Nose

Question 1

What are the local causes of epistaxis?

Answer 1

Trauma

Infections

• Rhinitis
• Sinusitis
• TB
• Syphilis

Foreign body

Neoplasms

Atmospheric changes

Adenoiditis

Juvenile nasopharyngeal angiofibroma

Question 2

What are the general causes of epistaxis?

Answer 2

HPT

Anticoagulants

Blood diseases

• Leukaemia
• Haemophilia
• Von Willebrand’s

Heriditarty haemorrhagic telangiectasia

Question 3

What is the first-aid management of epistaxis?

Answer 3

Apply pressure to the anterior septum of the nose

Tilt head forward to allow excess blood to come out and not to be swallowed

Question 4

What are the general measures for management of epistaxis?

Answer 4

Packing
* Blow out nose to remove clots

Cauterization
* Silver nitrate

Treat underlying cause

Question 5

What are the options for packing in epistaxis?

Answer 5

Insert ribbon gauze with bismuth iodoform paraffin paste (BIPP)

Nasal tampon

Rapid Rhino-activate in saline then inflate balloon

Question 6

How do you manage epistaxis when packing fails?

Answer 6

Probably due to bleeding from the posteriorly placed branches of the sphenopalatine artery

Foley’s catheter

Specialized nasal inserts with a double balloon

If still bleeding..

• Formal exam under aneasthesia
• Diathermy
• Arterial ligation of the sphenopalantine artery/ maxillary artery

Question 7

When are antibiotics manditory in the management of epistaxis?

Answer 7

Postnasal pack is in situ

Anterior pack is left in > 48 hours

Question 8

Discuss Juvenile Nasopharyngeal Angiofibroma

Answer 8

A benign vascula tumour

Common in boys around the age of puberty

Symptoms

• Nasal Obstruction
• Epistaxis
• Hearing loss
• Tinnitis
• Proptosis
• Diplopia
• Facial swelling

Management
* Surgical excision

Question 9

Name the 4 sinuses

Answer 9

Frontal sinuses

Maxillary sinuses

Ethmoidal sinuses (anterior and posterior)

Sphenoid sinuses

Question 10

What is the definition of sinusitis?

Answer 10

Inflammation of mucosa of the paranasal sinuses

Question 11

What is the function of the sinuses?

Answer 11

Resonance of the voice

Protection of the brain

Humidifies air

Lightens the facial skull

Question 12

Describe the pathophysiology of rhinosinusitis

Answer 12

Anterior sinuses drain into the osteomeatal complex

OMC becomes blocked

• Oedema
• Polyps
• Septal deviation
• Turbinate hypertrophy

Blockage leads to decreased clearance

Stasis and mucus retention

Secondary bacterial infection

Question 13

What are the causative organisms of acute rhinosinusitis?

Answer 13

Strep Pneumonia

H. influenza

Moroxella catarrhalis

Question 14

What are the causative organisms of chronic sinusitis?

Answer 14

Staph aureus

Strep viridens

Question 15

What are the causative organisms in immunocompromised patients?

Answer 15

Fungal - Mucor Mycosis (black lesions)

Question 16

List 5 major symptoms of rhinosinusitis

Answer 16

Facial pain/pressure

Nasal obstruction/blockage

Nasal dischage/purulence

Discoloured posterior drainage

Hyposmia/anosmia

Question 17

List 5 minor symptoms of rhinosinusitis

Answer 17

Headache

Halitosis

Fever (non-acute)

Ear pain (refferred otalgia)

Dental pain

Question 18

Classify rhinosinusitis

Answer 18

Acute: >7days - <4weeks

Sub-acute: 4weeks - 12weeks

Chronic: >12weeks

Question 19

How would you manage a patient with acute rhinosinusitis?

Answer 19

Antibiotics - Amoxicillin/Augmentum 10-14 day course

Nasal decongestants - Iliadin

Analgesia - Paracetamol

Saline wash/steam inhaler

Question 20

How would you manage a patient with chronic rhinosinusitis?

Answer 20

Prevent an acute episode

Saline washes

Life-long nasal steroids

Short course systemic steroids if severe polyps

Short course antibiotocs

Surgery if medical therapy fails

Question 21

What are the complications of Rhinosinusitis?

Answer 21

Pott’s Puffy Tumour (osteomyelitis of the frontal bone)

Orbital cellulitis/abscess

Cavernous sinus thrombosis

Dental abscess

Intracranial abscess

Meningitis

Question 22

What are the 5 stages of orbital involvement in complicated sinusitis?

Answer 22

Preseptal

• Lid oedema
• Normal ocular movement

Orbital cellulitis

Subperiosteal abcess

• Pus deep to periosteum of lamina papyracea
• Ophthalmoplegia
• Mild proptosis
• Mild chemosis

Orbital abcess

• Proptosis
• Ophthalmoplegia > threatened vision

Cavernous Sinus Thrombosis

• Bilateral eye involvement with meningeal signs
• Cranial nerve fallout
• Visual loss

Question 23

What is the management of complicated sinusitis?

Answer 23

Drain complication eg. brain/ orbit

Address appropriate sinus

Washout maxillary sinus

Keep drains in to irrigate until clear

Broad spectrum antibiotics
* Change according to MC+S

Nasal decongestants - Iliadin

Nasal steroids: long term

Question 24

List 5 signs of allergic rhinitis

Answer 24

Boggy, oedematous nasal mucosa (nasal obstruction)

Nasal discharge (rhinorrhoea)

Nasal salute

Red, itchy swollen eyes

Associated atopy

• Eczema
• Asthma
• Allergic dermatitis

Question 25

What is the management of allergic rhinitis?

Answer 25

Avoid triggers

Topical Sodium Cromoglycate
* Stabalises mast cell membrane

Short-term local decongestants - Nazene

Long term topical steroids spray

Systemic antihistamine

Nasal washout - saline