Disorders of the Nose and Sinuses

Question 1

What is the function of the nose?

Answer 1

respiration (humidification, filtration, nasal resistance)

olfaction

Question 2

Septal Hematoma:

Answer 2

Must remove close to prevent destruction of cartilage

Question 3

Septal Perforation:

Answer 3

Due to trauma, digital manipulation, surgery or drugs (cocaine)

tx: saline irrigation, bactroban/vaseline
surgery for small perforations

Question 4

Septal Deviation:

Answer 4

Can be congenital or acquired (trauma)

Question 5

When is a septal deviation symptomatic?

Answer 5

Only symptomatic if anterior deviation

Question 6

Symptoms of a septal deviation:

Answer 6

nasal obstruction
dryness due to airway compromise
mucus formation increased
ciliary mobility impaired

Question 7

Tx of septal deviation:

Answer 7

septoplasty

Question 8

Epistaxis:

Answer 8

nose bleeds; more common in cold dry environment

Mainly anterior

Kiesselbachs plexus/Littles area

Question 9

Tx of Epistaxis:

Answer 9

vasoconstricting agent - AFRIN
external pressure (10-15 min)
cautery
nasal packing
surgery

Question 10

Anosmia

Answer 10

complete loss of smell

Question 11

Hyposmia

Answer 11

diminished sense of smell

Question 12

Parosmia

Answer 12

alteration in smell such that normally pleasant odors are interpreted as foul smelling

Question 13

Most common causes of olfactory disturbances:

Answer 13

chronic sinus disease
trauma
post viral illness

Question 14

Rhinitis:

Answer 14

nasal hyperfunction and tissue inflammation
nasal congestion/obstruction
rhinorrhea
pruritis and/or sneezing (histamine release from mast cells and basophils)

Question 15

Allergic Rhinitis:

Answer 15

IgE mediated response

Etiology: inhalants, foods, chemicals, pet dander

Question 16

PE for Allergic Rhinitis:

Answer 16

Pale blue nasal mucosa, swollen
allergic saltue
allergic shiners, conjuctivitis, puffy eyes

Question 17

Tx for Allergic Rhinitis:

Answer 17

Avoidance

Topical steroids- 1st line (flonase, nasonex)
Antihistamines
Oral steroids

Question 18

Non Allergic Rhinitis:

Answer 18

Due to:
hormonal response
drug-induced
gustatory (spicy foods)
infectious
vasomotor

Question 19

Infectious Rhinitis:

Answer 19

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)

Question 20

Vasomotor Rhinitis:

Answer 20

nasal congestion and rhinorrhea
NO SNEEZING OR PRURITIS

hyperresponsive to various stimuli (odor, temp, humidity change)
more common in elderly

Question 21

Dx of Vasomotor Rhinitis:

Answer 21

boggy and erythmatous mucosa

Question 22

Tx of Vasomotor Rhinitis:

Answer 22

Intranasal anticholinergics (atrovent, ipratropium bromide)

Question 23

Rhinitis Medicamentosa:

Answer 23

Due to continues use of AFRIN (should only use for 3-5 days)

Question 24

Atrophic Rhinitis:

Answer 24

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

Question 25

Tx of Atrophic Rhinitis:

Answer 25

irrigation, abx, or vit replacement if indicated

Question 26

Nasal Polyps:

Answer 26

abnormal lesion that arise from the nasal, sinus mucosa

a/w allergies, cystic fibrosis

Question 27

Samtens triad:

Answer 27

asthma, ASA allergy, polyps

Question 28

Where do nasal polyps originate?

Answer 28

lateral nasal wall/middle meatus

Question 29

Symptoms of Nasal Polps:

Answer 29

obstructionm rhinorrhea, facial pressure

Question 30

Tx of Nasal Polyps:

Answer 30

medical- antihistamines, topical/systemic abx, allergic decongestants

surgical- polpectomy

Question 31

Sinusitis

Answer 31

inflammation of the sinus mucosa

ostial blockage- sinus hypo-oxygenation and stagnation of secretions

Question 32

Dx of sinusitis:

Answer 32

MRI and CT

Question 33

Tx of sinusitis:

Answer 33

abx (amoxicillin, augmentin, septra, levaquin)
decongestants
mucolytics
saline irrigations

Question 34

Complications of Sinusitis:

Answer 34

periorbital cellulitis
intraorbital subperiosteal abscess
osteomyelitis and subperiosteal abscess

Question 35

Tx for Fungal Sinusitis:

Answer 35

amphotericin B, debridement