Nasal blockage

Question 1

5 causes of Nasal blockage

Answer 1

1) Nasal polyps
2) Chronic rhinosinusitis
3) Foreign body in the nose
4) Nasal septal deviation
5) Nasal valve collapse

Question 2

what is a red flag for nsasal polyps?

Answer 2

unilateral
o r
bleeding

Question 3

commonest cause of nasal obstruction?

Answer 3

Chronic Rhinosinusitis

Question 4

commonest cause of unilateral nasal obstruction?

Answer 4

foreign body in the nose

Question 5

what may foreign body in the nose be associated with

Answer 5

unilateral nasal discharge

Question 6

pathophysiology of nasal valve collapse?

and how is it tested for?

Answer 6

Collapse of nasal valve on inspiration due to weak lateral cartilage

Tested for by asking the patient to sniff in

Question 7

3 investigations for nasal blockage

Answer 7

• nasal misting on back of metal spatula
• nasal inspiratory peak flow
• acoustic rhinometry

Question 8

Causes of nasal septum deformity?

Answer 8

• Chronic inflammatory conditions such as sarcoidosis + GPA
• Infective septal haematoma
• Trama

Question 9

GPA manifestation in the nose

Answer 9

generalised crusting + granuloma formation; destruction of cartilage of nose –> nasal septal perforation + collapse of cartilaginous dorsum of nose

Question 10

presentation of Nasal spetal haematoma?

Answer 10

Boggy swellings either side of septum, usually post trauma

Question 11

Nasopharyngeal carcinoma usually presents…

Answer 11

unilaterally

Question 12

Management of Nasal septum deviation

Answer 12

Septoplasty

Question 13

management of nasal septal haematoma

Answer 13

Surgical drainage
+
IV abx

Question 14

Samter’s triad in Nasal polyps

Answer 14

• Nasal polyps
• Asthma
• Aspirin sensitivity

Question 15

symptoms of Nasal polyps

Answer 15

• sneezing + rhinorrhoea
• nasal obstruction
• poor sense of taste + smell

Question 16

describe Septoplasty procedure

Answer 16

cut made inside the nose to straighten out the septum by taking away some of the cartilage and bone + moving the rest of the septum back to the middle of the nose

Question 17

post op advice to patients

Answer 17

• sneeze with mouth open to protect nose
• do not blow nose for about a week due to risk of bleeding
• blood stained fluid for the first 2 weeks is normal
• 10-14 days post op: experience blocked nose

Question 18

diagnosis of Nasal polyps?

Answer 18

• visually by nasal endoscopy
  or
• CT scan

Question 19

treatment of nasal polyps

Answer 19

nasal steroid sprays

Question 20

Allergic Rhinitis is…

Answer 20

inflammatory disorder of the nose

Question 21

triad of typical symptoms of Chronic allergic Rhinosinusitis

Answer 21

• Bilateral nasal obstruction
• Anterior rhinorrhoea
• Sneezing

Question 22

30% patients with Chronic allergic rhinosinusitis also have what condition?

and why?

Answer 22

asthma

nasal cavity + lungs are lined by the same epithelium

Question 23

3 types of allergic rhinitis

Answer 23

• seasonal
• prennial
• occupational

Question 24

symptoms of Chronic allergic rhinosinusitis

Answer 24

• sneezing
• bilateral nasal obstruction
• clear nasal discharge
• post nasal drip
• nasal pruritus

Question 25

colour of nasal discharge in chronic allergic rhinosinusitis

Answer 25

clear

Question 26

investigations for chronic allergic rhinosinusitis?

Answer 26

- RAST testing - Inspect external nose - Anterior rhinoscopy - Nasal endoscopy

Question 27

What is RAST testing?

Answer 27

blood test that identifies any allergies to specific allergens

Question 28

Management of Chronic allergic rhinosinusitis (4)

Answer 28

- Allergy avoidance - oral/intranasal antihistamines - spray intranasal corticosteroids - nasal decongestants (1 week)

Question 29

How long should nasal decongestants be used for for Chronic allergic rhinosinusitis?

Answer 29

short term relief, max 1 week

Question 30

why are nasal decongestants not suitable for long term management of chronic disease

Answer 30

can cause rebound decongestion upon withdrawal

Question 31

2 examples of nasal decongestants

Answer 31

- Oltravine | - Sudafed

Question 32

list poss allergens (4)

Answer 32

- dust mites | - grass/tree/weed pollens

Question 33

Acute rhinosinusitis in adults is defined as:

Answer 33

sudden onset of 2 or more of the following symptoms: - nasal blockage/obstruction/congestion - nasal discharge (anterior/posterior nasal drip) +/- facial pain/pressure +/- reduction/loss of smell for > 12 weeks

Question 34

Acute bacterial rhinosinusitis is characterised by presence of at least 3 symptoms/signs of:

Answer 34

- Discoloured discharge (unilateral predominance) and purulent secretion in the nasal cavity - Severe local pain w/ unilateral dominance - Fever (>38 deg) - Elevated ESR/CRP - Double sickening (deterioration after an initial phase of illness)

Question 35

4 symptoms of allergy:

Answer 35

- nasal itching - watery itchy eyes - sneezing - rhinorrhoea

Question 36

Rhinosinusitis is defined as:

Answer 36

inflammation of the nose + paranasal sinuses; defined by; - nasal blockage and another of the following

Question 37

definition of recurrent acute rhinosinusitis?

Answer 37

more than or equal to 4 episodes per year, without symptoms of rhinosinusitis between episodes

Question 38

definition of acute bacterial rhinosinusitis

Answer 38

symptoms/signs of rhinosinusitis that worsen over a 10 day period (may be double worsening)

Question 39

definition of viral rhinosinusitis

Answer 39

symptoms/signs that are present for less than 10 days