Nose Flashcards by Sean Phelan

What are the bony projections on the lateral nasal wall called?

Turbinates

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What is the tin plate of bone that separates the erythroid sinuses from the orbit called

lamina papyracea

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The lamina papyracea is very thin, what are the implications of this regarding disease?

Infections from sinuses can spread to the orbit, brain and meninges

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In what three pt groups does epistaxis commonly occur?

Children
Elderly
Middle aged

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From what major blood artery are the blood vessels in the nose derived from?

Internal and external carotid

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What name is given to the area in the nose where the blood vessels converge and what is the significance of this?

Little’s area

Common site of bleeding

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What vascular feature is a common source of bleeding in children?

reterocolumellar vein - prominent vein running between the junction of the skin and mucosa of the nasal septum

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3 steps to stopping a nosebleed

Pressure for 10 mins on fleshy part of nose
cautery with local anaesthetic
nasal packing

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4 causes other than HTN and trauma that can lead to recurrent epistaxis?

Anticoagulant therapy
Thrombocytopaenia 
Leukaemia 
Haemophilia 
Telangiectasia

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What chemical is commonly used to cauterise the nose to prevent recurrent nose bleeds?

Silver nitrate

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4 broad causes of septal perforation

Trauma 
Surgery
Infections
Vasculitic conditions 
Recreational drug use

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What infections can cause a septal perforation?

Syphilis

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Why is a septal haematoma bad news for the cartilage?

It’s a bleed under the perichondrium that lines the cartilage. So blood supply will be interrupted and necrosis can occur.

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What is the treatment for a septal haematoma and why does this need to be done quickly?

Drain the blood.

Otherwise necrosis of the cartilage can occur

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If necrosis occurs following a septal haematoma what is the possible consequence of this?

Septal perforation

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If someone comes into A&E with a smashed nose, what do you need to check for?

Septal haematoma

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If someone breaks their nose, when should they/you try and reset it?

Immediately following injury
Otherwise wait for 1 week for swelling to go down
After 3 weeks surgery will be required

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How long have you got to treat a septal haematoma before necrosis occurs?

48 hours

Other than obvious trauma, how does a septal haematoma present and what would you see in inspection?

Progressive nasal obstruction

Large, soft bluish, red swelling

If there is clear nasal discharge following trauma what should you suspect is going on and what might be damaged ?

CSF leak

Cribriform plate

If you suspect someone has a CSF leak, how can you test it to check?

Glucose test - should be similar to serum

2 transferrin - protein present in CSF and perilymph

What is the management of CSF leak?

Most resolve themselves

Otherwise require surgical intervention

What should pts be advised that there is a risk of until a CSF leak resolves?

Meningitis

What is acute rhinosinusitis?

Acute inflammatory condition of the nose and paranasal sinuses

ARS is defined as a sudden onset of two or more symptoms, one of which should be either.....?

``` Nasal blockage/congestion/obstruction nasal discharge (anterior or posterior) ```

In addition to nasal symptoms, what else might the patient complain of?

facial pain/pressure | loss/reduction of smell

To be diagnosed with ARS how long can the symptoms be going on for?

Less than 12 weeks

What is ARS usually caused by?

preceding viral URTI which leads secondarily to a bacterial infection

What are the 5 pathophysiological steps in the development of ARS?

``` Viral URTI Mucosal Oedema of nose and para nasal sinuses Blockage of sinus drainage Stasis of mucosal secretions Secondary bacterial infection ```

What are the most common bacterial pathogens in the development of ARS?

Streptococcus pneumoniae Haemophilus influenzae Moraxella catarrhalis

A pt with preceding history of coryzal illness, clear rhinorrhoea, nasal congestion, fever and malaise will go on to develop what is they have ARS? 5

``` Prurulent rhinorrhoea Nasal congestion (more marked) Facial pain/pressure Hyposmia or altered taste Dental pain ```

3 principles of management of ARS/

Analgesia (NSAIDS) Decongestants (topical or systemic) Antibiotics (amoxicillin, cephalosporins)

What is the most common complication of ARS, notably in children?

Peri orbital cellulitis

How does periorbital cellulitis develop from ARS?

Infection spreads through lamina papyracea or via venous thrombophlebitis

What are the implication if periorbital cellulitis is not treated promptly?

Orbital cellulitis - blindness subperosteal/orbital bacess cavernous sinus thrombosis - death

What is the management of periorbital cellulitis?

hospital admission | IV antibiotics

What is the most common intercranial complication of ARS?

Subdural abcess

If ARS causes osteomylitis of the frontal bone what can this result in?

Subperiosteal abscess known as Potts puffy tumour

Chronic rhinosinusitis is the nasal symtoms of ARS plus either...?

``` Endoscopic signs of; polyps mucopurulent discharge oedema CT changes of mucosal complex ```

Which meatus is usually affected in rhinosinusitis and what is this located lateral to?

Middle meatus | Middle turbinate

Which sinuses drain through the middle meatus?

Maxillary Frontal anterior erythmoid

Which sinuses drain through the superior meatus?

Posterior erythmoid | Sphenoid

What aetiologial factors would predispose someone to CRS?

``` Atopy Ciliary dysfunction - cystic fibrosis NSAID sensitivity Immune dysfunction Airway disease ```

What is the mainstay of CRS management?

Topical and oral steroids antibiotics]saline nasal irrigation Allergy investigation and avoidance