Nose Flashcards
Inflammation of the area near the osteomeatal complex. Often follows URI, can be viral or bacterial (same bacteria that cause AOM). Risks = cigarette smoke, exposure to secondary smoke, history of trauma, foreign body.
Acute sinusitis
Sxs: Purulent nasal discharge, facial pain and pressure, nasal obstruction, congestion, fever.
PE: Sinuses tender to palpation. Decreased light transmission with transillumination over sinuses.
Acute sinusitis
Complications of acute sinusitis
Orbital cellulitis, osteomyelitis, cavernous sinus thrombosis.
How do diagnose acute sinusitis
Bx is usually clinically diagnosed.
X-ray can be used but is not recommended but can be useful in certain cases
CT or MRI
NSAIDS, saline washes, steam and oral/nasal decongestants, intranasal corticosteroids
If no improvement in 10-14 days or worsening of fever, pain, swelling use antimicrobial therapy
Treatment acute sinusitis
Amox = DOC; use Amox-Clav if no improvement
Macrolides, TMP-SMX, doxycycline if PCN allergic
Quinolones = treatment failure/recent Abx use
Treatment acute sinusitis
Negative air pressure in sinus cavities; chronic or acute.
PE: Obstruction or chronic pain in sinuses. Get imaging to R/O mass, mucocele if warranted.
Barosinusitis
Nasal decongestant spray short term & steroid spray
Referral
Complications: Can decrease O2 sats if completely blocked
Barosinusitis treatment
Secondary to common cold, mild to moderate congestion (less than allergic) clear rhinnorhea
Viral rhinitis
Nasal saline, symptomatic, caution with oral decongestants
Mostly self-limiting
Viral rhinitis
Symptoms confused with those of a common cold. Signs may include allergic shiners (bluish discoloration below the eyes); rhinorrhea; itchy or watery eyes; sneezing; nasal congestion; dry cough; pale, boggy, or bluish mucosa. Children may develop allergic salute from ruling nose
D/C is clear and watery
Allergic rhinitis
Avoid known allergens and use antihistamines, cromolyn sodium, nasal or systemic corticosteroids, nasal saline drops or washes and immunotherapy
Allergic rhinitis treatment
Increased secretion of mucus from nasal mucosa. Can come from changes in temp/humidity, odors, alcohol, or neurovascular imbalance. Bogginess of nasal mucosa associated with a complaint of stuffiness and rinorrhea
Symptoms are labile and clear quickly.
Vasomotor rhinitis
Avoid irritant
Tx vasomotor rhinitis
Overzealous use of decongestant drops or sprays with oxymetazoline or phenylephrine. Severe congestion and pain, discharge minimal
Medicamentosa rhinitis
Discontinue irritant. May be quite uncomfortable for patient; use of topical corticosteroids is warranted through the withdrawal period.
Medicamentosa rhinitis
Ethmoid sinusitis causing rhinosinusitis
S. pneumoniae, H. influenzae, M. cattarhalis
Risk = smoker –> longer treatment course
Purulent discharge, can culture
Bacterial rhinitis
If goes on for more than 7 days treat like otitis media; AMOX
Bacterial rhinitis treatment
Pale, boggy masses on nasal mucosa; sometimes w/ allergic rhinitis
C/O chronic congestion and decreased sense of smell
Nasal polyps
3 month use topical nasal corticosteroid; oral steroid can also help reduce size
Surgical removal necessary if therapy is unsuccessful
Nasal polyp treatment
Most commonly occurs in Kiesselback plexus; unilateral anterior bleeding. Posterior bleeding less frequent (Woodruff plexus) and is associated w/ hypertension and atherosclerosis.
Risk = nasal trauma, dry nasal mucosa, hypertension, cocaine use, alcohol use
Epistaxis
Direct pressure to area. Have pt sit and lean forward to lessen swallowing of blood. Compress nares 15 min.
Identify site of bleeding if goes on for more than 15 min.
Topical cocaine can be used as anesthetic and vasoconstrictor. Can use topical decongestants and topical anesthetics as well. Can cauterize if source is visible. Anterior packing also option.
Epistaxis treatment
