Nasal, Paranasal and Sinus Disorders Flashcards
Define: Rhinitis
nasal hyperfunction and tissue inflammation. There is allergic and nonallergic
What is rhinorrhea?
tissue transudate
What is the most common cause of chronic rhinitis? What about acute?
allergies. infection.
Acute viral rhinitis: most common virus
rhinovirus
When does viral rhinitis usually occur?
winter
What are the four stages of Acute Viral Rhinits
Prodromal (lasts hours): unusually clear nose
Catarrahal (hours to day): watery, nasal discharge. sneezing, fever.
Mucous Phase: most mucopurlent stage
Resolution: symptoms usually regress in 10 days
What are some complications of acute viral rhinitis?
otitis media and sinusitis
Patient presents to clinic complaining of a mild fever and runny nose. You determine that it is an acute viral rhinits…what is the treatment
supportive, oral fluids, and pain meds, irrigation of nose, decongestants
nasal irrigation: improves sx and reduces need for NSAID’s
- oral decongestants (ex pseudoephedrine) can provide temp relief of rhinorrhea and nasal obstruction
- nasal sprays (ex oxymetazole or phenylephrine) can be rapidly effective but can only be used for a few days
- WARNING! can lead to rebound congestion AND rhinitis medicamentosa if withdrawn after prolonged use - addictive in nature
Patient presents with rhinorrhea, itchy watery eyes, sneezing and cough. They have a history of atopy. Patient says this happens frequently with certain exposures. What is the cause of this?
Allergic rhinitis, it is a TYPE I hyerpsensitivity. Exposure with IgE. Common antigens include: pollens, mold, dust.
Fixed: each time exposure occurs.
Cyclic: based on frequency
Patient presents with rhinorrhea, itchy watery eyes, sneezing and cough. They have a history of atopy. Patient says this happens frequently with certain exposures.What do you expect their nasal mucosa to appear like?
pale and boggy, swollen inferior turbinates, large amounts of CLEAR secretion. can have an allergic shiner under their eye.
Patient presents with rhinorrhea, itchy watery eyes, sneezing and cough. They have a history of atopy. Patient says this happens frequently with certain exposures. What ways can you diagnose this? how do you treat?
hx, pe, skin testing.
casual: avoidance, desenstitization
symptomatic: antihistamines (loratadine, certirizine), steroids, decongestants
A patient with acute viral rhinitis, their nasal mucoa appears..
erythematous, edema, watery discharge
patient with EXCESSIVE rhinorrhea bilaterally, especially in response to cold or hot air, intense smells.
vasomotor rhinitis, this is caused due to the vidian nerve. excessive parasymp stimulation.
patient with EXCESSIVE rhinorrhea bilaterally, especially in response to cold or hot air, intense smells. treatment:
anticholinergic. surgery if very bad–> directed at inferior turbinate
patient with EXCESSIVE rhinorrhea bilaterally, especially in response to cold or hot air, intense smells. appearance of turbinates
extremely RED AND HEMORRHAGIC
acute sinusitis: what is the general rule?
rhinitus precedes sinustitis
Patient presents with facial congestion and fullness, nasal blockage, nasal discharge that is yellow/green, decreased smell, and facial pain or pressure. They also have a FEVER. They say they had a cold for about 15 days.
You know this must be acute sinusitis because rhinitis should only last 10 or less, and they have facial pain, discharge, and a worsening of symptoms.
Patient presents with facial congestion and fullness, nasal blockage, nasal discharge that is yellow/green, decreased smell, and facial pain or pressure. They also have a FEVER. They say they had a cold for about 15 days. what organisms cause this?
s. pneumo, H. flu, M. cat
Patient presents with facial congestion and fullness, nasal blockage, nasal discharge that is yellow/green, decreased smell, and facial pain or pressure. They also have a FEVER. They say they had a cold for about 15 days. what is the pathology?
decreased movement of the mucociliary in the sinuses enoucrages bacteria to grow. This is most common in the middle turbinate.
Acute sinusitis treatment:
Medication / Surgery:
- intranasal CCS for first 5 days of sx (reduces facial pain and congestion)
- NSAID’s for inflammation
- oral or nasal decongestants for sinus sx (ex. Pseudoephedrine)
- 80% of pts. Recover w/o Ab’s, use sparingly
- 1st Line: penicillin, amoxicillin (7 - 10 days)
- Alt for penicillin allergies: macrolide therapy or tetracycline
At what point to acute sinustis become chronic?
when symptoms persist for 12 weeks. symptoms look similar to acute EXCEPT that sometimes there is a fever, sometimes there isnt..the discharge is paler. You can sometimes do a CT to confirm.
What is Sampter’s triad?
polyps, asthma, and aspirin senstivity
How do you diagnose nasal polyps?
rhinoscopy, CT scan
What is treatment for nasal polyps?
General: Presense of polyps in children possibly sugg. cystic fibrosis
Medications / Surgical: Nasal Poly-topical intranasal corticosteroids for 1-3 mos for sm. polyps; If polyps are massive then remove surgically; Inverted Papilloma- because SCC-complete excision and removal (medical maxillectomy)-recurrence rates are high, make sure to follow up
Complications: Pts with nasal polyps and asthma, avoid aspirin, could cause bronchospasm (triad asthma-Samter triad)-immunologic salicylate sensitivity;
sinusitis usually presents uni or bi?
uni
