ENT (nose) Flashcards
(50 cards)
What is epistaxis?
Nosebleeds
Where is the most common source of bleeding in nosebleeds?
Kiesselbach’s plexus which is in Little’s area. This is at the front of the nasal cavity and contains a lot of blood vessels that are prone to bleeding.
What can trigger nosebleeds?
Nose picking
Colds
Sinusitis
Vigorous nose blowing
Trauma
Changes in weather
Coagulation disorders - e.g. thrombocytopenia, HHT
Anticoag medications - e.g. aspirin, DOACs, warfarin
Foreign body - e.g. something up the nose, snorting drugs
Tumours
What may bilateral epistaxis suggest?
That the bleeding is posterior to the nose - most commonly from the sphenopalatine artery
Which artery most commonly causes posterior, more severe nosebleeds?
Sphenopalatine artery
How are nosebleeds managed?
Sit up, tilt head forwards, squeeze soft part of nostrils for 10-15 mins. If still doesn't stop then - anterior packing - cautery with silver nitrate - posterior packing Then consider surgical ligation.
What are nasal polyps?
Growths of the nasal mucosa that occur in the nasal cavity or sinuses. They grow slowly and gradually cause obstruction.
What are nasal polyps often associated with?
Chronic rhinitis or sinusitis
Asthma
Cystic fibrosis
How may nasal polyps present?
Chronic rhino-sinusitis Difficulty breathing through the nose Snoring Nasal discharge Loss of sense of smell (anosmia)
What is anosmia?
Loss of sense of smell
How are nasal polyps managed?
Nasal douching
Intranasal topical steroid sprays
Surgery - polypectomy or FESS (functional endoscopic sinus surgery - to improve drainage of sinuses)
If unilateral refer to exclude malignancy
What is sinusitis?
Inflammation of the paranasal sinuses in the face.
What is the difference between acute and chronic sinusitis?
Acute < 12 weeks
Chronic >12 weeks
Chronic > 12 weeks
Name the different paranasal air sinuses
Frontal
Ethmoidal
Sphenoid
Maxillary
What are paranasal air sinuses?
Hollow spaces within the bones around the nasal cavity.
What is the physiology behind sinusitis?
The paranasal air sinuses produce mucous which drains into the nasal cavities via holes called ostia. When these ostia get blocked the mucous builds up causing sinusitis.
What can cause sinusitis?
Infection - particularly following upper respiratory tract infections
Allergies
Obstruction of drainage - due to foreign body, polyps or trauma
Smoking
How does acute sinusitis present?
Recent upper resp infection Nasal congestion Nasal discharge Facial pain, pressure, swelling Headaches Loss of smell
How does acute sinusitis present?
Recent upper resp infection Nasal congestion Nasal discharge Facial pain, pressure, swelling, tenderness Headaches Loss of smell Fever
How is acute sinusitis managed?
Most acute are viral - self limiting.
If not improving by 10 days then
- high dose corticosteroid nasal spray for 14 days - e.g. mometasone 200mg bid (twice a day)
- antibiotics - most commonly phenoxymethylpenicillin 500mg qid (4 times a day) for 5 days.
If patient has systemic infection or sepsis then admit to hospital.
How is chronic sinusitis managed?
Advice - avoid triggers, stop smoking, good dental hygiene
Saline nasal irrigation
Intranasal corticosteroids - e.g. mometasone/ fluticasone for up to 3 mnths
Refer to specialist - Functional endoscopic sinus surgery
Describe the correct nasal spray technique
- Tilt head slightly forwards
- Use opposite hand to nostril (left hand to spray up right nostril ) so the spray is away from the septum
- Don’t sniff hard during the spray
- Gently inhale through the nose after the spray
Describe the correct nasal spray technique
- Tilt head slightly forwards
- Use opposite hand to nostril (left hand to spray up right nostril ) so the spray is away from the septum
- Don’t sniff hard during the spray
- Gently inhale through the nose after the spray
What is allergic rhinitis?
IgE mediated type 1 hypersensitivity reaction which cases an inflammatory response in the nasal mucosa
