ENT - Nose Flashcards
How do we compartmentalise the nose?
Upper
Middle
Lower zones
What is the cartilage at the front of the nose made of?
Quadrangular cartilage
What do you have in the nose which helps with air warming etc
Turbinate
Different turbinates?
Superior
Middle
Inferior turbinate
What else is there
paranasal air sinuses
Nasal cavity is split up into
Inflow area
Functional area
Functions of the sinuses(?)
Warming Humidification Olfaction Respiration Filtration
Hx for nose/symptoms you’d ask for
Sneezing Itching Congestion Rhinorrhoea Hyposmia Anosmia Any known allergies Pain Bleeding Related problem
What is another name for runny nose?
Rhinorrhoea
Why would you ask about pain?
Facial pain - sinusitis
Nose pain - cancer (it’s not normal)
Unilateral glue ear is a red flag, why?
Could be cancer sitting in nasal cavity blocking eustachian tube
Nasopharygneal cancers presentation?
Neck lump
Where is the nasopharynx?
Back of hard palate to uvula
Where are adenoids?
Back of the nose, above eustachian tube
Describe the growth of adenoids in children
Normally they’re massive but they go down in size
However they often cause glue ear as they sit on top of the
What is the device used for anterior rhinoscopy (o hold open the nose to look at it)?
Thudicum’s speculum
Rhinitis classifications
Allergic
Non allergic
Allergic rhinitis symptoms/hx vs non allergic
Allergic: Seasonal Rhinorrhoea (thick mucousy discharge) Sneezing itching Blueishness of nasal mucosa
Non-allergic:
all round,
Pink mottled discolouration of nasal mucousa
Diagnosis of rhinitis
Skin prick testing
Diagnosis classification
Less than 4 days a week - intermittent
More than 4 days a week - severe
mild- affects work
Severe -
Management of mild intermittent rhinitis?
Non-sedating antihistamine
Saline nasal douche
Allergen and irritant avoidance
What is given for severe persistent rhinitis?
Intranasal steroids
Topical cromone/anithistamine
Immunotherapy (graded exposure of allergen under tongue)
What does the saline do?
Washes out allergens and mucous
Signs of rhinosinusitis
Polpys - exudates in the nasal mucosa
Management of rhinosinusitis
Same as rhinitis + steroids
Surgery if complete blockage or if nasal meds can’t get through
Acute sinusitis signs
Mucopurulent discharge
Viral vs bacterial sinusitis
Bacterial sinusitis lasts longer - puss-y discharge
vs thick discharge from viral ifneciton
Complication of acute sinusitis
Periorbital cellulitis (urgency as can cause blindness) Intracerebral abscess
Complication of nasal trauma
Septal hematoma
What is the golden window for referral after nose trauma?
within 21 days
Where do nose bleeds most commonly originate from in the nose?
Kiesselback’s plexus/Lithel’s area
What might you look for in the lips if someone has frequent nose bleeds?
Hereditary haemorrhagic telangiectasia
Acute community management of nose bleeds
Lean forward
Ice on forehead/mouth/back of neck
If this doesn’t work, what do you do?
Silver nitrate cautery
Nasal packing
Surgery
Risk factors for nasopharyngeal cancers
EBV
Ethnicity exposure to nasopharyngeal cancers
SE asians who have exposure to EBV
