ENT Rhinology Flashcards
What is the commonest cause of nasal obstruction?
Deviated septum
What is rhinitis?
Reaction which causes nasal discharge, congestion, sneezing, etc.
What is the most common type of rhintitis?
Allergic rhinitis
e.g. after exposure to pollen, etc.
Epistaxis?
Nosebleed
Anosmia?
Total lack of smell
Hyposmia?
Reduced sense of smell
In which part of the nose is there olfactory epithelium meaning you can smell things?
Upper 1/3 of nose
Describe the physiology behind allergic rhinitis.
Patient develops IgE antibodies against certain antigens in things like like dust, pollen, cats, dogs, etc.
Every time a person in exposed to the antigen, there is a release of histamine leukotrienes prostaglandins from the nose which causes allergic reactions e.g. sneezing.
Which technique can be used to look fully at the nose?
Nasal endoscopy
What would be done in those with a septum deviation in terms of endoscopy?
A flexible endoscope may be used instead of a rigid one
Which blood tests would be done in rhinology patients?
(rare to do blood tests in rhinology cases however).
FBC
ANCA (type of antibody)
ESR
ACE (levels of angio-tensin converting enzyme)
RAST (allergen specific IgE)
Imaging is rarely used in rhinology, unless surgery is reuqired.
Which imaging may be used if surgery may be required in a rhinology case?
CT
When may skin tests be used?
Can be used to test against different allergens by putting a small sample on needle, prick the skin and then check reaction.
Commonly done for food allergies.
What must always be carried out during skin testing?
Positive and negative control
Give an example of a positive control during skin testing.
Histamine- if you do not react to histamine, you are unlikely to react to anything.
Give an example of a negative control used during skin testing.
Saline- if you react to saline, you will likely react to everything.
What is rhinomanometry?
Investigation which can be used to measure air breathed in and the pressure of the air in the nasal space
A patient presents with a broken nose. He got injured during a rugby game last week and comes to the hospital to see the you.
What is the possible treatment?
As it has been less than two weeks, local anaesthetic can be given and you can try and move the nasal bones back into position.
What would the treatment be if someone presents with a broken nose but it’s been more than two weeks?
Rhinoplasty may be carried out- changes shape of nose
If a patient has undergone nasal trauma, which complication must you be aware of?
Blood clot forming in septum- septal haematoma
What van happen if septal haematoma is not treated?
If blood is not drained, reduced blood supply to cartilage which then can become necrotic and may perforate.
Nasal dorsum may become deformed
What can be a common nasal issue in those with asthma?
Nasal polyps
What is the cause of nasal polys?
Unknown
->possibly inflammation, genetics…
Which conditions are nasal polyps predisposed in?
Cystic fibrosis
AFS (Allergic fungal sinusitis)
Churg-Stauss Syndrome
What would you test if you suspect cystic fibrosis?
Sweat test to check chlorine
If a child came in with nasal polys, which condition would you need to rule out?
Cystic fibrosis
Which test may be done is someone has severe allergic rhinitis?
Skin tests
RACE blood test
->if severe reactions, best patient knows specifically what they are allergic to so that they can avoid it.
If doing a nasal smear and there are predominantly neutrophils in the sample, which condition may this be?
Chronic sinusitis.
If doing a nasal smear and there are predominantly eosinophils in the sample, what would this suggest?
Allergy based
When would you send a patient with nasal issues for an MRI?
If you suspect any intracranial involvement.
What is the treatment for nasal polpys?
Oral and nasal steroids
Dietary changes to increase vitamins to increase immuinity
->steroid sprays for nasal use are efficient in some, need to be used everyday
There lower bioavailability in modern nasal steroids. What is meant by bioavailability?
Amount of drug systemically delivered to the body compared with how much drug the body actually absorbs.
If a patient has surgery to remove nasal polyps, which treatment will they still need to take after?
Nasal steroid spray for rest of their lives to reduce chances of them coming back
If medical treatment for nasal polyps doesn’t’ work, which surgery may be considered?
Endoscopic sinus surgery to remove polyps
Describe the symptoms of acute sinusitis.
Nasal blockage
Nasal congestion
Nasal discharge
Facial pain
Reduction or loss of smell
When would acute sinusitis become chronic sinusitis?
Symptoms <4wks= acute
>4wks=chronic
Majority of acute sinusitis patients do not require antibiotics. However, would would be some indications that a patient does require antibiotics?
Developing complications e.g. orbital oedema, severe headaches, double vision, pus coming from nose.
In patients with acute sinusitis with complications, what would be done?
Hospital admission, IV antibiotics, scan, work out if something else is going on
Which two strains of bacteria are the most common cause of bacterial rhinosinustitis?
S.pneumoniae
H.influenzae
Which symptoms would be present in those with chronic sinusitis?
Presence of at least two of the following for at least 12 consecutive weeks:
-Nasal obstruction
-Nasal drainage
-Facial pain
-Hyposmia/ anosmia
What is the usual medical treatment for chronic sinusitis?
Topical steroids
When may a scan be carried out in patients with chronic sinusitis?
If they are not responding to medical treatment
Acute sinusitis can have a complication of orbital swelling. This can mean that there is an abscess behind the eye. What is the treatment for this?
Immediate drainage, if not, could result in vision loss
What may be the cause of severe headaches as a complication of acute sinusitis?
Pus collections e.g. at front of head.
Will need to be drained.
What is a mucocele?
Build up of mucus as sinus does not drain it
What is the treatment for a mucocele?
Surgically drain mucous via FESS (functional endoscopic sinus surgery).
Those on which medications are more likely to have nosebleeds?
Anticoagulants like warfarin
Why is the nose one of the most common sites of bleeding?
Exposed to many irritants
What are some of the various categories of causes of epistaxis?
Trauma
Inflammatory
Neoplastic
Infective
Congenital
Genetic
Which types of infection may cause a nosebleed?
Rhinitis
Sinusitis
Nasopharyngitis
What is the initial management of epistaxis?
Hold nose to stop bleeding
In those with a nosebleed, which part of a history is particular important?
Medical history- which drugs they’re on, if they have any bleeding disorders.
If bleeding doesn’t stop, which procedure can be done in epistaxis?
Cauterisation
If you cannot find the blood vessel causing the nasal bleed, cauterisation cannot be done.
What may be done instead?
Nasal packing
Name an inherited condition which can affect blood vessels and cause bleeding.
HHT
(Hereditary haemorrhagic telangiectasia)
What may you see upon examination in those with HHT?
Visible red spots on parts of the body like fingers and lips.
What is the treatment for those with HHT?
Laser coagulation
Septodermoplasty
What is angiofibroma?
Rare benign tumour which forms in the nose
Who might get an angiofibroma?
Male teenagers
Never see in females, nobody knows why
What should be done if you suspect angiofibroma?
Biopsy
What is the treatment for angiofibroma?
Preoperative embolism
Surgery
An elderly man presents with mild epistaxis and hearing loss. Upon examination, you see there is fluid in the ear.
What might be happening here? Describe your thought process.
Elderly man- children often get fluid but not elderly.
Fluid in ear= Eustachian tube not working properly. Connects nose and ear…
Tumour= would explain blockage and bleeding
How would you confirm the diagnosis of a nasal tumour?
Endoscope, if seen, biopsy tumour
What is the treatment of a nasal tumour?
Combined radiotherapy and surgery
