Nasal blockage Flashcards
5 causes of Nasal blockage
1) Nasal polyps
2) Chronic rhinosinusitis
3) Foreign body in the nose
4) Nasal septal deviation
5) Nasal valve collapse
what is a red flag for nsasal polyps?
unilateral
o r
bleeding
commonest cause of nasal obstruction?
Chronic Rhinosinusitis
commonest cause of unilateral nasal obstruction?
foreign body in the nose
what may foreign body in the nose be associated with
unilateral nasal discharge
pathophysiology of nasal valve collapse?
and how is it tested for?
Collapse of nasal valve on inspiration due to weak lateral cartilage
Tested for by asking the patient to sniff in
3 investigations for nasal blockage
- nasal misting on back of metal spatula
- nasal inspiratory peak flow
- acoustic rhinometry
Causes of nasal septum deformity?
- Chronic inflammatory conditions such as sarcoidosis + GPA
- Infective septal haematoma
- Trama
GPA manifestation in the nose
generalised crusting + granuloma formation; destruction of cartilage of nose –> nasal septal perforation + collapse of cartilaginous dorsum of nose
presentation of Nasal spetal haematoma?
Boggy swellings either side of septum, usually post trauma
Nasopharyngeal carcinoma usually presents…
unilaterally
Management of Nasal septum deviation
Septoplasty
management of nasal septal haematoma
Surgical drainage
+
IV abx
Samter’s triad in Nasal polyps
- Nasal polyps
- Asthma
- Aspirin sensitivity
symptoms of Nasal polyps
- sneezing + rhinorrhoea
- nasal obstruction
- poor sense of taste + smell
describe Septoplasty procedure
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
post op advice to patients
- 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
diagnosis of Nasal polyps?
- visually by nasal endoscopy
or - CT scan
treatment of nasal polyps
nasal steroid sprays
Allergic Rhinitis is…
inflammatory disorder of the nose
triad of typical symptoms of Chronic allergic Rhinosinusitis
- Bilateral nasal obstruction
- Anterior rhinorrhoea
- Sneezing
30% patients with Chronic allergic rhinosinusitis also have what condition?
and why?
asthma
nasal cavity + lungs are lined by the same epithelium
3 types of allergic rhinitis
- seasonal
- prennial
- occupational
symptoms of Chronic allergic rhinosinusitis
- sneezing
- bilateral nasal obstruction
- clear nasal discharge
- post nasal drip
- nasal pruritus
colour of nasal discharge in chronic allergic rhinosinusitis
clear
investigations for chronic allergic rhinosinusitis?
- RAST testing
- Inspect external nose
- Anterior rhinoscopy
- Nasal endoscopy
What is RAST testing?
blood test that identifies any allergies to specific allergens
Management of Chronic allergic rhinosinusitis (4)
- Allergy avoidance
- oral/intranasal antihistamines
- spray intranasal corticosteroids
- nasal decongestants (1 week)
How long should nasal decongestants be used for for Chronic allergic rhinosinusitis?
short term relief, max 1 week
why are nasal decongestants not suitable for long term management of chronic disease
can cause rebound decongestion upon withdrawal
2 examples of nasal decongestants
- Oltravine
- Sudafed
list poss allergens (4)
- dust mites
- grass/tree/weed pollens
Acute rhinosinusitis in adults is defined as:
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
Acute bacterial rhinosinusitis is characterised by presence of at least 3 symptoms/signs of:
- 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)
4 symptoms of allergy:
- nasal itching
- watery itchy eyes
- sneezing
- rhinorrhoea
Rhinosinusitis is defined as:
inflammation of the nose + paranasal sinuses; defined by;
- nasal blockage
and another of the following
definition of recurrent acute rhinosinusitis?
more than or equal to 4 episodes per year, without symptoms of rhinosinusitis between episodes
definition of acute bacterial rhinosinusitis
symptoms/signs of rhinosinusitis that worsen over a 10 day period (may be double worsening)
definition of viral rhinosinusitis
symptoms/signs that are present for less than 10 days
