Nose

Question 1

Rhinitis

Answer 1

• Mild allergic rhinitis is controlled by antihistamines or topical nasal corticosteroids. Topical nasal decongestants can be used for a short period to relieve congestion and allow penetration of a topical nasal corticosteroid.
• More persistent symptoms and nasal congestion can be relived by topical nasal corticosteroids e.g. sodium cromoglicate. Montelukast can be used for patient’s with seasonal allergic rhinitis + concomitant asthma. Topical nasal ipratropium bromide can reduce watery rhinorrhoea.
• Sodium chloride 0.9% given as a nasal drop or spray, may relieve nasal congestion by liquifying secretions.

Question 2

• If a pregnant woman cannot tolerate the symptoms of allergic rhinitis, treatment with

Answer 2

nasal beclometasone dipropionate, budesonide, fluticasone or sodium cromoglicate may be considered.

Question 3

Nasal polyps

Answer 3

• Short-term use of corticosteroid nasal drops helps to shrink nasal polyps; to be effective, the drops must be administered with the patient in the ‘head down’ position. A short course of a systemic corticosteroid may be required initially to shrink large polyps. A corticosteroid nasal spray can be used to maintain the reduction in swelling and also for the initial treatment of small polyps.

Question 4

Sinusitis

Answer 4

• Sinusitis is the inflammation of the sinuses. Acute sinusitis is a self-limiting condition usually caused by an upper respiratory tract viral infection e.g. common cold.
• Acute sinusitis symptoms: nasal blockage/congestion, nasal discharge, dental or facial pain or pressure, and reduction or loss of the sense of smell. Symptoms usually improve in 2 or 3 weeks without requiring treatment.

Question 5

Sinusitis - Symptoms around 10 days or less: treatment

Answer 5

Self care for pain and fever with paracetamol or ibuprofen. Also, inform Abx are usually NOT required. Nasal saline and nasal decongestants have limited evidence to help relieve nasal congestion.

Question 6

Sinusitis - Symptoms around 10 days or more with no improvement: treatment

Answer 6

High dose of nasal corticosteroid e.g. mometasone furoate or fluticasone for 14 days. Abx could be considered if symptoms don’t improve with 7 days or if symptoms worsen rapidly or significantly.

NOTE: if symptoms are more serious, then an immediate Abx should be considered.

Question 7

Use of decongestants in infants and children under 6 years

Answer 7

has been associated with agitated psychosis, ataxia, hallucinations, and even death—avoid

Question 8

MHRA corticosteroid warning

Answer 8

The MHRA recommends that patients should be advised to report any blurred vision or other visual disturbances with corticosteroid treatment given by any route