Nose

Question 1

What are the four core nasal symptoms?

Easy way to remember them?

Answer 1

Core nasal symptoms
- Blockage
- Loss of smell
- Discharge – snot 
- Facial pain
Four S = stuffy, smell, snot, sore.

Question 2

How can you divide up rhinitis?

Answer 2

1. Non infective
   - Allergic - intermittent or persistent
   - Non allergic - vasomotor rhinitis, polyps
2. Infective -viral URTI

Question 3

Give some features of intermittent vs persistent allergic rhinitis

Answer 3

Intermittent: symptoms <4 days per week OR symptoms for <4 weeks
- Grass pollen
- Tree pollen
- Fungal spores
Persistent: symptoms >4 days per week AND >4 weeks duration
- House dust mite
- Cat 
- Dog

Question 4

Nasal polyps

• Often associated with?
• Treatment?

Answer 4

Often associated with non-allergic asthma.

Treat with oral then topical steroids – if no better then do surgery.

Question 5

Acute infective rhinosinusitis

• Symptoms?
• Bacterial or viral?
• Treatment?
• Complication?

Answer 5

Symptoms
- Facial pain
- Discharge
- Nasal blockage
98% are viral, and therefore self limiting – don’t need antibiotics, just give analgesia and maybe decongestant.
Treat with analgesics and decongestants.
If persisting/worse, then add an antibiotics
Rhinosinusitis complications – pus forming in ethmoid sinus -> causes pus within the orbit.