ENT - Nose

Question 1

What is acute rhinosinusitis?

Answer 1

Inflammation of mucosa in nasal passage and sinuses

Question 2

Different types of sinusitis?

Answer 2

Viral - rhino/corona
Post-viral
Bacterial - S.pneumoniae, H.influenzae

Question 3

How long do symptoms last for it to be classed as Acute rhinosinusitis?

Answer 3

<12 weeks

Question 4

What symptoms in Acute sinusitis?

Answer 4

Sudden onset of any two:

• Coloured nasal dischage
• Nasal obstruction
• Weird smell
• Face pain

Question 5

Mx of Acute rhinosinusitis?

Answer 5

If <5 days or improving, just analgesia and decongestants

If >5 days and not improving or >10 days full stop, try steroid nose spray and oral antibiotics.

If >14 days or red flag symptoms, refer to ENT

Question 6

Red flag Sx in acute rhinosinusitis?

Answer 6

Eye signs
Bad bad headache/swelling
Reduced neurological status

Question 7

What would a specialist do about an acute rhinosinusitis referral?

Answer 7

Nasal endoscopy

Ct scan of sinuses

Question 8

Chronic sinusitis Sx?

Answer 8

Over 12 week of symptoms, any two of:

Coloured nasal discharge
Nasal obstruction
Weird smell
Face pain

Question 9

Ix for chronic sinusitis?

Answer 9

All cases undergo nasal endoscopy

Question 10

Mx for chronic sinusitis?

Answer 10

Saline and steroid sprays first

Then antibiotics and steriod sprays

Question 11

What is the little’s area?

Answer 11

Area in nose where 5 arteries anastomose - cause of 90% of nose bleeds

Question 12

Immediate Mx of nose bleed?

Answer 12

Sit patient up and forward

Press down on nose for 20 mins

Apply ice to bridge of nose

If still bleeding after 20 mins, use nasal speculum to view septum –> if spot an anterior bleed, use silver nitrate cautery

Check oropharynx for posterior bleed

If too much blood to visualise septum, apply adrenaline soaked gauze to cause vasoconstriction

Question 13

Mx for nose bleed if it doesn’t stop with cautery?

Answer 13

If anterior bleed, try packing with nasal pack –> then contralateral

If posterior bleeding (oropharynx), try packing w foley’s catheter –> then contralateral

–> surgical ligation -

Question 14

Which vessels are surgially ligated / embolised to stop nose bleed?

Answer 14

splenopalatine artery

anterior ethmoidal - NEVER embolised tho cos it’s from ICA

external carotid as LAST RESORT

Question 15

What are some common injuries from nose trauma?

Answer 15

Laceration or Fracture

Septal Haematoma

Question 16

What would a septal haematoma look like on nasal endoscopy?

Answer 16

Boddy red/purple swelling - Use a Jobson Horne probe to palpate the mucosa - haematoma will be fluctuant

Question 17

Mx for septal haematoma?

Answer 17

Incision and drainage

Question 18

Complications of septal haematoma?

Answer 18

Avascular necrosis of septum –> leaves it very susceptible to infection and abscess formation

Avascular necrosis long term –> septal perforation / saddle nose deformity

Question 19

Nasal bone fracture Mx?

Answer 19

Not that urgent - seen electively in a week - no point doing any X-rays or anything - maybe a CT if it’s a multiple fracture

Remember Septal haematoma is urgent!

Question 20

What to assess for with nose fracture?

Answer 20

Deformity

Obstruction

Question 21

What is MUA of nose fracture?

Answer 21

Manipulation Under Anaesthetic after 2 weeks - using lidocaine w adrenaline –> use fingers to straighten nose –> if not good enough, rhinoplasty!

Question 22

What causes a CSF leak following nose trauma?

Answer 22

Fracture to the cribiform plate - test CSF for beta-2-transferrin. Usually conservative approach.