nose Flashcards
what organism can causes sinusitis
strep pneumo // H. influ // rhinovirus
RF developing sinusitis
nasal obstruction eg deviation, polyp // local infection eg rhinits, dental extraction // swimming or diving // smoking
symptoms sinusitis
facial pain/ pressure worse bending forward!! // thick nasal discharge // obstruction
mx sinusitis
analgesia +/- nasal decongestants or saline
mx sinusitis lasting 10+ days
intranasal steroids
abx for sinusitis
only if severe/ systemically unwell - may worsen a viral infection // 1 = pen V // 2 = co-amox if v unwell
complication sinusitis
brain abscess // orbital abscess
what is seasonal allergic rhinits
comes with the seasons secondary to pollen - hayfever
what is perennial allergic rhinits
throughout the year
what is occupation allergic rhinits
antigens in a work place
mx mild-moderate allergic rhinitis
oral/ nasal antihistamine
mx moderate-severe allergic rhinitis
intranasal steroids
what can be prescribed for allergic rhinitis to control symptoms prophylactically
oral steroids
role of nasal decongestants allergic rhinitis
short periods of time // prolonged = require increasing dose + causes rebound hypertrophy on withdrawal
what is vasomotor rhinitis
(non-allergic rhinitis) when blood vessels in nose dilate –> runny nose, nose drip
triggers vasomotor rhinitis
strong smell, cold air, alcohol, spicy food
what is chronic rhino-sinusitis
inflamm disorder of paranasal sinus linings + nasal passage that lasts 12+ weeks
RF chronic rhino-sinusitis
atopy // obstruction (deviation or polyp) // local infection // swimming, diving // smoking
symptoms chronic rhino-sinusitis
frontal pressure pain worse leaning forward // nasal discharge (clear) // mouth obstruction (from nasal obstruction) // post nasal drip +/- chronic cough
mx chronic sinusitis
allergy avoidance // intranasal steroids // nasal irrigation + saline
Red flags chronic rhino-sinusitis
unilateral!! // persistant after 3 months // epistaxis
what causes nasolacrimal duct obstruction
incomplete membrane lower end of lacrimal duct
symptoms + age nasolacrimal duct obstruction
infants + watery eye
mx nasolacrimal duct obstruction
massage lacrimal duct // if 1 year refer to ophthalmologist
assoc nasal polyps
asthma // aspirin sensitivity // sinusitis // CF // EGPA (Churg-Strauss) // Kartageners
what is samters triad
asthma + aspirin sensitivity + nasal polyps
features nasal polyps
nasal obstruction // runny nose // sneezing // decreased taste + smell
what symptoms require further testing in nasal polyps
unilateral or bleeding
mx nasal polyps
refer ENT // topical steroids
most common nasopharnygeal cancer
SCC
what virus is nasopharnygeal cancer assoc with
EBV
symptoms nasopharnygeal
sore ear // unilateral otitis media + effusion // nasal obstruction, discharge, nose bleed // cranial nerve palsy (esp III-VI) // cervical lymph (bad)
invx nasopharnygeal cancer
CT + MRI
mx nasopharnygeal cancr
radiotherapy
source of bleeding anterior nose bleed
kisselbach plexus (esp sphenopalatine)
RF assoc with posterior epistaxis
aspiration or airway compromise
RF epistaxis
nose picking or blowing // trauma // bleeding disorder // juvenile angiofibroma // cocaine use // E+GPA // hereditary haemorrhagic telangiectasia
first aid mx nosebleed
sit forward, mouth open // pinch soft cartilage for 20 mons
potential nosebleed mx if first aid successful
topical antiseptic eg naseptin (chlorehexidine + neomycin) // avoid blowing nose, heaving lifting, alcohol
cautions naseptin
peanut, soy, neomycin allergy
mx nosebleed that does not stop after 15 mins
cautery (usually best) or packing
what is nasal cautery
apply topical anaesthetic // use silver nitrate // dab clean and apply naseptin or muciprocin // (not well tolerated in kids)
when is nasal packing indicated
bleeding vessel cannot be visualised
emergency epistaxis mx
sphenopalatine ligation
who needs admitted with epistaxis
severe comorbidity (ACS, hypertension) // under 2 (haemphilia, leukaemia) // haemodynamically unstable // unknown source eg posterior bleed
symptoms septal heamatoma
following trauma // obstruction // pain // runny nose // bilateral, red swelling
mx nasal septal heamatoma
surgical drainage + IV abx
complications septal heamatoma
septal necrosis
