Nose

Question 1

Topography of the nose?

Answer 1

Radix between the eyes
Dorsum
Tip

Anatomy:
Nasal bones
Upper lateral cartilage
Lower lateral cartilage

Question 2

Anatomy of the nasal cavity?

Answer 2

MEDIAL:
quadrangular cartilage (septum)
ethmoid plate
vomer

premaxilla
maxillary crest
palatine crest

LATERAL:
alar cartilage
upper lateral cartilage
superior, middle, inferior concha

Question 3

Causes of nasal obstruction?

Answer 3

• rhinitis
• nasal polyps
• rhinosinusitis
• deviated septum
• adenoid hypertrophy
• alar collapse
• tumour
• foreign body
• choanal atresia
• septal perforation

Question 4

What is rhinosinusitis?

Answer 4

Inflammation of the lining of the nose and parasitises with
- either nasal congestion OR rhinorrhoea
AND 1 of:
- facial pain or pressure
- hyposmia
- polyps or CT obstruction 
- (itching)

Allergic / infective / non-allergic-non-infective types

Rx: Abx, steroids PO/top, antihistamines PO/top, mast cell stabilisers, antileukotrienes, decongestants, irrigation /douching.

Question 5

Acute sinusitis
Sx?
Bacteria?
Rx?

Answer 5

Mild (common cold) - self limiting; Sx relief analgesics, nasal saline irrigation, decongestants; >10day trial intranasal corticosteroids.

Moderate (post viral) - Sx relief and s intranasal corticosteroids, 14 days refer.

Severe (incl bacterial) - topical steroids and Abx, reassess at 48hr

Pain, nasal obstruction, pyrexia

Strep pneumonia
Staph pyrogenes
Staph aureus
H. influenza
Moraxella

Could xray or CT

Question 6

What is your Ddx for sinusitis?

Answer 6

Migraine
TMJ dysfunction
Dental pain
Neuropathic pain
Temporal arteritis
Herpes zoster

Question 7

What can predispose to an acute bacterial sinusitis?

Answer 7

1. direct spread (from dental root infection, swimming in infected water)
2. odd anatomy (septal deviation, large ethmoidal bulla, polyps, lateralised uncinate process)
3. ITU (mechanical ventilation, recumbency, nasogastric tubes)
4. systemic causes (Kartagener’s, immunodeficiency, debility)
5. Biofilms: type of infection which destroys mucosal cells like cilia and goblet cells.

Question 8

Steps to biofilm formation?

Answer 8

1. Reversible adsorption of bacteria – in this step the bacteria comes in contact with a surface, but is not bound to the surface
2. Irreversible attachment of bacteria – the cells of the bacteria form a bond with the surface. At this point the bacteria cannot detach itself
3. Growth & division of bacteria – after the cells attach they multiply, forming a cluster of bacteria
4. Exopolymer production & biofilm formation – the bacteria excrete substances that can form a protective layer over the cluster of bacteria
5. Attachment of other organisms to the biofilm – the protective layer can serve a food for other organisms that may attach to the biofilm layer

Question 9

Complications of sinusitis?

Answer 9

Orbital (emergency)
Osteomyelitis
Mucocele
Intracranial

Question 10

So rhinitis can be allergic or infective, but what are the causes of non-allergic-non-infective rhinitis?

Answer 10

?cause unknown
Factors:
- intrinsic
- pollution
- humidity /temp
- drugs
- endocrine
- alcohol
- smoking
- emotion
- autonomic