Nasal and Paranasal Sinus Disorders - Ingram Flashcards
Nasal and Paranasal Anatomy
channel your inner Dr. Keim : ) you know this stuff . . . if you neeed a little review: slides 3-22 serve as a good review
Common Patholgoy of the Nasal and Paranasal Sinus
hint: KITTENS
K = Congenital
I = Inflammatory, Infectious, Immune, Idiopathic.
T = Trauma, Tumor
T = Toxic
E = Endocrine
N = Neurologic
S = Systemic, Psychogenic
Rhinitis vs. Rhinorrhea
rhinitis: nasal hyperfunction, tissue inflammation
rhinorrhea: tissue transudate (hypersecretion)
Causes of Acute Viral Rhinitis
most common cause: Rhinovirus
others: Corona viruses, respiratory syncytial virus (RSV), parainfluenza viruses, Coxsackie virus, adenovirus
Acute Viral Rhinitis: Prodromal Stage
hours
local invasion and nasal ischemia
hot, tickling sensation
“unusually clear nose”
Acute Viral Rhinitis: Catarrhal Stage
hours to days
infection spreads over the mucousal surface via lymphatics
sneezing, profuse watery discharge nasal obstruction
mucousal erythema and edema, mild fever
Acute Viral Rhinitis: Mucous Stage
days
venous stasis/secondary infection
nasal discharge thickness/”mucopurulent”
mucosa becomes dusky
nasal obstruction at its worst
Acute Viral Rhinitis: Resolution
regression of signs and symptoms within 10 days
Identify the condition and describe the managment:
pt reports nasal obstruction, sneezing, head feeling full and itchy eyes and nose, clear nasal discharge
exam: pale-bluish, boggy nasal mucosa, inferior turbinates are swollen
Allergic Rhinitis
Type 1 Hypersensitivity reaction: antigen binds to IGE, mediators (histamine) is released producing symptoms
causal tx: avoidance, immunotherapy
symptomatic: antihistamines, steroids, decongestants
Identify this condition and describe the management:
pt complains periods of congestion and a runny nose that come on after eating the spicy salsa that Zemogs put on his burrito
exam shows bilateral watery secretion, deep red mucosa and turbinate swelling
Vasomotor Rhinitis
idiopathic nasal congestion and rhinorrhea not associated with sneezing or pruritus
triggers: chemical, climatic, and emotional factors
medical tx: steroid, ipratropium bromide
surgical: directed to the inferior turbinate
Identify this condition and describe the management:
pt complains of:
facial pain and fulless, sinus pain
nasal blockage, post nasal drainage, mucopurulent smelly discharge
headache and fatigue
exam:
nose: mucous red, edmatous; purulent discharge noted
sinuses: tender to palpation
Acute Sinusitis
predisposition: subsequent inflammation, blockage, deviated septum, trauma, excessive dryness, impaired cilia, immunocrompomised states
micrbiology: Strep pneumo, H. flu, Moraxella catarrhalis (rare - Staph aureus, Strep pyogenes)
tx:
- antibiotics if symptoms persit for 7-10 days
- decongestant
- steam, saline, irrigations
- mucolytic decongestants
- antihistamines
Symptoms of Acute Sinusitis
Major Symptoms:
- facial pain/pressure
- facial congestion/fullness
- nasal obstruction/blockage
- nasal discharge/purulence/discolored postnasal drainage
- hyposmia/anosmia
- purulence in nasal cavity
- fever (acute rhinosinusitis only)
Minor Symptoms
- headache
- fever (all non-acute)
- halitosis
- fatigue
- dental pain
- cough
- ear pain/pressure/fullnes
Identify this condition and describe the management:
pt compalins of nasal obstruction, postnasal drainage and occasional pain/pressure for the past 3.5 months
Chronic Sinusitis
microbial causes: anaerobic gram positive cocci, Fusarium species, alpha-strep, H. Flu, Staph a.
tx:
- antibiotics
- saline irrigation
- steroid spray
- allergen densitization
- envrionmental controls
- antihistamines if allergic
- Functional Endoscopic Sinus Surgery (FESS) to open drainage pathways and aerate the sinuses
Chronic Rhinosinusitis Types
- Aspirin Exacerbated Respiratory Disease
- Allergic Fungal Sinusitis
- Asthmatic Sinusitis
- Allergic Sinusitis
- Cystic Fibrosis
- Chronic Rhinosinusitis with/without polyposis
- Chronic Rhinosinusitis with/without biofilm
- Chronic Eosinophilic Rhinosinusitis
Identify this condition and describe the management:
pt complains of increasing nasal obstruction, inability to smell and a feeling of head fullness
pt is taking aspirin to prevent MI, and has hx of seasonal allergies
exam shows a sessile mass, it is soft and mobile on probing
Nasal Polyposis
Sampter’s Triad: polyps, asthma, aspirin sensitivity
TX:
- diet if allergy due to specific foods
- immunotherapy
- decongestants
- antihistamines
- steroids
- avoiding NSAIDS if a trigger
- leukotriene-receptor antagonists
- SURGICAL: endoscopic polypectamy and FESS
