module 3 sinusitis, tumors, and polyps of the nose Flashcards
rhinosinusitis
symptomatic inflammation of the mucosal surface of the paranasal sinuses
subclassifications of rhinosinusitis
acute: resolves in less than 4 weeks
subacute: resolves within 4-12 weeks
chronic: continues beyond 12 weeks
Acute rhinosinusitis
inflammatory process of the paranasal sinuses caused by:
- viral
- bacterial
- fungal
- allergic
Usually proceeded by an acute viral respiratory infection which extends into the paranasal sinus cavities
Acute Bacterial rhinosinusitis usually caused by
streptococcus pneumoniae
HIB
moraxella catrrhalis
S. pneumonia
Acute rhinosinusitis s/s
Abrupt onset:
nasal congestion
purulent nasal discharge
dental pain
post-nasal drip
halitosis
ear fullness/otalgia
dec. smell
headache
fever
fatigue
chronic sinusitis
prolonged sinus infection that resist tx or recurrent acute infections
- anatomic abnormality
- immunocompromised
- continued irritant/allergen exposure
- incompletely treated bacterial or fungal infection
medical devices that can cause sinusitis
NG tube
intubated through nare
largest paranasal sinus
maxillary
maxillary anatomy and infections
ostium into nose is superiorly placed
- no gravity advantage
- infected secretions are forced into sinus cavity
bacterial sinusitis
- most often a complication of viral rhinosinusitis OR
- allergies
- dental infection
- fluid introduced into sinuses: diving, swimming
sinusitis r/t anatomic abnormalities
deviated septum
adenoidal hypertrophy
neoplasms
foreign body
ciliary dysfunction: CF
acute bacterial rhinosinusitis s/s
mucopurulent discharge
nasal obstruction
facial pain or pressure
- ARS s/s > 10 days or initial improvement followed by worsening of s/s
Chronic rhinosinusitis s/s
purulent nasal drainage
nasal obstruction: bilateral
facial pain or pressure
dec. or loss of smell
- > 12 weeks
frequent throat clearing
cough
INC. in:
- allergy s/s
- asthma
- eczema
rhinosinusitis physical exam
General inspection for facial:
- asymmetry
- periorbital edema
- cellulitis
Speech: hyponasal quality
Nasal turbinate:
- edema
- erythema
- discharge
- patency of nares
- septal deviation
- polyps
Transillumination
- inability to transilluminate indicates fluid in sinuses
Palpation and Percussion:
- frontal and maxillary sinuses
Pharynx:
- postnasal drip
- erythema
- lymphoid hypertrophy
Otic exam
- otitis media
Rx management of rhinosinusitis
antibiotic tx if s/s > 7 days
NSAIds
nasal saline
oral or topical decongestants
nasal steroids
complications of rhinosinusitis
quality of life
osteomyelitis
orbital infection
vision loss: pressure on optic nerve
invasive fungal sinusitis
osteomyelitis of frontal bone
fever
pain
edema over bone: Pott’s puffy tumor
primary sites for malignant tumors
nose
nasopharynx
paranasal sinuses
malignant lesions include
carcinomas
lymphomas
sarcomas
melanomas
squamous cell carcinoma: most common
most common type of benign tumor
inverted papilloma
- arises from the common wall between the nose and maxillary sinuses
juvenile angiofibroma
highly vascular benign tumor
- common in adolescent boys
- bleeds easily
- can cause nasal obstruction
nasal polyps
inflammatory disorder of the nose and paranasal sinuses
-> chronic nasal obstruction
-> diminished sense of smell
nasal polyps on exam
pale
edematous
developing: teardrop shape
Mature: resembles a peeled seedless grape
nasal polyps assoc. with
allergic rhinitis
asthma
acute or chronic infections
cystic fibrosis
squamous cell carcinomas arise from
keratinocytes of the epithelium
- more common in male
Associated with:
- smoking
- ETOH
- sunlight exposure
inverted papillomas develop from
squamous cells in which the epithelium is invaginated into the vascular connective tissue
complications of inverted papillomas
invasion of the orbit or cranial vault
nasopharyngeal angiofibromas may be assoc. with
familial adenomatous paolyps
- almost exclusively occur in adolescent males who have red hair and fair skin
nasal polyps originate
from the mucous membrane linings of the maxillary sinuses and prolapse into the nasal cavity
4 types of polyps
antrochoanal
idiopathic
eosinophilic
polyps with underlying systemic disease
antrochoanal polyp
non-eosinophilic
unilateral
idiopathic polyp
unilateral or bilateral
eosinophilic without lower airway involvement
eosinophilic polyps
assoc. with asthma or aspirin sensitivity
polyps with underlying systemic disease
CF
Churg-Strauss syndrome
Kartagener syndrome
s/s that suggest presence of cancer
unilateral nasal obstruction
discharge w/ pain
recurrent hemorrhage
headache
visual or olfactory changes
Benign nasal tumors s/s
nasal obstruction
discharge
facial swelling
bleed easily: recurrent epistaxis
nasal polyps s/s
nasal obstruction
hyposmia or anosmia
recurrent sinusitis
headache
post-nasal drip
Granulomatosis with polyangiitis (GPA)
systemic vasculitis of unknown causes characterized by glomerulonephritis plus granulomas of the nose and lung
- without tx survival rate less than a year
GPA s/s
nasal congestion
nasal ulcerations
rhinitis
sinusitis
otitis media
otorrhea
hearing loss
gingival hypertrophy
cough
dyspnea
hemoptysis
fever
weakness
malaise
wt loss
conjunctivitis
rash or skin lesions
polyarthralgias
GPA physical exam
nasal congestion and crusting
rhinorrhea
ulceration of nasal septum
epistaxis
destruction of nasal septum
-> saddle nose deformity
erosion through skin that cover the nose and sinuses
rales
rhonchi
wheezing
unilateral proptosis
red eye
otitis media
symmetric polyarticular arthritis
purpura
