NOSE

Question 1

Epistaxis

CHIEF ENT EMERGENCY

Answer 1

• a) Anterior haemorrhage – source of bleeding visible= from nasal septum at Little’s area where Kiesselbach’s plexus forms
  b) Posterior haemorrhage – source is from deeper structures of nose; occurs commonly in elderly; large volume and ↑risk of airway compromise
  RF: trauma, insertion foreign bodies, thrombocytopenia, splenomegaly, drugs (aspirin, anti-coag), malignancy, cocaine

Hx: out of nose and one nostril (anterior), into throat and both nostrils (posterior)

Bloods: FBC, group and save, cross match.

Management:
1. Resuscitate
2. sit patient forward, squeeze bottom of nose, if still bleeding..
3. cuatery with Silver Nitrate or electric
If bleeding continues try anterior pack. then postnasal pack
- Injectable tranexamic acid

Question 2

Nose Trauma
1. Nasal fracture

2. Septal Perforation
3. CSF Rhhinorrhea

Answer 2

** Nasal Fracture
Un-displaced – no treatment required
Displaced?
1. Reduction under GA/LA with post-op splint is best within 2 wks (complete setting occurs at 3 wks)
2. Apply ice for 12hrs post-op
3. Sleep with head elevated
4. Septoplasty – post-traumatic deformity is common (14-50%), this is reducible to 9% by complete nasal assessment and primary septal reconstruction

**Septal Perforation
Whistle noise, crust, epistaxsis

** CSF- basal skull fracture, send CSF sample to lab. Cover with abx and Pneumococcal vaccine.

Question 3

Foreign bodies

Answer 3

• Most self-inserted by child
  Organic material = purulent discharge (can be bloody), rhinitis
  Inorganic material = often inert
  1. Remove foreign body with forceps carefully
  2. 2.5% cocaine spray (avoid in child) can shrink mucosa to allow suction
  3. Batteries require URGENT removal

Question 4

Rhinitis

Answer 4

CF: runny nose, sneezing, snuffly

Allergic: Causes e.g pollen
TX antihistamines and steroids

Non allergic: Causes eg viral, smoke, hormones
Tx: nasal steroids

Question 5

Sinusitis

Answer 5

• Common inflammation of the paranasal sinuses

CF: pain, swelling and tenderness around your cheeks, eyes or forehead, a blocked nose, reduced sense of smell

TX: Fluids, paracetemol, wash nose with salty water, steroid nasal sprays and antihistamines

Refer to ent if chronic

Question 6

Nasap polyps

Answer 6

Nasal polyp (1% UK) – lesions arising from nasal mucosa (typically clefts of middle meatus)
● MALE ADULTS
● a/w asthma, aspirin sensitivity, infective sinusitis, CF, Kartagener’s, Churg-Strauss synd

CF: Nasal obstruction – mouth breathing, snoring
Rhinorrhoea – watery, post-nasal drainage
Sneezing, Poor sense of taste and smell

IVX: Examine, Cystic fibrosis screening in children
Refer to ENT

Management: topical Beclomethasone may shrink polyp size