Nasal Disorders Flashcards
What viruses are the most common viruses associated with the
common cold?
Rhinoviruses
The common cold is also called what?
Viral Rhinitis
What are some complications of viral rhinitis?
Middle ear effusion
Secondary bacterial infection
Associated with prolonged use of nasal decongestant sprays
Can be caused by chronic Afrin use or cocaine abuse
Rhinitis Medicamentosa
Consistent use of nasal decongestant spray subsequently leads to
rebound nasal congestion as the medication wears off
This frequently causes the patient to re-administer more of the medicine
Rhinitis Medicamentosa
IgE mediated disease that leads to activation and release of inflammatory mediators from mast cells in response to allergen
exposure
Classifications - Seasonal or Perennial
Atopic dermatitis can be associated with this (atopic triad)
Allergic Rhinitis
What are the two classifications of allergic rhinitis?
Seasonal – IgE-mediated reaction to seasonal aeroallergens (i.e. pollen)
Perennial – IgE-mediated reaction to perennial (year round) – environmental aeroallergens (dust mites, mold spores, animal dander, etc)
Atopic dermatitis can be associated with this
Allergic Rhinitis
What is the standard of care for allergic rhinitis?
Nasal corticosteroids
Defined as inflammation of the nasal passage and paranasal sinuses
lasting up to 4 weeks
Incidence in adults: 2-3 episodes per year
Secondary bacterial infection of paranasal sinuses following a viral
URI is estimated to occur in 0.5-2% of adult cases
Acute Rhinosinusitis
What is the most frequent cause of acute rhinosinusitis?
Viral etiology associated with a URI or the common cold
What are the most common pathogens in secondary bacterial rhinosinusitis?
Strep pneumonia and H. influenzae
What are some complications of secondary bacterial rhinosinusitis?
Chronic sinusitis
Orbital cellulitis and abscess
Osteomyelitis
Meningitis
Intracranial extension (rare)
Cavernous sinus thrombosis
Describe the clinical presentations (any of 3) are recommended for
identifying patients with acute bacterial v. viral rhinosinusitis
Onset with persistent symptoms or signs compatible with ARS, lasting for ≥10 days without clinical improvement
Onset with severe symptoms or signs of high fever (≥102 F) and purulent nasal discharge or facial pain lasting for at least 3-4 consecutive days at the beginning of illness
Onset with worsening symptoms or signs characterized by the new onset of fever, headache, or increase in nasal discharge following a typical viral URI that lasted 5-6 days and were initially improving
What is the drug of choice in bacterial rhinosinusitis?
Amoxicillin/Augmentin (7-10 day course)
Definition of recurrent acute rhinosinusitis
4 or more episodes per year of ABRS without signs or symptoms of
rhinosinusitis between episodes
Definition of chronic rhinosinusitis
Twelve weeks of longer of two or more of the following signs and symptoms:
Mucopurulent drainage
Nasal obstruction (congestion)
Facial pain/pressure/fullness
Decreased sense of smell
What are the two most common organisms seen in invasive fungal sinusitis?
Rhinocerebral mucoromycosis
Aspergillus
What is the classic finding of rhinocerebral mucomycosis?
Black eschar on middle turbinate
Symptoms are similar to bacterial sinusitis: Facial pain is more severe, insensate turbinate, nasal mucosa with black, necrotic eschar, cranial neuropathies
MEDICAL and SURGICAL EMERGENCY!!
Mortality rate 20% or more
Rhinocerebral Mucomycosis
What is the treatment for rhinocerebral mucomycosis?
Wide debridement and amphotericin B
Inflammation/infection of the
nasal vestibule
Commonly from folliculitis
Nasal Vestibulitis
What is a concern with nasal vestibulitis to be aware of?
Retrograde infection through valveless veins via the cavernous sinus into the cranium
What is the most common organism responsible for nasal vestibulitis?
Staph aureus
Unilateral nasal obstruction and rhinorrhea
Most are inorganic and do not cause many symptoms
Occur most commonly in young children (toddlers and preschoolers)
Nasal discharge typically purulent - Foul smelling
Nasal Foreign Bodies
What is the most common epistaxis?
anterior (95%)
What are the two classifications of epistaxis?
anterior (95%) and posterior
hereditary hemorrhage telangiectasia
Oster-Weber-Rendu syndrome
Where majority of anterior epistaxis occurs (anterior septum) – 90%
Anastomose to form Kiesselbach’s plexus
What is the most common cause of epistaxis in children?
nose picking
List some triggering factors for epistaxis
Viral URI
Allergic rhinitis
Trauma
Foreign body
Bleeding disorders (<5%)
Highly vascular invasive neoplasm
Presents as epistaxis, nasal obstruction
Juvenile angiofibromas
Which type of epistaxis is described below?
The most common type of epistaxis
Common in kids
Most active hemorrhages can be controlled
Anterior packing (outpatient)
Anterior Epistaxis
Which type of epistaxis is described below?
Very rare
Elderly most common
Originate most commonly from the posterolateral branches of the sphenopalatine artery
More serious problem - May be life threatening
Posterior Epistaxis
In epistaxis, any patient given packing of any sort should be placed on what until packing removed?
antibiotics
What are some complications of anterior epistaxis to be aware of?
complications can include sinusitis or more rarely TSS
Posterior epistaxis is most commonly associated with what chronic diseases?
HTN and atherosclerosis
What are some complications of posterior epistaxis to be aware of?
Respiratory failure
Cardiac arrhythmias
death
Patients with posterior packaging - is it managed in outpatient or inpatient settings?
must be hospitalized if posteriorly packed – typically ICU
List some clinical features of a nasal fracture?
History of trauma
Pain
Epistaxis
Nasal obstruction
Periorbital ecchymosis
edema
What is the best way to assess for a nasal fracture?
Palpation and Xray
Why is it recommended in a suspected nasal fracture to get facial series?
to rule out Le Forte fracture
What are some complications of a nasal fracture?
Septal hematoma
Unmanageable/uncontrollable hemorrhaging
Why should you be concerned about a septal hematoma?
Don’t miss this!!! Can lead to saddle deformity
