Nose Flashcards
Aetiology and pathogenesis of nasal deviation
Etiology
- Developmental
- Traumatic
- tip nose displacement
- untreated nasal bone fracture
Pathology
- Convex surface- twd narrow side & Concave surface- twd other
- Enlarged inferior & middle turbinates on concave side to compenste wide airway
- ¯ airflow thru middle meatus
- 2° sinusitis
Clinical features of nasal deviation.
Clinical Features
Symptoms
Convex side
- nasal obstruction
Concave side
- catarrh
- facial pain (sinus infection)
- enlarged turbinates
Malfunction of Eustachian Tube
- chronic otitis media
Physical Examination
- Caudal dislocations
- Present of spur
- Turbinate enlargement
- Displaced external nose fr midline
- Displaced nasal bones/tip/ both
Investigations and teatime of nasal deviation.
Investigation
1. X – ray - infection of sinuses
Treatment
- Submucosal resection
- Removal of deviated section of cartilage & septum but maintain
- Superiorly - septal support
- Caudally- nasal tip position
Indication
- no caudal dislocation of septum
- deviation < inferior 2/3 cartilage
Contraindication
- In children (due to growth of facial skeleton)
2. Septoplasty - Minimal removal of bone cartilage
- To free all attachment of septal cartilage
- To remove spring of defelction
- To reposition to midline
Indication
- Caudal dislocation of cartilage
- Cosmetic procedure for nose tip displacement
- Present nasal bone deviation/ hump/ saddle
- For children as alternative to submucosa resection
Symptoms of nasal folliculitis.
Symptoms Infiltrative - Pain with pressure - Tension at nose tip - Reddening & swelling of nose tip, nasal ala & upper lio - Edema - Fever
Suppurative
- Resolving of swelling
- Pus
- Central necrotic core
Pathogenesis, treatment and complications of nasal folliculitis.
Pathogenesis
- Etiology: Staphylococcal
- Infection at hair follicle at area
- Only skin but not mucosa
Treatment
- Antibiotic oral / parenteral + local
- Course: after symptoms subside
- Fluid diet
- Voice rest
- Alcohol soaks / ice water
- Hospital admission if severe
Complication
- Thrombophlebitis
- Cavernous sinus thrombosis (use heparine as prophylaxis)
Important venous system
- Facial vein à neck
- Angular / Opthalmic vein à orbit à cavernous sinus
Pathology of acute rhinitis.
Pathogenesis
- Etiology: Rhinovirus Picorna grp
- Incubation period: 1 –3 days
- Route: droplet
- Potentiated by cooling of body
Symptoms of acute rhinitis.
Symptoms 1. Dry prodromal stage Complaints - generalize symptoms: chills & cold alternate with heat - head ache - fatigue - loss of appetite - subfebrile/high temperature - itching, burning of nose & throat - dryness of nose and throat - nasal irritation
Examination
- pale & dry nasal mucosa
2. Catarrhal Stage (after few hours) Complaints - few hours later - watery secretions - nasal obstruction - temporary loss of smell - lacrimation - rhinolalia clausa - worsening of main symptoms
Examination
- Deep red nasal mucosa
- Swollen nasal mucosa
- Profuse secretio of mucosa
- Mucous stage (after days)
- ¯ general symptom
- improve smell sense
- ¯ local symptoms - Resolution (after 1 week)
- ¯ local symptoms
Treatment of acute rhinitis.
Treatment Symptomatic treatment - Decongestant (nose/oral drops) - Antibiotics if there is 2° bacterial infection - Culture test & Sensitivity test - Steam inhalations - Infrared lamps - Analgesics - Bed rest
Chronic catarrhal rhinitis.
Pathogenesis
- Recurrent irreversible acute inflammation of mucosa
- Sinuses infection
- Nasal drainage obstruction (tumor, enlarged adenoid)
- Tobacco smoke, dust,
- Chemicals, toxins
- Extreme temperature
- Excessive / abnormal humidity
Symptoms Early stage - Nasal obstruction - Fluctuation - Alternate sides
Later
- Both sides
- Secretion is tough, stringy, colorless
- Postnasal catarrh
Other
- Rhinolalia clausa
- Epiphora
- 2° dacrocystitis
- 2° pharyngitis
Severe
- Fatigue
- Sleeplessness
- Unstead/woozy head
- Headache/ pressure in head
- Psychological & well being loss
Diagnosis
- History of etiology
- Dark red + bluish violet swelling esp at inferior turbinate
- Narrow nasal lume
- Thicken mucosa responds to decongestant nose drop
Treatment
- Removal of etiological factors
- Endocrinologic test
- Decongestant nose drop (short term)
Allergic rhinitis.
Sensitized subject: Foreigh protein / haptens + a.a = protein
- Non sensitized: Foreign protein à Reticuloendothelial system forms AB (IgE) à IgE in blood
- Ig E + mast cells à sensitization à histamine release à local vasodilation, capillary permeability à edema
- Cellular infiltration, eosinophils, plasma cells
- activity of seromucisnous glands of nasal mucosa à thin mucus
Etiology
- Hereditary: 2 parents – 75%. 1 parent – 50%
- Inhalants: pollens, mite, fur, feather, wool, moulds
- Ingestants: fish, tomatoes, citrus, milk, aspirin
Symptoms Complaints - Nasal stuffiness - Sneezing - Profuse watery rhinorrhea - Conjunctival irritation à epiphora - Itchy soft palte & nose
Clinical features
- Personal family history of allergic
- Anterior rhinoscopy
a. Acute phase
- pallor & swellin gof turbinates
- thin watery secretion
- Congested conjunctivae
b. Remission stage
- normal nasal mucous membrane
- small edema of nose floor
- nasal polyp (long term)
Pecularities
a. Pollen:hot windy season
b. Hay fever
- Varies duration & place
- Symptoms in low lying areas with profuse vegetations
- Symptoms ¯ in hilly district
3. Perennial allergies/ mite/ animal
- less marked symptoms
- acute exacerbations
Treatment
- Removal/ avoid allergens
- Antihistamines
a. Spray decongestants
b. Tablets - Hyposensitization
- Sodium cromoglycate
- Steroids
Vasomotor rhinitis.
Etiology
- Pathological
- Psychological stress
- Change climate (warmer countries immigrant)
- Endocrinological - myxodema - Physiological
- Pregnancy
- Contraceptive pill
- Drugs: B – blockers, psychotropic drugs
Symptoms
Complaints
- Nasal blockage
- Watery rhinorrhea
- Sneezing
- Stimulated by change of posture, temperature, lying down, morning wake up
- Nose blowing does not relieve obstruction
- Dull vascular type face aches (mucosal hyperemia à block sinus ostia à sinus pressure)
Examination
- Anteriorhinoscopy
- turgid turbinates
- mucus production
- normal septum color (DD with infection)
- NO purulent crust & sticky secretion - Pharyngoscopy
- Granular pharyngitis
- Enlarged pharyngeal bands (due to postnasal catarrh)
- NO polyp formation
Treatment
- Avoid of stimulus
- Medical
a. Local decongestants
- (drop/ tablet < 1month to avoid rhinitis meidcamentosa)
- Naphtizine
- Halasoline
b. Systemic decongestants
- Suprastine
- Amitryptiline
- Surgical
a. Reduction of turbinate size
b. Ultrasound desintegration
c. Submucosal vasotomy
d. Partial inferior turbinectomy
Chronic hypertrophic rhinitis.
Etiology
- repeated nasal infection
- Chronic sinusitis
- Irritation of air pollutatns
Pathology
- size and no. cell of mucosa
- fibrosis of turbinates à ¯ venous outflow
Symptoms
Complaints
- Nasal obstruction
- Smell impairment
Examination
- Nasal congestion
- Mulberry – like swellings of posterior ends
- Affected anterior & posterior end of inferior turbinates
- Affection of anterior end of middle turbinate
Treatment
- Decongestant drops / tablets
- Partial turbinectomy
Chronic strophic rhinitis.
Etiology 1° - Malnutrition - Poor living condition - Infection
2°
- End result of treated nasal dss
- Sarcoidosis, TB
- Midline granuloma
- Rhinitis caseosa
- Nasal surgery (turbinectomy)
- Unsuccesful submucous resection.
Pathology
- Endarteritis & periarteritis à ¯ blood supply + atrophy of ciliated columnar epithelium à metaplasia to cuboid/stratified squamous epithelium à atrophy
- Secretion à dry à crust
- Bilateral
Symptoms Complaints - Dryness of nose - Nose blockage (by crust) - Epistaxis - Headache
Examination
- Atrophic mucosa
- Dry mucosa
- Crust in nasal cavities
Treatment Medical 1. Treat infection 2. 25% glucose in glycerin nasal drops/cream (to lessen crust) 3. Nasal douching by normal saline
Surgery Aim - To narrow nasal cavities Method 1 1. Sublabial incision to raise - Mucosa of the nose - Lower lateral up to attachment of inferior turbinate - Lower half of septum
- Packing of Teflon
- to narrow nostril & reduce depth
Method 2
- Close nostril anteriorly
- After years, healthy respiratory epithelium regenerated
Ozaena.
Etiology
- Klebsiella ozaenae
Symptoms
- Foetor at some distance
- Complete anosmia
- Blockage by nasal crust
Examination
- Wide nasal passages
- Flat inferior turbinates
- Difficult to distinguish lateral wall of nose
- Dark mucous membrane
- Dry mucous membrane
- Shiny mucous membrane
- Crusting: yellow as rule. (or dark/greenish)
- Remove crust à see posterior wall of nasopharynx
- Glazing of posterior nasopharynx (atrophy extension)
- Sometimes glazing till laryngeal cavity
Treatment
- Antibiotics
- Same like atrophic rhinitis
Classification of sinusitis.
Acc To Form
- Catarrhal
- Purulent
- Hypertrophic
- Atrophic
- Mixed
Acc To Course
- Acute
- Chronic
