Nose ! Flashcards
What is the osteometal complex
channel that links the frontal sinus, anterior ethmoid air cells and maxillary sinus to the middle meatus, allowing airflow and mucociliary drainage.
A pt presents with CLEAR rhinorrhea
Nasal congestion, and sore throat
Think
Acute vital sinusitis
AKA COMMON COLD
What are the agents of the common cold
Adeno and rhinovirus
What is the treatment for acute viral sinusitis
NO ABX!
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Treat the congestion
Pseudoephedrine
Saline rinse
Or Nasal sprays : Oxymetazoline
x 3 days
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A pt presents with PURULENT nasal d/c
Congestion
Fever, and a perception of a foul odor.
+/- dental pain
Think
Acute BAC sinusitis
2/2 Strep Pneumoa, H. Flu, M. Cat
Or STAPH aureus
Most likely after a VIRAL URI
Prolonged NG tunes can lead to…
Acute bacterial sininusitis
What is the imaging appraoch for a acute Bac sinusitis
Typically NOT needed
However can get a CT if hospital acquired or is refractory to tx with comorbidites
What is the tx approach to a BAC. Sinusitis
Treat pain 1st with NSAIDS
Then decongest with INS or decongestants
ABX; if no resolution in 10 days, or immuno comp pts
—augmentin x 7 days (500/125 mg)
If Severe, comorbuid or older than 65
-Augmentin (2000/125) x 7-10 days
In pts with allergies to PCN
What is the ABX that can be used in sinusitis
DOXY or Clindamycin + cephalosporin
A pt with proptosis, gaze restriction and orbital pain
Following a Acute Bac Sinusits
Think
Orbital Cellulitus
IMMEEDIATELY order a CT
Treat with IV ABX with referal to ENT
Osteomyelitis is most common where…
Frontal Sinuses
What is the Tx approach to Osteomyelitys of the facial sinus
ABX, surgical removal of necrotic bone and cosmetic reconstruction
What is the common pathogen of nose picking infections
S. Aurues
What is a furuncle
Pus-filled bump under the skin arising from hair follicles
Seen in nose picking s. Aureus infections
What is the Tx for nose picking s. Aurues infection
Aka nasal vestibulitis
Tx: dicloxacillin x7-10 days
+/- Rifampin if recurrent
(Last 4 days of tx)
+/- mupirocin
I&D and furuncle
What is the major complication of sinus infections
Retrograde spread of infection
Valveless veins->Cavernous sinus->intracranial structures
What is the most common nosocomial infection of the nose
S. Aureus
What is the tx approach to s. Aureus nose infection
Mupirocin + chlorhexadine x 5 days
What is the classic sign of fungal sinusitis
Black eschar on the middle turbinate
What is the testing DX for fungal sinusits
Nasal BX with silver stains
What must you do to tx a pt with fungal sinusitis
MEDICAL EMERGENCY!
Referal to ENT
Start IV voriconazole
(Amphotericin B is less toxic)
WIDE surgical debridemnt
What is the tx approach to allergic rhinitis
Send pt for blood testing -RAST or skin testing
Then allergy avoidance Pharmacotherapy -INS :Fluticasone, mometasone, beclamethasone etc. -Mainstay of treatment -Especially for congestion
Can use antihistamines
-Azelastine/ Olopatadine
Can add on montelukast or Cromolyn
What pts have the highest risk of anaphylaxis in allergic rhinitis
Poorly controlled asthma pts
What is vasomotor rhinitis and who does it mostly effect
Common in the elderly
Triggered by air temp, odor or light
Vivian nerve sensitivity
Tx with Ipatropium Bromide
