Nasal Obstruction 1 Flashcards
barrier function of nasal physio
- mucociliary system: mucous cells to trap foreign substances, ciliated cells to eliminate infected mucous
immunologic function of nasal physio
- observed by commensal flora
- secrete ig and proinflammatory molecules
nasal congestion vs obstruction
congestion: intermittent, has triggers
obstruction: more permanent, progressive
narrowest portion of the nasal cavity
internal nasal valve
regular respiration vs sniffing
regular respiration: air passes through common and middle meatus -> nasopharynx
sniff: air goes up to olfactory cleft
exhalation
- turbulent flow
- retronasal olfaction
normal changes in airflow
- nasal cycle
- “opening up” associated with elevated pulse that occurs during exercise
- “recumbency rhrinitis”
laterality of obstructoin
alternating = physiologic bilateral = rhinitis unilateral = foreign body, fixed obstruction
what is anterior rhinoscopy
- checking septum, turbinates, nasal valve
- look before and after decongestion
what is rigid nasal endoscopy
- for tumors, mucosa, polyps, masses, adenoidal size
what is gross nasal valve assessment
checking for normal and exaggerated breathing
maneuvers in internal nasal valve assessment
- cottle maneuver (lateral)
- bachman’s maneuver (open internal nasal valve)
t/f xray can be used to visualize the nose
false, only for suspected metallic foreign object
t/f before doing ct/mri, refer to ent for nasal endoscopy
true
mucosal vs anatomic ddx
mucosal: rhinitis, sinusitis, nasal polyposis, adenoid hypertrophy
anatomic: septal deviation, internal/ext nasal valve narrowing, nasal cavity and nasopharyngeal neoplasm
t/f allergic rhinitis can be caused by perfumes or changes in temperature
false
common allergens
- dust mites
- cat dander and cockroaches
- others (spores, mildew, molds)
pathophysio of allergic rhinitis
phase 1: sensitization
- primer, no symptoms
phase 2: clinical disease
- re-exposure
- early: sneezing, rhinorrhea, congestion, IGE AND MEDIATORS
- late phase: more congestion, leukotrienes
in diagnosing allergic rhinitis, if you suspect asthma do ___
auscultate the lungs
intermittent vs persistent symptoms
intermittent: <4 d per week OR < 4 weeks at a time
persistent: >/= 4 days per week AND >/= 4 weeks at a time
t/f you can diagnose a patient with AR if symptoms are present daily for 2 weeks
false
mild severity of ar symptoms
normal sleep, daily activities, work and school, no troublesome symptoms
moderate to severe severity of ar symptoms
abnormal sleep OR impairment of daily activities OR problems with work or school OR troublesome symptoms
treatment for intermittent mild ar
oral antihistamines, intranasal antihistamines, decongestants, or leukotriene receptor antagonist (montelukast with asthma)
treatment for intermittent moderate severe and persistent mild ar
intermittent mild
+ review patient after 2-4 wks of treatment
failure = step up improve = continue for 1 more month
treatment for persisntent moderate severe ar
- intranasal cs > h1 blocker > ltra
- review after 2-4 wks
- improved = step down and continue for 1 mo
- failure = review dx, compliance, query
- –> add or icnrease intranasal cs dose
- —> for rhinorrhea add ipratroprium
- —> for blockage add decongestant or oral cs
- —> persistent symptoms = refer
t/f for all severities of ar, allergen and irritant avoidance is appropriate
true
if ar patient has conjunctivitis, add __
h1 blocker, intraocular h1 blocker, intraocular cromone or saline
t/f multimodal environmental control strategies are better than any single strategy
true
mediators for ar symptoms
sneezing: histamine, endothelin
rhinorrhea: histamine, leukotrienes, endothelin
itching: histamine, endothelin
blockage: histamine, leukotrienes, prostaglandins, kinins
actions of antihistamines
- blocks histamine release from basophils and mast cells
- inhibits eicosanoids from mast cells and macrophages
- inhibit release of ltc4 and histamine
- reduce icam 1
action of intranasal corticosteroids
suppress inflammatory process and effective in prevention and treatment of ar
what is senile rhinitis
- > 65 yo
- no endonasal mucosal or anatomic pathology
- neurogenic dysregulation
- tx: ipratropium bromide
what is gustatory rhinitis
- water rhinorrhea after ingestion of hot and spicy food (neurogenic inflammation)
what is occupational rhinitis
- hmw agents trigger ige mediated allergic inflammation
- prolonged exposure = asthma
what is hormonal rhinitis
- menstrual, puberty, pregnancy, menopause
- estrogens exert vascular engorgement effect in the nose (more histamine and eosinophils)
- testosterone decreases eosinophil activation and viability
what is drug induced rhinitis
- due to neuronal imbalance
- abuse in decongestive nasal therapy = rhinitis medicamentosa
treatments for non allergic rhinitis
- nonallergic senile rhinitis: ipratropium bromide
- gustatory rhinitis: avoid nasal capsaicin
- nonallergic occupational: avoid
- hormonal: nasal cs
- drug induced: avoid
- idiopathic: nasal cs, nasal capsaicin
allergic vs nonallergic rhinitis
table 2
