ENT VI Flashcards
Symptoms present with rhinitis
- sneezing
- rhinorrhea
- nasal congestion
- nasal itching
Most common forms of rhinitis
- allergic rhinitis
- nonallergic rhinitis
- rhinitis due to structural nasal problems
- rhinitis of pregnancy
- occupation rhinitis
Classification of allergic rhinitis
- intermittent
- seasonal
- persistent/perennial
What helps to distinguish allergic rhinitis from other forms of rhinitis
nasal itching
Physical exam in pts with allergic rhinitis
- nasal mucosa edematous and pale
- allergic shiners
- nasal crease from rubbing nose
- pale or bluish boggy mucosa
- clear mucous
- polyps
- septal issues
Treatment for allergic rhinitis
- environmental control and allergen avoidance
- oral anhistamines
- leukotriene receptor antagonist
- mast cell stabilizers
- immunotherapy
Leukotriene receptor antagonists are best for what kind of rhinitis
allergic
What does nasal mucosa look like in non allergic rhinitis
normal
What does nasal mucosa look like in acute rhinosinusitis or rhinitis medicamentosa
beefy red
How is nonallergic rhinitis distinguished from allergic rhinitis
- onset at later age
- absence of nasal and ocular itching
- nasal congestion and postnasal drainage are prominent
- symptoms are perennial
Types of nonallergic rhinitis
- vasomotor rhinitis
- mixed rhinitis (most common)
- gustatory rhinitis
Classifications of rhinosinusitis
- acute, less than 4 weeks (bacterial or viral)
- subactue, 4 to 12 weeks
- chronic, more than 12 weeks
- recurrent, 4 or more episodes a year
Most common cause of acute rhinosinusitis
VIRAL INFECTION
- rhinovirus
- influenza
- parainfluenza
Clinical presentation of acute rhinosinusitis
- nasal congestion
- purulent nasal discharge
- fever/fatigue
- cough
- ear pressure
- facial pain/pressure worse with bending forward
Exam finding with acute rhinosinusitis
rhinoscopy
- diffuse mucosal edema
- narrowing of middle meatus
- inferior turbinate hypertrophy
- polyps or septal deviation
When to do a CT scan with acute rhinosinusitis
complication or involvement of the orbital, intracranial or soft tissue
How do you treat acute rhinosinusitis
resolves in 10 days to treat symptomatically
Most common pathogens for acute bacterial rhinosinusitis
s. pneumoniae
h. influenzae
Treatment for bacterial rhinosinusitis
if sx last longer than 10 days -amoxicillin AUGMENTIN -doxy if PCN allergy -levo if failed augmentin
Most common causes of fungal rhinosinusitis
- mucor
- rhizopus
- aspergillus
- absidia
- basidiobolus
Pts at risk for fungal rhinosinusitis
- immunocompromised
- diabetic
- heme malignancies
- chemo induced neutropenia
- organ transplant
What differentiates bacterial rhinosinusitis from others
- facial numbness if cranial nerves involved
- necrotic tissue in nares/oropharynx
Treatment for fungal rhinosinusitis
- surgical eval for biopsy and debridement
- amphotericin B
- voriconazol
Risk factors for chronic rhinosinusitis
- allergic rhinitis
- asthma
4 symptoms that must be present for diagnosis of chronic rhinosinusitis
- anterior/posterior mucopurulent drainage
- nasal obstruction
- facial pain, pressure, fullness
- hyposmia
3 subtypes of rhinosinnusitis
- CRS with nasal polyposis
- CRS without nasal polyposis
- allergic fungal rhinosinusitis
Samter’s triad
asthma, CRS with nasal polys, aspirin
Presentation of allergic fungal rhinosinusitis
- sx similar to CRS with NP
- usually nasal polyps are present
- semi solid nasal crusts or rubbery globs of dark colored mucus
What is the first choice in imagine for chronic rhinosinusitis
sinus CT scan
- mucosal thickening
- obstruction of ostimeatal complex
- sinus opacification
Treatment of CRS with NP
- oral glucocorticoids to shrink polyps
- nasal gluccorticoids to follow
- add leukotriene inhibitor for maintenance therapy
Treatment of CRS without NP
- oral glucocorticoids
- abx
- nasal glucorticoids
- 2nd gen antihistamine
- leukotriene inhibitor
Treatment of allergic fungal rhinosinusitis
- surgery
- prolong course of oral glucocorticoids
Most common spot of anterior nosebleeds
Kiesselbach’s plexus
Most common source of posterior nosebleeds
sphenopalatine artery
Common casue of posterior nosebleeds
- carotid artery aneurysm
- nasal neoplasm
Treatment for anterior nosebleed
- compression
- short acting topical nasal decongestant
- topical cocaine
- cauterize bleeding site
Treatment for posterior nosebleed
- topical sympathimimetics
- double balloon packs
What do you have to do if using a rhino rocket
provide abx coverage
What two things need to be removed immediatly if lodged in the nose
button batteries and disc magnets
