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
What is it called when you overuse Afrin (Oxymetazoline)
Rhinitis medicamentosa
Tx: stop Rx use
Start INS or Anticholinergic
What is the most common cause of olfactory dysfunction
Blockage from polyps or septal deformities
What are the two sites of bleeding in Epistxsis
Anterior- Kesselbach’s plexus (MC)
Posterior- Woodruff’s plexus (worse)
What is the tx approach to anterior epistaxis
Direct pressure x 15 min
Then topical decongestant
- phynelephrine
- Oxymetazoline
Attempt to locate bleed
-may use topical cocaine or Oxymetazoline +lido
Cauterize if visible
Or pack with iodofrom gauze
What is the tx approach to a posterior epistaxis
Refer to ENT for posterior packing
Emergency setting- double balloon pack
- Admit
- Opioids for comfort
Surgery- when packing fails
When treating epistaxis what ABX should be used while packing is in place
Antistaph antibiotics while packing in place (min 5 days)
Cephalexin, clindamycin
If a nose bleed lasts longer than 15 minutes
What should you do
Send Pt to the ER
What is the most common bone fx in the body
Nasal pyramid
What must you r/o in a nasal fx
Ensure no infraorbital rim step-off
Zygomatic complex fracture
Post nasal truama a pt presents with widening of the nasal sepultura
Think
Infection if s. Aureus and septal hematoma
Tx: I&D
PACK!
ABX- Cephalexin or Clindamycin while packing is in place
What is the tx approach to nasal polyps
INS 1st line
Short course of prednisone
Surgery when large or recurrent
Nasal polyps + asthma =
AVOID ASPRIN!
Nasal polyps in childern =
Eval for cystic fibrosis
You see a cauliflower like growth on the middle meatus of the nose
Think
Inverted papilloma 2/2 HPV infection
What is the most common cancer of the nose
SCC
What are the key sings of nasal cancer
Pain and recurrent hemorrhage
Unilateral serous otitis media, with proptosis, and ill fitting dentures
Think
Malignancy of the nose
A pt presents with blood stained crusts in the nose with friable mucosa
Think
Granulomatosis with polyangitis
A pt presents with engorged tubinates, and small white granulomas, and NONCASEATING granulomas
Think
Sarcoidosis
