ENT, Speech & Hearing Flashcards
What percentage of epistaxis originates from Little’s area?
80-95%
A patient presents with recurrent nosebleeds over the years despite no trauma history or infective signs.
What medications could cause this to happen?
-Decongestants
-Corticosteroids
-Cocaine
A patient presents with recurrent nosebleeds over the years despite no trauma history or infective signs.
What vascular causes might be behind this?
-Hereditary haemorrhagic telangiectasia
-Granulomatosis with polyangitis
A patient presents with recurrent nosebleeds over the years despite no trauma history or infective signs. They are all from the left nostril.
Why is this concerning?
May indicate a tumour e.g. SCC especially in older patient
A patient presents with recurrent nosebleeds over the years despite no trauma history or infective signs. Their history includes AF, OSA, and OA.
Why does this increase the risk of epistaxis?
AF - blood thinners
OSA - CPAP and drying out of nasal mucosa
A patient presents with recurrent nosebleeds over the years despite no trauma history or infective signs.
What haematological issues may be underlying?
-Thrombocytopenia
-Platelet dysfunction
-Von Willebrand disease
-Leukaemia
-Haemophilia
Is there a connection between high BP and epistaxis?
Some studies find correlation but their is insufficient evidence to show causation
A 1 year old is brought in by mum with nosebleeds - under what age are spontaneous nosebleeds rare?
Under age 2 - injury including NAI or coagulopathy should be considered
A patient presents with recurrent nosebleeds over the years despite no trauma history or infective signs. They are all from the left nostril.
What other symptoms would warrant 2ww referral?
-Nasal obstruction
-Rhinorrhoea
-Facial pain
-Hearing loss
-Persistent lymphadenopathy
-Cranial neuropathy
A patient presents with recurrent nosebleeds over the years despite no trauma history or infective signs.
What other signs on examination might cause suspicion of telangiectasia?
Red/purple spots on fingertip pads/lips/nasal lining, and sometimes on ears or face
What management can be considered in primary care for recurrent epistaxis?
IF not at high risk of having serious underlying pathology:
-Naseptin
-Nasal cautery
In what forms are intranasal corticosteroids available?
Drops and sprays
Why is the risk of systemic adverse effects higher with nasal corticosteroid drops than with nasal spray?
Drops are more likely to be administered incorrectly, resulting in greater bioavailability
What adverse effect is it important to monitor for if a child is using long term intranasal steroid spray?
Growth suppression/Height
What are the contraindications to intranasal corticosteroids?
-Untreated nasal infections
-Recent nasal surgery/trauma
-Pulmonary TB
Can intranasal corticosteroids be safely used in pregnancy?
Yes
Can intranasal corticosteroids be safely used while breastfeeding?
Yes
What local adverse effects can intranasal corticosteroids cause?
-Nasal or throat dryness/irritation
-Nosebleeds
-Erythema/rash
-Headache
-Smell/taste disturbance
-Nasal burning/irritation/ulceration
Describe ideal nasal spray technique
- Gently blow nose
- Shake bottle well
- Close off one nostril and tilt head slightly forward to keep the bottle upright
- Breath in slowly while administering dose, but avoid sniffing
- Breathe out through mouth
Describe ideal nasal drop administration technique
- Gently blow nose
- Standing/kneeling, bend right over OR lie back with head off edge of bed
- Insert opened container and squeeze in drops
- Squeeze until sides of container touch each other (dose is around 6 drops usually) - repeat both nostrils
- Stay with head down for 1 minute at least
How long can it take for intranasal corticosteroids to show maximal effect?
A few weeks
What advice should be given to a patient regarding adverse local effects of intranasal corticosteroid?
If adverse effects occur, stop using it. Can be restarted when adverse effect settles.
