Nose and Sinus Disorders Flashcards
This nasal septal disorder occurs following trauma when blood pulls away the perichodrium from the septum
Septal Hematoma
Why is a septal hematoma considered a surgical emergency?
The pressure created by the hematoma can cut off blood supply leading to cartilage death.
Additionally, you need to be concerned over infections and sepsis (Remember its in the DANGER ZONE)
This occurs when the septum is “pushed to one side” often due to trauma…
Septal deviation
What are three ways a septal perforation can occur?
- Drug Use (Nasal Sprays, Cocaine, etc…)
- Trauma
- Wegner’s Granulomatosis (inflammation of blood vessels)
What are three symptoms of nasal polyps?
- Nasal Obstruction
- Anosmia
- Recurrent Sinusitis
Are nasal polyps commonly associated with allergic, non-allergic patients, or both?
BOTH
Children with polyps usually also have what?
Cystic fibrosis
What underlying condition is also closely associated with nasal polyps?
Asthma
Why are unilateral polyps concerning?
Concerning for neoplastic disease
How are nasal polyps treated?
- Nasal Steroids
- Oral Steroids
- Leukotriene inhibitors
- Immunotherapy for allergic rhinitis
- Surgery
How do you distinguish between acute, sub-acute, and chronic rhinitis in terms of symptom length?
Acute: Duration of Sx is less than 4 weeks
Sub-acute: Greater than 4 weeks but less than 12 weeks
Chronic: greater than 12 weeks
T/F: Most URIs require Abx
False, they DO NOT
This disease presents with 7-10 days of rhinorrhea, cough, erythematous mucous membranes, general body aches and a fever, but it would not respond to ABx
Viral Rhinosinusitis
What are secondary issues that can arise from viral Rhinosinusitis?
- ET Dysfuntion/ Serous Otitis
- Secondary Bacterial Rhinosinusitis
- Secondary acute bacterial OM
How is viral rhinosinusitis treated?
- Time
- Saline rinses
- Decongestants
- Afrin (1-4 days maximum)
As the Sx of bacterial sinusitis overlap with viral sinusitis, how could you distinguish between the two?
- Sx lasting longer than 7-10 days or worsening
2. Recurrent sinusitis
What are the major factors (think Sx) that could indicate acute sinusitis?
- Facial pain/pressure
- Nasal congestion
- Purulent drainage
- Hyposmia/Ansomia
- Nasal obstruction
Generally imaging studies are not indicated in acute sinusitis, however, what imaging studies could you order and when?
Plain XR (However on ~75% sensitive and tend to be over-read)
CT Sinuses (most sensitive, commonly uses if you suspect complicated sinusitis or chronic infection)
How would acute bacterial sinusitis be treated?
- Appropriate ABx
- Oral decongestants
- Saline irrigation
- Sx control (ie: Fever)
- Nasal Steroids (Not FDA Approved for ABS)
- Topical Decongestants
- Oral Steroids
What are the two most common bacteria associated with acute bacterial sinusitis?
- Streptococcus pneumoniae (20-43%)
2. H. Influeanzae (22-35%)
Prescribing ABx for sinusitis has led to an increase in what?
ABx resistance
What are 4 complications of acute bacterial sinusitis?
- Orbital cellulitis
- Meningitis
- Osteomyelitis
- Cavernous sinus thrombosis
This is an IgE-mediated inflammatory reaction triggered by allergen exposure?
Allergic Rhinitis
What Sx are commonly present in allergic rhinitis?
- Nasal Congestion
- Itching
- Sneezing
- Rhinorrhea (Anterior/Posterior)
What three additional conditions is allergic rhinitis linked to?
- Asthma
- Otitis Media
- Sinusitis
To help distinguish between allergic and non-allergic rhinitis, what are key components of the history?
- Sx triggers, magnitude, duration
- Hx of allergic Sx
- FHx of allergies
- Environment (Pets, Day care, home, etc..)
- Previous treatment
To help distinguish between allergic and non-allergic rhinitis, what are key components of the physical examination?
- Enlarged turbinates
- Erythematous Mucosa
- Nasal crease/repeated nose rubbing
- Thick watery nasal secretions
- Dark circles under the eyes (Allergic shiners)
- Mouth breathing
- Eye Sx (Conjunctival injection, watering, etc..)
How are nasal smears helpful in diagnosing allergic rhinitis?
Eosinophils will be typically present in allergic rhinitis where as neutrophils would be present in infectious rhinitis
When would allergy testing be warranted in a patient with suspected allergic rhinitis?
Is this diagnostic?
Allergy testing is recommended when Sx pattern matches allergic rhinitis, are severe and persistent, and when the disease impacts quality of life.
Not Diagnostic
What are the treatment methods for allergic rhinitis?
- Allergen Control/Elimination ***
- Intranasal Antihistamines ***
- Intranasal corticosteroids ***
- Oral antihistamines +/- decongestants
- Oral Leukotriene inhibitors
- Intranasal mast cell stabilizer
- Immunotherapy
This is the most common form of non-allergic rhinitis which causes an imbalance in neurological input to the nasal mucosa.
Vasomotor Rhinitis
What kinds of things can exacerbate vasomotor rhinitis?
PErfumes, odors, smoke, eating, temperature changes, sexual arousal
What symptoms are more prominent in a patient with vasomotor rhinitis?
Itching
Sneezing
T/F: Allergic rhinitis incidence rates increase in the elderly
False, they decrease
How is vasomotor rhinitis treated?
- Anticholinergic nasal spray
- Oral/Nasal antihistamines
- Nasal steroids
What would be the surgical management of vasomotor rhinitis if pharmacological management were to fail?
Turbinate reduction
This is commonly referred to as “rebound rhinitis” which is associated with long term use of nasal decongestant (ie: afrin).
Rhinitis Medicamentosa
How is Rhinitis Medicamentosa treated?
- Introduce nasal steroids
2. Serially dilute nasal decongestant spray
What is key to managing Rhinitis Medicamentosa?
Manage underlying allergies, sinusitis, or nasal septal disorders
Epistaxis occurs primarily from what “plexus of arteries” in the nose?
Kiesselbach’s plexus in the anterior nose
What are three important things to obtain in the history when a patient presents with epistaxis?
- Hx of HTN
- Hx of bleeding disorders
- Medication Hx (Ie: NSAID use, anticoagulants)
What are three important things to obtain in the physical examination when a patient presents with epistaxis?
- BP
- Nasal examination with headlight and suction
- Nasal endoscopy
(identify source of the bleeding)
What are the two most common cause of epistaxis?
What are some additional causes?
- Nasal Dryness
- Trauma
Drugs/Medications (cocaine, nasal sprays, etc..), HTN, Tumors
How is epistaxis managed?
- Identify bleeding source
- Afrin
- Pressure
- Ice
- Cauterization (Silver Nitrate)
- Packing (Rhino-packet)
- HTN control
What are three forms of packing for epistaxis
- Temporary
- Anterior
- Posterior
Are ABx warranted in epistaxis management?
Yes
How can you prevent epistaxis?
- No straining
- Stop NSAIDs
- HTN control
- Humidification
- Moisturization
- Avoid trauma (nose picking)
Any child with nasal drainage that is malodorous has what until proven otherwise?
Nasal foreign body
What type of foreign body in the nose is an emergency?
Batteries
If closing one nostril and “blowing out” is not successful in removing a nasal foreign body, how could it be removed?
- Topical anesthetics/decongestant
2. Use proper instrument and a good light source to remove the FB
