Nose: allergic rhinitis, epistaxis, nasal foreign body, nasal fracture

Question 1

Define/cause of allergic rhinitis?

Answer 1

An inflammatory condition of the nasal mucosa.

Occurs due to allergic reaction of an allergen e.g. pollen and dust mites.

IgE mediated inflammatory response.

Question 2

Diagnosis/IVx of allergic rhinitis?

Answer 2

Clinical diagnosis

May do skin prick tests or blood tests for specific IgE antibodies to identify allergen.

Question 2

Presentation of allergic rhinitis?

Answer 2

sneezing
nasal itching
rhinorrhoea
congestion
postnasal drip
cough
eye watering, redness, itching, puffiness

may be associated to allergic conjunctivitis

Question 3

Management of allergic rhinitis?

Answer 3

Avoid triggers.

Saline -for nasal irrigation

Antihistamines (oral or intra-nasal)

Intranasal steroids (if other method are ineffective)

Oral steroids (for severe cases affect QOL)

Refer to ENT
- red flags
- allergen testing needed
- no improvement

Question 4

Define/cause of epistaxis?

Answer 4

Nose bleed

Primary cause -no identifiable cause

Secondary cause:
- alcohol
- antiplatelets, anticoagulants, aspirin, NSAIDs
- trauma
- surgery
- septal perforation
- tumour

Question 5

Diagnosis/IVx of epistaxis?

Answer 5

Clinical diagnosis

May do blood tests -for coagulation disorders

Imaging -nasal or sinus abnormalities

Question 6

Management of epistaxis?

Answer 6

Direct Compression (1ST LINE):
- resolves 10-15 mins after compression without interruption

Cautery (2ND LINE):
- can be chemical or electrical

Nasal packing (3RD LINE):
- stop local bleeding

Aggressive therapies:
- nasal balloon catheter
- transnasal endoscopy with direct cautery/arterial ligation

Question 7

Presentation of nasal foreign body?

Answer 7

Depends on the type of object and size.

Unilateral purulent offensive discharge
Nasal obstruction
May have epistaxis
Facial pain

Question 8

Diagnosis/IVx of nasal foreign body?

Answer 8

Clinical diagnosis

Question 9

Management of nasal foreign body?

Answer 9

Topical vasoconstrictors -reduce swellings

DO NOT ATTEMPT REMOVAL IN YOUNG PERSON UNLESS CONFIDENT OF SUCCESS.
- After removal of object, examine nasal cavity.

Mother’s kiss -parent holds one nostril and blows into the child’s mouth to push out foreign object.

Crocodile forceps, ballon catheter, magnet, suction catheter.

Question 10

Management of nasal fracture?

Answer 10

ED:
- manage nose bleed or acute problems
- rule out serious complications (e.g. facial fracture, head injury, CSF leak (clear unilateral nasal discharge), chest/abdo injuries, septal haematoma)

GP:
- see within 7 days for manipulation under anaethesia
- Refer immediately if:
* gross displacement
* compound fracture
* uncontrolled bleed
* CSF rhinorrhoea
* septal haematoma