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Y4 Neuro and Special Senses > Nose > Flashcards

Nose Flashcards

1
Q

Give four roles of the nose

A
  • Warms and humidifies
  • Removes and traps pathogens
  • Responsible for smell
  • Drains and clears Paranasal sinuses and lacrimal ducrs
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2
Q

Describe the anatomy of the nose

A 
Root - as it joins forehead
Bridge - top of the nose
Dorsum Nasi 
Nares - Nostrils
Apex - between nostrils
Ala - side of nostrils
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3
Q

Name two bones in the external nose

A 
Nasal Bone (ethmoid)
Maxilla
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4
Q

Name four cartilages associated with the external nose

A

Septal
Lateral
Major Alar
Minor Alar

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5
Q

Describe the blood supply to the external nose

A 
Facial Artery (Angular and Lateral Nasal)
Branches of Maxillary and Opthalmic
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6
Q

The external nose is drained by the facial vein. Why is this relevant?

A

Valveless structure that runs into opthalmic and then cavernous sinus so infection in this region can cause intracranial spread (danger triangle)

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7
Q

What are the three regions of the nasal cavity?

A

Area surrounding external opening - Vestibule
Respiratory region
Olfactory region

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8
Q

What are conchae/turbinates?

A

Bony shelves protruding into cavity (superior, middle and inferior)
Increase SA of cavity and slows air flow down

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9
Q

What are meatuses?

A

4 Pathways between conchae

Inferior - between inferior conchae and floor
Middle - between inferior and middle conchae
Superior - between middle and superior conchae
Sphenoethmoidal - Superoposterior to superior

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10
Q

What structures open up into middle meatus?

A

Frontal, Maxillary and Ethmoid Sinuses

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11
Q

What structures open up into inferior meatus?

A

Nasolacrimal duct

Eustacian tube

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12
Q

What are two gateways of the nasal cavity?

A

Cribriform plate - into Ethmoid bone

Sphenopalantine - Between nasal cavity and Pterygopalantine fossa

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13
Q

The vasculature of the nasal cavity has to be rich. Describe this

A

Internal Carotid - Anterior and Posterior Ethmoidal (branches of opthalmic through cribriform plate)

External Carotid - Sphenopalantine, Greater Palantine, Superior Labial, Lateral Nasal

Anastamose in Little’s Area

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14
Q

Describe the innervation of the nasal cavity

A

Special Sensory - Olfactory

General Sensory - Nasociliary (Opthalmic) and Nasopalantine (Maxillary)

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15
Q

How would a Cribriform plate fracture present?

A

CSF Rhinorrhoea

Anosmia

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16
Q

What are Paranasal Sinuses?

A

Air filled extensions of nasal cavity, lined with pseudostratified epithelium and interspersed with goblet cells

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17
Q

Name four roles of Paranasal SInuses

A

Reduce weight of head
Supports immune defence
Humidifies inspired air
Increases vocal resonance

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18
Q

Describe the anatomy of the Frontal Sinus

A

Triangular shaped within the frontal bone
Drainage into middle meatus
Sensation by Supraorbital (CNV1)

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19
Q

Describe the anatomy of the Ethmoidal Sinus

A

Made up of three

Anterior - into middle meatus
Middle - into middle meatus
Inferior - into superior meatus

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20
Q

Describe the anatomy of the Maxillary Sinus

A

Drains into middle meatus (just below frontal so fluid can enter maxillary)
Maxillary nerve also supplies teeth - referred toothache

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21
Q

Give three broad causes of Nasal Obstruction

A

Anatomical
Nasal lining
Autonomic

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22
Q

Name three anatomical causes of nasal obstruction

A

Septal Deflection
Adenoidal Hypertrophy
Chonal Atresia

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23
Q

Chonal Atresia is a part of CHARGE Syndrome. How would it present?

A

Unilateral - persistent nasal drainage, recurrent sinus infections
Bilateral - RDS or Cyanosis

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24
Q

Name two nasal lining causes of nasal obstruction

A

Rhinitis

Nasal Polyps

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25
Name an autonomic cause of nasal obstruction
Vasomotor Rhinitis (increased parasympathetic flow causes engorgement)
26
Nasal discharge has two different terms, what are they?
Rhinorrhoea - out of nostrils | Catarrh - Post nasal drip
27
Give two causes of watery nasal discharge
Allergic | CSF
28
Give two causes of mucopurulent nasal discharge
Bacterial Rhinitis | Foreign Body
29
Give two causes of serosanguinous nasal discharge
Neoplasia
30
Give two causes of bloody nasal discharge
Trauma | Neoplasia
31
How do allergies to dust mites present?
Sneezing upon waking (bed acts as resevoir)
32
What is Cacosmia?
Unpleasant smell detected mainly by others Indicated nasal sepsis
33
Name two nasal causes of Halitosis
Chronic Sinusitis | Post Nasal Drip
34
Describe the pathophysiology of Allergic Rhinitis
IgE mediated inflammation of nasal mucosa due to mast cell degranulation
35
Describe the acute and late response of Allergic Rhinitis
Acute - Stimulation of afferent nerves (sneezing), Increase in nasal secretions 15-20 mins later Late - 6 to 12h later nasal obstruction
36
Other than sneezing and nasal obstruction, name two features of Alllergic Rhinitis
Mouth Breathing | Halitosis
37
Allergic Rhinitis may require further investigation to determine allergen. What would these be?
``` Skin Prick Test (note - surpressed by antihistamines, steroids and TCAs) Blood IgE (useful if patient is on antihistamines ```
38
Name some general advice for pollen allergy
Avoid exposure to open grassy spaces Keep windows shut Regular servicing of car pollen filter
39
Name some general advice for house dust mite allergy
Special bedding Soft toys off of bed Wash bedding weekly Laminate>carpet
40
Describe the possibly medical managements for allergic rhinitis
1) Topical Antihistamines for symptom relief and oral for prevention 2) Nasal Corticosteroids 3) Consider using Corticosteroid and Antihistamine combination (Dimysta) or adding LTRA 4) Short course of oral steroids Increasing immunological tolerance? Nasal Douching with Saline? Avoiding allergens
41
Describe a possible surgical management for allergic rhinitis
Reduce inferior turbinates to improve airways
42
Vasomotor Rhinitis presents similarly to allergic but without the positive test. Describe the pathophysiology
Imbalance in sympathetic and parasympathetic, increasing vascularity and secretions Causes - Humidity, temperature, pregnancy, alcohol
43
How can Vasomotor Rhinitis be managed?
Nasal Antihistamines +/- Corticosteroids Laser treatment or partial turbinectomy
44
What is Rhinitis Medicamentosa and how is it managed?
Reactive vasodilation of nasal mucosa due to prolonged use of topical agents Substitution of offending drug to one containing a steroid (if established - partial turbinate resection)
45
What is Hormonal Rhinitis?
May be linked to increased oestrohen or hypothyroidism
46
What is Gustatory Rhinitis?
After eating hot and spicy foods, vagus nerve causes nasal vasodilation Watery rhinorrhoea typically 2h after ingestion Can be managed with Ipratropium Bromide Spray
47
What are Nasal Polyps?
Sac like entities of eosinophil rich oedematous walls, arise from nasal mucosa, most commonly in the clefts of the middle meatus Considered part of the spectrum of chronic rhinosinusitis
48
Name three associations of Nasal Polyps
Asparin Sensitvity Asthma CF
49
What is Asparin Sensitivity?
Within 20-120 minutes of ingestion - facial flushing, rhinorrhoea and congestion
50
How do Nasal Polyps present?
``` Nasal airway obstruction Nasal discharge Dull headaches Snoring Hypo-osmia ```
51
How can you distinguish nasal polyps from inferior turbinate?
Paler in colour (poor blood supply) | Ability to get between wall and the polyp
52
How are nasal polyps investigated?
Rhinoscopy | CT if failing medical therapy/severe disease
53
What Nasal Polyps should you refer to ENT?
Unilateral | Children (underlying CF)
54
How are Nasal Polyps managed?
Educated on recurrent nature Then step down to Topical Steroids (if Beclometasone - monitor childs growth Antihistamines if allergy If refractory can give a short course of oral steroids
55
What is the gold standard definitive management for Nasal Polyps
Endoscopic Sinus Surgery
56
Why is time an important factor in Nasal Injuries
After about four hours, swelling obscures diagnosis
57
What are important things to look for OE in a nasal injury?
``` Septal haematoma Epistaxis/CSF Rhinorrhoea Septal Deviation Opthalmoplegia Facial Anaesthesisa ```
58
How are nasal injuries managed?
Mild - ice and analgesia, review in 5d Deviation - seen by ENT within 7-10 days Fracture reduction - 5-10d for adults and 3-7 for children (allows swelling to settle)
59
How could Nasal Foreign Bodies present?
Directly after if observed Nasal obstruction Foul discharge
60
What are the management options for Nasal FB
``` Topical anaesthetic and vasoconstrictor in affected nostril ?Blow positive presure through nose ?Strong Suction ?Thin forceps ? Fogarty balloon ``` Button batteries should be removed immediately Refer to ENT after two unsuccessful attempts
61
What is a Septal Perforation?
Defect through any part of the cartilagenous/bony septum with no overlying perichondrium/periosteum
62
How does Septal Perforation present?
Nasal whistle Discharge Congestion Epistaxis
63
Give four causes of Septal Perforation
Nose picking Trauma Steroids Cocaine
64
Describe some early signs of Septal Perforation
Bothersome bleeding and crusting
65
How is Septal Perforation managed?
Nasal Douching/Emollients Adjust nasal cannulae if relevant Surgery if affecting QoL
66
How does a common nasal infection present?
``` Hyperaemic nasal lining Nasal Obstruction Sneezing Rhinorrhoea Headache ```
67
What would you advise patients regarding management of common infective rhinitis?
Steam inhalation Nasal Congestants Simple Analgesia May get post nasal drip if glands don't return to normal
68
What is Nasal Vestibulitis?
Excoriation of skin of vestibule (from nose picking, rhinorrhoea, allergy)
69
How would you manage Nasal Vestibulitis?
Topical Abx Steroid based ointments If persistent with ulceration - BCC/SCC
70
What is Atrophic Rhinitis?
Severe crusting in the nasal cavities and atrophy of mucosa and turbinates (often secondary to poor hygiene and malnutrition Associated with foul odour that patients can't smell
71
How is Atrophic Rhinitis managed?
Douching nose 3-4 times a day Prolonged Abx based on cultures Narrow nasal cavities using bone/cartilage
72
What is Nasal Furunculosis?
S.Aureus causing hair follicle infection in nasal vestibule often initiated by nose picking)
73
How is Nasal Furunculosis managed?
Systemic and Topical Abx (based on swabs) Don't squeeze pus - danger triangle
74
How does a Septal Deflection present?
Unilateral obstruction typically Facial Pain Nasal discharge Compensatory Hypertrophy of inferior turbinates on opposite side
75
If Septal Deflections are symptomatic, how are they treated?
Submucous resection | Septoplasty (repositions septum after removal)
76
Why are Septal Haematomas most common in children?
Mucoperichondrium is only loosely adherent to underlying cartilage
77
How does Nasal Haematoma present?
Severe nasal obstruction If not adequately drained - avascular necrosis
78
How are Nasal Haematomas managed?
Drained (by aspiration or by formal incision and evacuation) Nasal packing to prevent recurrence Abx
79
What is Choanal Atresia?
Presence of bony septum between nose and pharynx Commonly on the right side
80
How is Choanal Atresia investigated?
No fogging under nostril | CT
81
How is Choanal Atresia managed?
Surgery (Pt may require periodic dilations) Bilateral - emergency oral airway
82
Name four causes of Epistaxis
Trauma Inflammatory Conditions Post Op Vascular Malformations
83
95% of Epistaxis comes from the Anterior Plexus. What is the posterior plexus?
Woodruff's Plexus
84
What is the initial management for Epistaxis?
- A to E assessment - Lean forward and pinch nose for 10-20 minutes (ice pack on back of neck) - Spit out any blood (it is an emetic)
85
How should refractory Epistaxis be managed?
IV Access (clotting, fbc, g+s) - ?Anticoag reversal - Cautery (with NO, Naseptin afterwards) - Nasal Packing and Admission (local anaesthetic, vasoconstrictor, rapid rhino)
86
How are posterior Epistaxis managed?
Double balloon catheter
87
What post Epistaxis advice would you give the patient?
Naseptin cream (not if peanut allergic) Avoid: Hot drinks, blowing nose, heavy lifting and lying flat for 24-48h
88
When should you refer an Epistaxis?
Under 2y - NAI | Recurrent - ?Leukaemia?Nasopharyngeal Ca?HHT
89
What is Sinusitis?
Inflammation of the membranous lining of the sinuses (may also implicate rhinitis) Acute - 7-30d Subacute - 4 to 12 weeks Chronic - >90d Recurring - >3 episodes in a year, each lasting atleast 10 days
90
What indicates Bacterial Sinusitis?
Worsening symptoms beyond 5d, or persisting beyond 10d
91
Give five risk factors for Sinusitis
``` URTI Allergy Polyps CF (Kartageners, Youngs) Smoking ```
92
What is Samter's Triad?
Aspirin Sensitivity Rhinitis Asthma
93
How would you palpate for the sinuses?
Frontal - upwards beneath medial supraorbital ridge Axillary - against anterior wall below infraorbital margin Ethmoidal - medial orbit
94
How could you percuss the Sinuses for Sinusitis?
Technically difficult as the area is very small Dullness indicates infection
95
How can you transilluminate for SInusitis?
Frontal - place under supraorbital ridge and look for reddish glow Maxillary - patients mouth open but lips sealed around torch
96
Describe the pathophysiology of Acute Sinusitis
Normally viral causing blockage and then a secondary bacterial infection Strep Pneumoniae, Haemophilus Influenza, Moraxella Catarrhalis Normally involves maxillary sinus
97
How does Acute Sinusitis present?
Non resolving cold Biphasic Pain/Pressure over affected sinuses - worse on leaning forward Unresponsive to nasal decongestants
98
Sinusitis is a clinical diagnosis. How should it be aimed to be managed?
Reassure it will take a little longer to settle Simple analgesia and intranasal decongestants Warm face packs Irrigation with warm saline
99
When should you treat sinusitis with Abx?
<10d if severely at risk | >10d - Deferred 5d Pen V (or co amoxiclav if systemic) only after a trial of 2 weeks nasal steroid
100
Who should you refer with sinusitis?
Severe High risk Suspicious unilateral symptoms
101
Name two complications of sinusitis
Meningitis | Orbital Cellulitis
102
Chronic Sinusitis can be infective/inflammatory/structural in aetiology. How does it present differently
Not as florid as acute Dull ache May have middle ear fluid Loss of smell is more common
103
Apart from acute exacerbations, how is Chronic Sinusitis managed?
Dental Hygiene Smoking Cessations 8-12 weeks nasal steroids Antihistamines if allergic aetiology If refractory still consider function endoscopic sinus surgery
104
What is Fungal Sinusitis?
Associated with immunocompromised or diabetics Associated with high humidity Can involve orbit
105
How is Fungal Sinusitis investigated?
Serum IgE CT Microbiology
106
How is Fungal Sinusitis managed?
Surgical debridement Steroids Antifungal
107
What is Barosinusitis?
Pressure changes disrupt gas and mucous exchange leading to accumulation Pain on returning to sea level, congestion and occasional epistaxis Managed the same as acute sinusitis

Y4 Neuro and Special Senses (9 decks)

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