Nasal Congestion & Rhinorrhoea

Question 1

What are the most common nasal symptoms patients present with

Answer 1

Nasal congestion
Hyposmia
Rhinorrhoea
Facial pain

Sneezing
Itching
Crusting
Epistaxis

Question 2

What are the three types of rhinitis

Answer 2

Infective (URTI)
Non infective, allergic
Non infective, non-allergic

Question 3

Allergic rhinitis pathophysiology

Answer 3

IgE-mediated allergic reaction (type I hypersensitivity)

Question 4

What are the two types of allergic rhinitis

Answer 4

Intermittent

• Symptoms <4 days per week or symptoms for <4 weeks
• Grass pollen, tree pollen, fungal spores

Persistent

• Symptoms >4 days per week AND >4 week duration
• House dust mite, cat, dog

Question 5

Mild vs moderate-severe allergic rhinitis

Answer 5

Mild - no significant affect on day to day life
Moderate-severe - abnormal sleep/ missing school etc

Question 6

Allergic rhinitis clinical; features

Answer 6

Sneezing, nasal itching, nasal discharge and nasal congestion

Question 7

What does an allergic crease on the nose indicate

Answer 7

Repeated itching of the nose

Question 8

Allergic rhinitis diagnosis

Answer 8

• Clinical diagnosis
• If uncertain => skin prick test

Question 9

Allergic rhinitis treatment

Answer 9

1. Oral antihistamine e.g. cetrizine
2. Topical steroids e.g. beclometasone
3. Topical steroids & oral antihistamine
4. Immunotherapy e.g. LTR blockers (montelukast)

& if mucosal hypertrophy => diathermy

Question 10

What is a nasal polyp

Answer 10

Soft, painless, noncancerous growths on the lining of the nasal passages

Question 11

What condition are nasal polyps associated with in adults vs kids

Answer 11

Adults - Non-allergic asthma
Young - Cystic fibrosis

Question 12

Nasal polyp histological features

Answer 12

respiratory or squamous epithelium, oedematous stroma containing mixed inflammatory cells +/- eosinophils

Question 13

Nasal polyp diagnosis

Answer 13

Nasoendocsopy

Question 14

Nasal polyp treatment

Answer 14

1. Oral then topical steroids
2. Surgical removal (if large/ unresponsive)

Question 15

Acute infective rhinosinusitis clinical features

Answer 15

•Discharge
•Nasal blockage
•Facial pain
•Preceding URTI
•Symptoms <12 weeks

Question 16

Acute infective rhinosinusitis aetiology

Answer 16

Usually viral (98%)

Question 17

Acute infective rhinosinusitis treatment

Answer 17

1. Analgesics & decongestants
2. If persistent/ worsening => antibiotic +/- nasal steroids

Question 18

Acute infective rhinosinusitis complications

Question 19

Summarise the types of rhinitis that fall under the three categories

Answer 19

Infective (preceding URTI (or dentition infection))
- Viral (98%)
- Bacterial (purulent discharge or severe pain)

Non infective, allergic (itching & sneezing)
- intermittent rhinitis
- persistent rhinitis

Non infective, non-allergic
- Vasomotor rhinitis
- Nasal polyps (CF, non-allergic asthma)
- Foreign body (child, unilateral)
- Tumour (adult, unilateral)

Question 20

What tests should you avoid in a patient presenting with nasal congestion or Rhinorrhoea

Answer 20

Nasal or sinus X-rays

Question 21

Summarise the treatment of rhinitis depending on the cause

Answer 21

• Viral rhino-sinusitis - decongestants & analgesia
• Bacterial - antibiotics
• Allergic rhinitis - antihistamines +/- steroids
• Vasomotor rhinitis - anticholinergics
• Nasal polyps - steroids or surgical removal
• Foreign body - removal
• Tumour - urgent referral