Nasal Problems

Question 1

what are nasal polyps

Answer 1

abnormal lesions from nasal mucosa / paranasal sinuses

Question 2

features of nasal polyps

Answer 2

pale, fleshy, non-tender

Question 3

symptoms of nasal polyps

Answer 3

nasal obstruction
rhinorrhoea
hyposmia (decreased sense of smell)

Question 4

what features of nasal polyps require urgent ENT referral? why?

Answer 4

unilateral symptoms
bleeding
- possible malignancy

Question 5

management of nasal polyps

Answer 5

1st line- intranasal steroids
2nd line - oral steroids
3rd line - endoscopic sinus surgery + polpectomy
- all patients should be referred to ENT for assessment

Question 6

what is Samter’s triad

Answer 6

nasal polyps, asthma, aspirin sensitivity

Question 7

nasal polyps in children might reflect what underlying condition

Answer 7

cystic fibrosis

Question 8

what is sinusitis

Answer 8

inflammation of the mucous membranes of the paranasal sinuses

Question 9

what is acute sinusitis typically secondary to

Answer 9

viral URTI

Question 10

risk factors for sinusitis

Answer 10

nasal obstruction: septal deviation / polyps
smoking
swimming / diving

Question 11

presentation of sinusitis

Answer 11

facial pain that is worse on bending forwards

thick + purulent nasal discharge (bacterial)

Question 12

management of acute sinusitis

Answer 12

majority self resolve within 2 weeks 
symptomatic relief
- intranasal decongestants 
- simple analgesia 
- saline nasal irrigation

Question 13

what is the maximum length of time nasal decongestants should be used for? why?

Answer 13

1 week

Tachyphylaxis - increase dose need to get same effect

Question 14

what treatment should be initiated if acute sinusitis symptoms persist > 10 days

Answer 14

intranasal corticosteroids

oral penicillin if bacterial infection likely

Question 15

treatment of chronic sinusitis (>12 weeks)

Answer 15

intranasal corticosteroids

saline nasal irrigation

Question 16

what is allergic rhinitis

Answer 16

IgE mediated inflammation of nasal membranes

sensitisation to allergens such as dust mites, pollen, animal dander, grass

Question 17

symptoms of allergic rhinitis

Answer 17

nasal congestion, rhinorrhoea, sneezing
nasal itch
may be seasonal

Question 18

investigation of suspected allergic rhinitis

Answer 18

skin prick testing

Question 19

management of allergic rhinitis

Answer 19

avoid allergen
intranasal antihistamines (azelastine)
intranasal corticosteroids (mometasone, beclometasone)
oral antihistamines (cetirizine, loratadine)
oral montelukast in very severe cases

Question 20

what is vasomotor rhinitis

Answer 20

non- allergic rhinitis

• seen in older patients
• nasal congestion + rhinorrhea
• all year round, no clear triggers

Question 21

what should be suspected in children with unilateral stuffy nose + rhinorrhoea

Answer 21

a foreign body

Question 22

what should be suspected in an adult with unilateral stuffy nose + rhinorrhea

Answer 22

nasal / paranasal tumour

Question 23

child with swollen eye following stuffy nose for few days

Answer 23

orbital cellulitis

- emergency

Question 24

what is epistaxis

Answer 24

nose bleed

Question 25

most common site for epistaxis

Answer 25

Kiesselbach’s plexus (little’s area)

- anterior part of the septum

Question 26

what can occur on withdrawal of intranasal decongestants

Answer 26

rhinitis medicamentosa

- rebound hypertrophy of nasal mucosa

Question 27

management of epistaxis

Answer 27

1. pinch nostrils, sit up, lean forward – 10 minutes
2. vasoconstriction with adrenaline
3. cautery with silver nitrate
4. nasal packing

Question 28

management of heavy nose bleed where you cannot locate bleeding site

Answer 28

anterior packing