Nose Flashcards
What are the local causes of epistaxis?
Trauma
Infections
- Rhinitis
- Sinusitis
- TB
- Syphilis
Foreign body
Neoplasms
Atmospheric changes
Adenoiditis
Juvenile nasopharyngeal angiofibroma
What are the general causes of epistaxis?
HPT
Anticoagulants
Blood diseases
- Leukaemia
- Haemophilia
- Von Willebrand’s
Heriditarty haemorrhagic telangiectasia
What is the first-aid management of epistaxis?
Apply pressure to the anterior septum of the nose
Tilt head forward to allow excess blood to come out and not to be swallowed
What are the general measures for management of epistaxis?
Packing
* Blow out nose to remove clots
Cauterization
* Silver nitrate
Treat underlying cause
What are the options for packing in epistaxis?
Insert ribbon gauze with bismuth iodoform paraffin paste (BIPP)
Nasal tampon
Rapid Rhino-activate in saline then inflate balloon
How do you manage epistaxis when packing fails?
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
When are antibiotics manditory in the management of epistaxis?
Postnasal pack is in situ
Anterior pack is left in > 48 hours
Discuss Juvenile Nasopharyngeal Angiofibroma
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
Name the 4 sinuses
Frontal sinuses
Maxillary sinuses
Ethmoidal sinuses (anterior and posterior)
Sphenoid sinuses
What is the definition of sinusitis?
Inflammation of mucosa of the paranasal sinuses
What is the function of the sinuses?
Resonance of the voice
Protection of the brain
Humidifies air
Lightens the facial skull
Describe the pathophysiology of rhinosinusitis
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
What are the causative organisms of acute rhinosinusitis?
Strep Pneumonia
H. influenza
Moroxella catarrhalis
What are the causative organisms of chronic sinusitis?
Staph aureus
Strep viridens
What are the causative organisms in immunocompromised patients?
Fungal - Mucor Mycosis (black lesions)
List 5 major symptoms of rhinosinusitis
Facial pain/pressure
Nasal obstruction/blockage
Nasal dischage/purulence
Discoloured posterior drainage
Hyposmia/anosmia
List 5 minor symptoms of rhinosinusitis
Headache
Halitosis
Fever (non-acute)
Ear pain (refferred otalgia)
Dental pain
Classify rhinosinusitis
Acute: >7days - <4weeks
Sub-acute: 4weeks - 12weeks
Chronic: >12weeks
How would you manage a patient with acute rhinosinusitis?
Antibiotics - Amoxicillin/Augmentum 10-14 day course
Nasal decongestants - Iliadin
Analgesia - Paracetamol
Saline wash/steam inhaler
How would you manage a patient with chronic rhinosinusitis?
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
What are the complications of Rhinosinusitis?
Pott’s Puffy Tumour (osteomyelitis of the frontal bone)
Orbital cellulitis/abscess
Cavernous sinus thrombosis
Dental abscess
Intracranial abscess
Meningitis
What are the 5 stages of orbital involvement in complicated sinusitis?
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
What is the management of complicated sinusitis?
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
List 5 signs of allergic rhinitis
Boggy, oedematous nasal mucosa (nasal obstruction)
Nasal discharge (rhinorrhoea)
Nasal salute
Red, itchy swollen eyes
Associated atopy
- Eczema
- Asthma
- Allergic dermatitis
What is the management of allergic rhinitis?
Avoid triggers
Topical Sodium Cromoglycate
* Stabalises mast cell membrane
Short-term local decongestants - Nazene
Long term topical steroids spray
Systemic antihistamine
Nasal washout - saline
