Lecture 14 Rhinology

Question 1

Investigations carried out if patient presents with rhinology related symptoms and history

Answer 1

FBC- blood loss
ANCA- exclude Wegener's granulomatosis
ACE- high in sarcoidosis
RAST
CT scan
MRI scan
Skin tests
Rhinoanometry

Question 2

35 yr old has sustained nasal trauma following an assault. He had been to the local pub and was involved in an argument.
Treatment?
Complication?

Answer 2

Within 72 hours can straighten bone manually using forceps and septal haematoma needs to be drained and the nose packed. Antibiotic cover is also advisable

Question 3

• 40 year old man with constant blocked nose, PN drip and hyposmia. He also has history asthma and aspirins sensitivity
  What does he have?

Answer 3

Samter’s Triad: aspirin hypersensitivity due to lack of an enzyme and cannot metabolise arachidonic acid

Question 4

Patient presents with nasal polyps what are the investigations

Answer 4

• Sweat test – normally already done for CSF
• RAST / skin testing
• Nasal smear
• Microbiology
• Eosinophils (allergic component)
• Neutrophils (chronic sinusitis)
• Coronal CT scan – if need for surgery
• MRI scan
• Flexible nasendoscopy
• Rigid nasendoscopy – in the clinic

Question 5

Treatment for nasal polyps

Answer 5

• Oral and nasal steroids – prevent it coming back. Surgery to help sprays reach
• High dose prednisolone and nasal steroid for 20 days will eliminate 50% of polyps
• Traditional polypectomy
• Microdebrider
• Endoscopic sinus surgery

Question 6

23yr old presents with runny nose, nasal blockage, general malaise and sore throat for 10 days. Otherwise fit and well, with no systemic upset.
Diagnosis

Answer 6

Acute sinusitis

Question 7

• 35 yr old with a one year history constant nasal blockage, PN drip, catarrh and halitosis, recurrent sinofacial pain. Diagnosis

Answer 7

Sinusitis

Question 8

What are the clinical classification of adult sinusitis

Answer 8

Acute
	– Acute onset of symptoms
	– Duration of symptoms <12 weeks
	– Symptoms resolve completely
• Recurrent acute
	– >1 to <4 episodes of acute rhinosinutitis per year.
	– Complete recovery between episodes.
	– Symptom-free period of >8 weeks between acute attacks in
	absence of medical treatment.

Question 9

Clinical classification of adult rhino sinusitis

Answer 9

• Chronic
• – Duration of sysmptoms >12 weeks
• – Persistent inflammatory changes on imaging >4 weeks
• after starting appropriate therapy
• • Acute exacerbations of chronic
• – Worsening of existing symptoms or appearance of new
• symptoms
• – Complete resolution of acute (but not chronic)
• symptoms between episodes

Question 10

Name the top 3 causes of acute rhinosinisutus

Answer 10

• S. pneumoniae 31%
• H. influenzae 21%
• M. catarrhalis 2%

Question 11

Treatment for rhino sinusitis

Answer 11

• β-lactams – penicillins, cephalosporins

* Macrolides - e.g erythromycin,clarithromycin

Question 12

10yr old boy presents to you with acute peri-orbital swellng. He had a 10 h/o acute URI.
Diagnosis and treatment

Answer 12

• Sinus infection that had spread to peri-orbital area
• Emergency referral
• Ophthal opinion
• Urgent CT
• IV Antibiotics
• Emergency surgery

Question 13

10yr old boy presents with acute onset fever, frontal headache, nasal discharge. Diagnosis and treatment

Answer 13

Frontal sinusitis/Pott’s puffy tumor
• Emergency referral
• Frontal sinus surgery
• ESS- Endoscopic Sinus Surgery

Question 14

45 yr old man presents to you with diplopi. Diagnosis and treatment

Answer 14

• Ethmoidal mucocele
• Treatment
-ESS

Question 15

25 yr old man presents with recurrent epistaxis. He has these lesions. What is the connection

Answer 15

• Lesions are defect in blood vessels that make them very weak (hereditary haemorrhagic telangiectasia)

Question 16

What is the treatment of HHT

Answer 16

LASER COAGULATION
YOUNG’S PROCEDURE
SEPTODERMOPLASTY