polyps/mucous+/-pus discharge from sinuses -CT shows mucous w/i sinuses (chronic rhinosinusitis defined as >3mo)
Rx of rhinosinusitis (3)
mild(<5d):analgesia+phenylephrine
worse after 5d: topical steroids
severe(temperature+severe pain):topical corticosteroids+amoxicillin
Main causes of nasal congestion in children (5)
rhinitis
choanal atresia (congenital blockage of back of nasal passage)
large adenoids
foreign body
tumour
Main causes of nasal congestion in adults (4)
deflected nasal septum
topical vasoconstrictors
granulomatous disease
TCAs
Features and Sx of allergic rhinosinusitis (5)
IgE mediated
can be seasonal of perennial
Sx:
- sneezing
- rhinorrhoea
- pruritus
Rx options for allergic rhinosinusitis (6)
antihistamines 1st line:
- citirazine
- loratidine
nasal steroids e.g. beclometosone 2nd line-can develop tachyphylaxis
may require course of oral corticosteroids
oral decongestants e.g. pseudoephidrine
nasal alpha agonists e.g. sodium cromoglycate,
oxymetazoline
leukotriene receptor anatgonist e.g. zafirlukast
Other causes of chronic rhinorrhoea/rhinitis (18)
allergies foreign bodies CSF old-age fungal infections HIV bacteria CF kartagener's RA atrophic pregnancy COCP Beta blockers NSAIDs decongestant overuse Ab deficiency non-allergic rhinitis w. eosinophilia atrophic
Features and associations of nasal polyps (8)
ciliary columnar epithelium
assoc. w.:
- allergic/non-allergic sinusitis
- chronic ethmoid sinusitis
- CF
- aspirin hypersensitivity
- asthma
- kartagener’s
- Churg-Strauss
Symptoms of nasal polyps (9)
watery anterior rhinorrhoea
anosmia/taste disturbance
purulent post-nasal drip
snoring
change in voice
nasal obstruction
sinusitis
headaches
mouth breathing
appearance of nasal polyps (3)
pale
immobile
insensitive to gentle palpation
Rx of nasal polyps (2)
nasal steroid drops (beclometasone)
endoscopic polypectomy-do CT before if unusual anatomy.
Symptoms of sinusitis (7)
pain:
- cheek(maxillary), between eyes (ethmoid)
- facial fullness
- worse leaning forward
discharge
anosmia
obstruction/congestion
systemic symptoms
DDx for sinusitis (6)
migraine
TMJ dysfunction
GCA
Cervical spine disease
neuralgias
VZV
Causes of sinusitis (6)
most after viral infection
direct spread
odd anatomy
mechanical ventilation/NGT
systemic e.g. kartagener’s, immunodeficiency
biofilms
common organisms involved in sinusitis (4)
rhinovirus main one
staph aureus following viral URTI
pseudomonas
strep pneumoniae
Ix for sinusitis
ESR/CRP more reliable than CT
Rx of sinusitis (3)
decongestant+paracetemol 1st line
if prolonged then amoxicillin (+steroids for Sx)
if chronic/recurrent:
- endoscopic surgery to remove sinus mucosa
- fluticasone nasal spray after helps
Complications of sinusitis (6)
orbital cellulitis
post-nasal drip
osteomyelitis
subperiosteal abscess
intracranial infection
mucocele>infected procele
assoc. and presentation of adenocarcinoma of the maxillary sinus (4)
assoc. w. wood inhalation
presents w. unilateral blocked nose, bleeding and paraesthesia on cheek.
Features and Ix for sinus fungal balls
sinusitis which fails to respond to Abx
CT shows round opacity w. mixed density
Features of sinus polyps
swelling coming from sinus seen on CT scan
often in ethmoid sinus
Mx of nasal fractures (3)
may not require intervention if undisplaced
if displaced, will need reduction under GA w. post-op splintage w/i 10-14d
if reduction unsuccessful, may require septorhinoplasty
(temporal bone fracture may transect VIIth and VIIIth nerves)
Causes and Ix for CSF rhinorrhoea (3)
ethmoid trauma-think fractured cribriform plate
if not trauma then tumour
Ix:
-electrophoresis to detect B2-transferrin in CSF.
Feature and causes of septal perforation
whistling noise when breathing out
relapsing polychondritis
sniffing salts/cocaine
malignancies e.g. rodent ulcer
nasal steroid/decongestant
chronic inflammatory/granulomatous disease
Features, presentation and Rx of septal haematoma (4)
blood between peri-chondrium and septal cartilage
presents w. asymmetrical septum and bluish-reddish fluctuance
can become infected so needs immediate drainage.
complications of nasal surgery(3)
bleeding
CSF leak
altered sensation on lips/gums/incisors
Causes of epistaxis (9)
trauma
infection
HTN (usually prolongs)
dyscrasias
hereditary: vWf, haemophilia, Osler-Weber-Rendu
increased alcohol intake
septal perforation
neoplasm
septal haematoma
Types of epistaxis (2)
anterior: almost always little’s area
posterior: may require more invasive Ix e.g. under GA
Kiesselbach’s Plexus
LEGS:
- labial (superior)
- ethmoidals (ant+post)
- greater palatine
- sphenopalatine
Initial emergency Mx of epistaxis (3)
ABCDE resus
Hx: which side? trauma? quantity of blood? DHx?PMHx?
Ice dorsum of nose.
Further emergency Mx of anterior epistaxis (5)
pinch nose+lean forward
encourage blowing out clots
look inside and spray lidocaine and phenylephrine
cauterise bleeding points w. silver nitrate from out to in, NB. don’t cauterise both sides of septum and avoid in clotting disorders
anterior nasal packing-can go home unlike posterior packing
Further emergency Mx of posterior epistaxis (6)
apply pressure for 15 mins but if blood loss increasing then continue to next step
posterior packing
inject local anaesthetic and insert foley catheter
brighton balloon
Give Abx to prevent Eustachian tube infection
may require ligation of sphenopalatine and maxillary arteries
Features of posterior epistaxis (4)
pressure not helping
bilateral
no obvious anterior source
blood in nasopharynx.
