Nose Flashcards
How do you treat an anterior bleeding point?
Examine nose
LA + Adrenaline on cotton ball
Cauterise:
Silver Nitrate stick or bipolar diathermy
Anterior Pack:
-Merocel (rough tampon) or RapidRhino (gentler)
-BIPP-Fibrillar / Surgicel / Tranexamic acid / Floseal
How do you treat a posterior bleeding point?
Pack with posterior rapid rhino
Correct clotting, consider tranexamic acid
If that fails then consider EUA +/- SPA ligation
Posterior Balloon pack is an old fashioned treatment, SPA ligation is usually better for most patients
Posterior balloon pack
14F Foley Catheter (10 ml water, padding, clamp), PLUS anterior pack with Merocel or BIPP or ribbon gauze
What advice is given for epistaxis?
No heavy lifting/ bending No hot showers or drinks No picking Gentle nose blowing Vaseline Vestibulitis (common, Staph aureus infection of nasal vestibule): treat with mupirocin ointment or Naseptin cream (Naseptin contains peanuts so check allegies)
What are the types of rhinitis?
Infective (systemically unwell, viral URTI)
Allergic rhinitis (AR) (sneezing, itch)
Occupational
Gustatory (on eating)
Medicamentosa (decongestant abuse)
Hormonal (pregnancy)
Non-allergic rhinitis (also sometimes called vasomotor): probably related to air irritants
Nasal cycle (one nostril blocks, then switches) and axillo-nasal reflex (lower nostril blocks on side-lying) are normal phenomena
What are oral antihistamines used for?
itch, sneezing, runny. (allergic rhinitis -AR). NB: antihistamines don’t work well for blockage
(Antihistamine nose spray-azelastine: add-on if steroid spray not enough)
What are steroids used for?
blockage, itch, sneezing, runny. Spray (any condition), drops (CRS), oral (CRS esp polyps); drops more potent than spray, restrict use to ~2 months
What are topical decongestants used for?
blockage (but only 1/52, otherwise nose gets addicted = rhinitis medicamentosa!). Acute infection
What are the other treatments for medical rhinology?
Nasal douching (all conditions) Ipratropium spray: discharge (vasomotor rhinitis) Clarithromycin 3 months (CRS without polyps)
How do you tell patients to take treatments for rhinology?
Spray: head forwards, right hand left nostril, no sniff
Drops: head back over end of bed, no sniff
Douching: salt/bicarbonate recipe or OTC solution eg Neilmed. Sniff or flush into nose, spit out or let it run out of nose. Washes irritants and mucus out
What are the types of rhinology surgery?
Septoplasty (reshape septum). (submucous resection is an old operation with higher risk of external deformity)
Septorhinoplasty (septum and appearance)
Rhinoplasty (appearance)
Nasal polypectomy
Functional endoscopic sinus surgery (open sinuses to allow them to drain)
Miserable post op: douching helps clear old blood and crusts
Don’t forget medical management
Surgery best for blockage symptoms
What is septal perforation?
Commonly caused by trauma (septal haematoma) or complication of septoplasty May be as sign Wegner’s granulomatosis Whistling Crusting Bleeding
What is the management for septal perforation?
Douching and vaseline is first line and sufficient for most
Septal button insertion may help some, but can cause more crusting
Surgery only suitable for small perforations
What are the risk factors for obstructive sleep apnoea?
Overweight Alcohol Sedative medication Large tonsils Nasal obstruction Small mandible
What is the management for snoring?
Advise weight loss, avoid alcohol, treat nasal obstruction medically, mandibular advancement split may be helpful. Snoring surgery is not funded by NHS and has relatively low and unpredictable success
Suspected OSA should go for respiratory sleep study and usually CPAP
