Nose Flashcards
What is more convenient between an inflattable balloon and ribbon gauze packs in the treatment of epistaxis?
Inflattable balloons are less traumatic to the mucosa
What percentage of epistaxis happens in littles area?
90%
Name the arteries that converge in kiesselbach’s plexu?
- Anterior ethmoidal artery 2. Posterior ethmoidal artery 3. Sphenopalantine artery 4. Greater palantine artery 5. Superior labial artery
What are the local causes of epistaxis?
- Trauma/nose picking 2. Viral infection 3. foreign body 4. Neoplasia 5. Idiopathic
What are the general/systemic causes of epistaxis?
- Hypertension 2. Drugs(anticoagulants) 3. Blood diseases such as leukemia 4. Hereditary haemorrhagic telangiectasia 5. Arteriosclerosis or other cardiovascular defects
What is hereditary hemorrhagic telangiectasia?
It is a hereditary condition associated with recurrent epistaxis. It presents with melena, haematuria and subarachnoid or cerebral haemorrhage
What is your initial treatment of epistaxis?
- Patient must sit up and lean forward(to reduce BP and not swallow blood)- trotters manoeuvre 2. Squeeze nostrils tightly 3. Anaesthetise and then use a silver nitrate stick application 4. If that does not work use a nasal pack with ribbon gauze bismuth iodoform paraffin paste(bipp)
What do you do if the patient continues to bleed from the nose after your initial management?
-use a postnasal pack that you insert with anaesthesia -Give antibiotic cover if nasal pack is in situ for more than 48 hrs
What is the classical triad of allergic rhinitis?
-nasal obstruction due to the the mucosal vasodilation and oedema -sneezing -rhinorrhea due to stimulation of the glandular tissue
What other atopy do you have to ask the patient about in allergic rhinitis?
You have to ask about -asthma -exzema -allergic dermatitis -drug allergies
What do anti-histamines do?
They stop the itching
What does rhinitis mean?
It means inflammation of the lining of the nose and can be intermittent or persistent
Name some of the causes of allergic rhinitis/hay fever?
-flowers -weeds -pet dander -grass -pollen -dust mites -feathers
How does allergic rhinitis occur?
The allergens bind to IgE and causes degranulation of the mast cells and that releases mediator substances such as histamine, leukotrienes and SRSA(slow reacting substance of anaphylaxis
What is the management of allergic rhinitis?
- Avoid allergens- in perennial allergic rhinitis clean out bed sheets and chage curtains etc. 2. Desensitisation injections 3. local decongestants-either steroidal or sympathomimetic 4. systemic drug therapy- antihistamines that block the H1 nasal mucosa receptors 5. Surgery- turbinate resection or cautery
What are 2 examples of local steroid nasal sprays?
- mometason 2. fluticasone
What is a downfall to using systemic antihistamines?
Drowsiness
What is nasal hyperreactivity(vasomotor rhinitis)?
It is prevalent in about 10-15% of people and it is caused by the imbalance between the parasympathetic and sympathetic autonomic nerve supply of the nasal mucosa
What are the clinical features of vasomotor rhinitis?
-nasal obstruction -rhinorrhea -sneezing(although significantly less than allergic rhinitis) The inferior turbinate is usually red, swollen and congested
What are some of the triggers of vasomotor rhinitis?
-pregnancy -menopause -hyerthyroidism -ambient changes in temperature and humidity -alcohol or tobacco
What is the Rx of vasomotor rhinitis?
- local and systemic decongestants 2.laser treatment 3. partial turbinectomy
What is rhinitis medicamentosa?
Rhinitis caused by the overuse of topical agents that contain sympathomimetic agents and the patient becomes addicted to the short period of relief
What is the treatment of rhinitis medicamentosa?
Substitute the one used with a steroidal nasal decongestant, or use systemic decongestants or surgery like-partial turbinate resection
What is sinusitis?
It is inflammation in the lining of the paranasal sinuses
What are the causes of sinusitis?
-Rhinitis -dental disease -facial trauma -neoplasia
Where does the frontal, maxillary and sphenoid sinuses drain into?
The drain into the ethmoidal sinus and into the nasal fossae
What is the most common cause of a sinusitis?
Viral rhinosinusitis
What are the mechanisms that cause the blockage?
-paralysis of the mucociliary clearance mechanism and the blockage of the sinus ostia -mechanical obstruction such as nasal polyposis, deflected nasal septum, turbinate hypertrophy
What is the treatment of acute sinusitis?
- Analgesia 2. nasal drops- oxymetazoline or ephedrine 3. broad spectrum antibiotics 4. steam or menthol inhalants last resort is aspiration of sinus contents
What is acute frontal sinus?
Potentially serious condition if it includes intracranial and orbital involvement-do CT scan to rule out these complications
What is the Rx of acute frontal sinuses?
- Topical vasoconstrictor nose drops 2. Broad spectrum AB 3. Proof puncture or endoscopic drainage 4. trephination and drainage(making a hole in the skull) 5. balloon dilatation and ethmoidal drainage
What is chronic sinusitis?
Inflammation of the paranasal sinuses for more than 12 weeks and the retained secretions have allowed bacteria to colonise
What are the signs/symptoms of chronic sinusitis?
- postnasal discharge/ chronic purulent discharge 2. nasal block 3. halitosis 4.headaches
What is a mucocele?
Expansion of an obstructed sinus specifically in the frontal and ethmoid sinuses
What is the Mx of chronic sinusitis?
1.intranasal ethmoidectomy 2. external ethmoidectomy 3.antrostomy(for the maxillary sinus) 4. frontoethmoidectomy
What other medical conditions are nasal polyps associated with?
- Asthma 2. Chronic allergic rhinitis 3.cystic fibrosis in children