Disorders of the Nose and Sinuses Flashcards
What is the function of the nose?
respiration (humidification, filtration, nasal resistance)
olfaction
Septal Hematoma:
Must remove close to prevent destruction of cartilage
Septal Perforation:
Due to trauma, digital manipulation, surgery or drugs (cocaine)
tx: saline irrigation, bactroban/vaseline
surgery for small perforations
Septal Deviation:
Can be congenital or acquired (trauma)
When is a septal deviation symptomatic?
Only symptomatic if anterior deviation
Symptoms of a septal deviation:
nasal obstruction
dryness due to airway compromise
mucus formation increased
ciliary mobility impaired
Tx of septal deviation:
septoplasty
Epistaxis:
nose bleeds; more common in cold dry environment
Mainly anterior
Kiesselbachs plexus/Littles area
Tx of Epistaxis:
vasoconstricting agent - AFRIN external pressure (10-15 min) cautery nasal packing surgery
Anosmia
complete loss of smell
Hyposmia
diminished sense of smell
Parosmia
alteration in smell such that normally pleasant odors are interpreted as foul smelling
Most common causes of olfactory disturbances:
chronic sinus disease
trauma
post viral illness
Rhinitis:
nasal hyperfunction and tissue inflammation
nasal congestion/obstruction
rhinorrhea
pruritis and/or sneezing (histamine release from mast cells and basophils)
Allergic Rhinitis:
IgE mediated response
Etiology: inhalants, foods, chemicals, pet dander
PE for Allergic Rhinitis:
Pale blue nasal mucosa, swollen
allergic saltue
allergic shiners, conjuctivitis, puffy eyes
Tx for Allergic Rhinitis:
Avoidance
Topical steroids- 1st line (flonase, nasonex)
Antihistamines
Oral steroids
Non Allergic Rhinitis:
Due to: hormonal response drug-induced gustatory (spicy foods) infectious vasomotor
Infectious Rhinitis:
viral is most common
nasal congestion, clear rhinorrhea, mailaise
symptomatic tx (decongestants, nasal saline)
may become bacterial if it leads to sinus blockage and infection (green purulent rhinorrhea - tx with abx)
Vasomotor Rhinitis:
nasal congestion and rhinorrhea
NO SNEEZING OR PRURITIS
hyperresponsive to various stimuli (odor, temp, humidity change)
more common in elderly
Dx of Vasomotor Rhinitis:
boggy and erythmatous mucosa
Tx of Vasomotor Rhinitis:
Intranasal anticholinergics (atrovent, ipratropium bromide)
Rhinitis Medicamentosa:
Due to continues use of AFRIN (should only use for 3-5 days)
Atrophic Rhinitis:
crusting atrophy of turbinates, foul odor
etiology: bacterial, post surgical, vit A/iron def., trauma
loss of normal respiratory epithelium leaging to retention of mucus and debris
Tx of Atrophic Rhinitis:
irrigation, abx, or vit replacement if indicated
Nasal Polyps:
abnormal lesion that arise from the nasal, sinus mucosa
a/w allergies, cystic fibrosis
Samtens triad:
asthma, ASA allergy, polyps
Where do nasal polyps originate?
lateral nasal wall/middle meatus
Symptoms of Nasal Polps:
obstructionm rhinorrhea, facial pressure
Tx of Nasal Polyps:
medical- antihistamines, topical/systemic abx, allergic decongestants
surgical- polpectomy
Sinusitis
inflammation of the sinus mucosa
ostial blockage- sinus hypo-oxygenation and stagnation of secretions
Dx of sinusitis:
MRI and CT
Tx of sinusitis:
abx (amoxicillin, augmentin, septra, levaquin)
decongestants
mucolytics
saline irrigations
Complications of Sinusitis:
periorbital cellulitis
intraorbital subperiosteal abscess
osteomyelitis and subperiosteal abscess
Tx for Fungal Sinusitis:
amphotericin B, debridement
