ENT - Other Flashcards
What is the likely location of bleeding in epistaxis?
Little’s area - Kiesselbach’s plexus.
Triggers of epistaxis.
- nose picking
- colds
- sinusitis
- trauma
- changes in weather
- snorting cocaine
- tumours
Why may a patient with epistaxis have haematemesis?
Patient swallows blood during nosebleed.
What is the cause of bilateral bleeding (from both nostrils)?
Indicates bleeding posteriorly in the nose - presents as a higher risk of aspiration.
Initial management of nosebleeds.
- Sit up and tilt the head forwards
- Squeeze the soft part of the nostrils together for 10-15 minutes
- Spit any blood out, rather than swallowing
Escalating management of nosebleeds.
When bleeding does not stop after 15 minutes, treatment options are:
1. Nasal cautery
2. Nasal packing
After treating a nosebleed, what can be prescribed to reduce inflammation and infection?
What are the contraindications?
Naseptin nasal cream
Contraindicated in peanut or soya allergy.
Define sinusitis.
a) acute
b) chronic
Inflammation of the paranasal air sinuses in the face.
a) <12 weeks
b) >12 weeks
What is the function of paranasal air sinuses?
Produce mucous and drain into the nasal cavity.
Causes of sinusitis.
- infection (URTI)
- allergies (e.g hayfever)
- obstruction of drainage (foreign body, trauma, polyps)
- smoking
Symptoms of acute sinusitis.
Recent viral URTI:
- nasal congestion
- nasal discharge
- facial pain / headache
- facial pressure
- facial swelling
- loss of smell
Signs of acute sinusitis.
- tenderness to palpation of face
- inflammation / oedema of nasal mucosa
- nasal discharge
- fever
Associations of chronic sinusitis.
Associated with nasal polyps.
Investigations of acute sinusitis.
Clinical diagnosis - investigations not necessary.
Investigations of chronic sinusitis.
- nasal endoscopy
- CT scan
Management of acute sinusitis.
Conservative management - warm compresses to the face, inhaling steam, paracetamol and ibuprofen.
When are antibiotics prescribed for acute sinusitis?
If symptoms are not improving after 10 days, options are:
- high dose steroid nasal spray
- delayed antibiotic prescription
Management of chronic sinusitis.
- saline nasal irrigation
- steroid nasal sprays
- functional endoscopic sinus surgery
Question to ask to check nasal spray technique.
Do you taste the spray at the back of your throat after using it?
This suggests it has gone past the nasal mucosa and will not be as effective.
Nasal spray technique.
- Tilt the head forwards
- Use the left hand to spray into the right nostril, and vice versa (spray away from the septum)
- Gently inhale through the nose after the spray.
NB: Do NOT sniff hard during the spray.
What is functional endoscopic sinus surgery?
A small endoscope inserted to remove or correct any obstructions to the sinuses.
Obstruction may be caused by:
- swollen mucosa
- bone
- polyps
- deviated nasal septum
What are nasal polyps?
Growths of nasal mucosa that occur in the nasal cavity or sinuses, associated with inflammation.
They grow slowly and gradually obstruct the nasal passage.
Associations of nasal polyps.
- chronic sinusitis
- asthma
- Samter’s triad
- cystic fibrosis
What is Samter’s triad?
- Nasal polyps
- Asthma
- Aspirin allergy
Symptoms of nasal polyps.
- chronic sinusitis
- difficulty breathing through the nose
- snoring
- nasal discharge
- anosmia
Investigating nasal polyps.
- nasal speculum
- otoscope with large speculum
- nasal endoscopy
Management of bilateral nasal polyps.
Medical management - intranasal steroid drops / spray.
Surgical management:
- intranasal polypectomy
- endoscopic nasal polypectomy
What is obstructive sleep apnoea?
Collapse of the pharyngeal airway results in episodes of apnoea during sleep.
The partner usually reports this happening, and the patient is unaware.
Risk factors for obstructive sleep apnoea.
- middle age
- male
- obesity
- alcohol
- smoking
Symptoms of obstructive sleep apnoea.
- episodes of apnoea during sleep (reported by their partner)
- snoring
- morning headache
- daytime sleepiness
- concentration problems
Complications of obstructive sleep apnoea.
- hypertension
- heart failure
- myocardial infarction
- stroke
What scale can be used to assess symptoms of sleepiness associated with obstructive sleep apnoea?
Epworth sleepiness scale.
Safety questions in obstructive sleep apnoea.
Ask about daytime sleepiness and occupation.
Patients that need to be fully alert for work, for example, heavy goods vehicle operators, require an urgent referral and may need amended work duties whilst awaiting assessment and treatment.
Investigating obstructive sleep apnoea.
Sleep clinic - monitoring of:
- oxygen saturation
- heart rate
- respiratory rate
Managing obstructive sleep apnoea.
- Correct any reversible risk factors (e.g. smoking cessation, weight loss, no alcohol).
- CPAP
- Surgery
What is the most common cause of tonsillitis?
Viral infection - do not require or respond to antibiotics.
What are the common causes of bacterial tonsillitis?
- Streptococcus pyogenes
- Streptococcus pneumoniae
Symptoms of tonsillitis.
- sore throat
- fever
- pain on swallowing
Signs of tonsillitis.
- inflamed tonsills +/- exudates
- anterior cervical lymphadenopathy
- tonsillar lymphadenopathy
Centor criteria.
Used to estimate the probability that tonsillitis is due to bacterial infection.
C - Cough absence
E - Exudates
N - Nodes
T - Temperature
A score of ≥3 suggests a bacterial cause, and it is appropriate to offer antibiotics.
Management of viral tonsillitis.
Simple analgesia with paracetamol and ibuprofen to control pain and fever.
Can consider a delayed prescription.
Safety netting - return if pain has not settled within 3 days or gets worse.
Management of bacterial tonsillitis.
Centor ≥3
Phenoxymethylpenicillin prescription.