NOSE AND SINUS Flashcards
URI
most frequent acute illness in US
preschool children:
5-7 episodes/yr
adults:
2-3 episodes/yr
Common Cold: etiology
most common: rhinovirus
over 200 viral subtypes
Common Cold: risk factors
daycare
at home parents
psychological stress
poor sleep
Common Cold: more severe infections
chronic disease
immunodeficiency
malnutrition
cigarette smoking
Common Cold: clinical presentation
rhinitis nasal congestion sore throat cough sneezing malaise \+/- fever \+/- conjunctivitis watery eyes headache (mild) myalgias (mild)
Common Cold: typical presentation
incubation: 2-3d
duration: 7-10d
day 1: sore throat
day 2-3: nasal congestions, runny nose
day 4-5: cough
Common Cold: physical exam findings
nasal mucosal edema nasal congestion pharyngeal erythema \+/- adenopathy lungs clear \+/- conjunctival injection
Common Cold: diagnosis
H&P - clinical diagnosis
Common Cold: complications
viral sinusitis bacterial sinusitis lower respiratory disease acute asthma exacerbation acute otitis media eustachian tube dysfunction/transient middle ear effusion
Common Cold: treatment
supportive care -fluids -rest patient education -duration -no antibiotics medications
Acute Rhinosinusitis
women > men
adults > children
4 weeks or less
Acute Rhinosinusitis: etiology
VIRAL
- rhinovirus
- influenza
- parainfluenza
<2% bacterial
Acute Rhinosinusitis: risk factors
older age smoking air travel changes in atmospheric pressure swimming asthma allergies dental disease immunodeficiency
Acute Rhinosinusitis: symptoms
nasal congestion/obstruction
purulent nasal discharge
facial pain or pressure
maxillary tooth discomfort fever fatigue hyposmia or anosmia ear pressure or fullness headache halitosis
Acute Rhinosinusitis: signs
cheek tenderness
purulent drainage in nose or pharynx
sinus pain with percussion
opacity of sinuses with transillumination
erythema or edema of cheekbone or periorbital
percussion of upper teeth tenderness
diffuse nasal mucosa edema, turbinate hypertrophy
Acute Rhinosinusitis: red flags
fever > 102 with severe headache abnormal vision changed mental status periorbital edema or erythema cranial nerve palsies altered mental status neck stiffness
Acute Rhinosinusitis: bacterial
10+ days with no improvement
onset with severe symptoms lasting at least 3 consecutive days
double worsening: viral was improving then onset of worsening symptoms
Acute Rhinosinusitis: treatment
Day 1-9: supportive care
Amoxicillin clavulanate (5-7 days)
Not recommended
- macrolide (z pak)
- trimethroprim-sulfamethoxazole (bactrim)
refer
Acute Rhinosinusitis: complications
periorbital or orbital cellulitis
meningitis
osteomyelitis of sinus bones
intracranial abscess
Chronic Rhinosinusitis: clinical presentation
12+ weeks
nasal mucopurulent drainage
nasal obstruction/congestion
facial pain/pressure
reduction/loss of smell
polyps
Chronic Rhinosinusitis: management
nasal irrigation
glucocorticoids
antimicrobials
antileukotriene agents
endoscopic sinus surgery
Allergic Rhinitis: risk factors
family hx atopy male born during pollen season first born early use antibiotics maternal smoking in first year of life indoor allergen exposure high IgE before 6yo allergen specific IgE
Allergic Rhinitis: pathophysiology
abnormal immune response to an environmental protein
Allergic Rhinitis: classification
intermittent (<4d/wk, <4wks)
persistent (>4d/wk, >4wks)
mild
moderate-severe
seasonal
perennial
Allergic Rhinitis: clinical manifestations
sneezing rhinorrhea postnasal drip fatigue eye itching, tearing, burning
allergic shiners allergic salute pale blue nasal mucosa clear rhinorrhea cobblestoning TM retraction or serous fluid behind TM
Allergic Rhinitis: diagnosis
clinical diagnosis
labs
allergy skin testing
serum IgE
Allergic Rhinitis: medication options
glucocorticoid nasal spray
oral antihistamines
+/-decongestant
mast cell stabilizer
leukotriene receptor agonist
ipratorpium bromide nasal
nasal decongestant spray
no systemic glucocorticoids
Nonallergic Rhinitis: etiology
abnormal autonomic regulation of innervation of nose
nasal eosinophilia without allergen sensitivity
no identifiable exposure
Nonallergic Rhinitis: triggers
temperature changes
eating
exposure to odors/chemicals
alcohol use
Nonallergic Rhinitis: clinical presentation
nasal congestion
postnasal drainage
boggy edematous nasal turbinates
Nonallergic Rhinitis: treatment
intranasal glucocorticoids
antihistamine
Epistaxis
95% anterior bleed
5% posterior bleed
Epistaxis: treatment
conservative
- occlusion
- lean forward
- cold compress
cautery
nasal packing
Epistaxis: persistent bleeding
contralateral packing
ENT consultation
posterior = emergency
Nasal Polyps
unclear etiology
associated with
- allergic rhinitis
- asthma
- cystic fibrosis
Samter Triad
immunologic salicylate sensitivity causes severe episode of bronchospasm
nasal polyps + asthma = no aspirin
Nasal Polyps: clinical presentation
nasal obstruction anosmia rhinorrhea post nasal drip pale, edematous, mucus covered mass
Nasal Polyps: treatment
intranasal glucocorticoid
surgical excision (high recurrence)
Malignant Neoplasms
squamous cell carcinoma and adenocarcinoma
rare
male > female
50+ yo
Malignant Neoplasms: risk factors
tobacco smoke
exposure to wood dust, glue, adhesives
HPV
Malignant Neoplasms: presentation
obstruction
epistaxis
Malignant Neoplasms: diagnosis
biopsy
CT, MRI
