Nose and sinuses Flashcards
What is rhinosinusitis and how do you diagnose it?
It is inflammation of the nose and paranasal sinuses with more than 2 symptoms:
- One symptoms must be nasal blockage/discharge/congestion
- Other symptoms include facial pain or pressure, reduction or loss of smell and endoscopic or CT signs
What is acute rhinosinusitis and what is the treatment?
This is a common cold and is usually self resolving
If it lasts longer than 5 days then it can be treated with nasal corticosteroid (fluticasone) spray, avoid antibiotics unless severe
What is chronic rhinosinusitis and what is the treatment of chronic rhinosinusitis without polyps?
Chronic rhinosinusitis is when syptoms last longer than 12 weeks
Intranasal corticosteroids and nasal saline irrigation are essential
If there is no improvement in 4 weeks consider sending cultures and adding long term antibiotics
What are the clinical features and treatment of allergic rhinosinusitis?
The features are an acute IgE mediated reaction to typically seasonal in children which causes itching, discharge, sneezing, itchy red eyes
It is treated with nasal irrigation and non sedating antihistamines (loratadine 10mg)
If persistent symptoms can have nasal steroids (fluticasone)
In severe cases can have oral prednisolone to resolve symptoms
How do you treat post nasal drip?
Often occurs with age and ipratroprium nasal spray can help
what is a nasal polyp and how do you treat it?
Can occur in chronic rhinosinusitis and is a prolapse of the nasal mucosa into the nasal cavity. This causes watery anterior rhinorrhoea and nasal obstruction.
Treated with topical steroids including betamethasone and fluticasone to shrink the polyp.
If this medical treatment fails then consider surgery.
What type of nasal polyp requires urgent referral?
A single unilateral polyp is uncommon so requires urgent referral for biopsy to rule out nasopharangeal cancer/ lymphoma
What are the clinical features of acute bacterial sinusitis?
3 symptoms/signs of:
- Discoloured discharge (unilateral predominance)
- Severe local pain
- Fever (>38)
- Elevated CRP/ESR
- Double sickening, deterioration of an initial milder state
What are the causes of bacterial sinusitis?
Most are viral infection
Direct spread from dental root infection
Odd anatomy
Mechanical ventilation
What is the treatment of acute sinusitis?
98% are viral and self limiting
Treat these with nasal irrigation, decongestants (ephedrine) and analgesia
If bacterial cause suspected then give antibiotics (doxycycline)
Surgery may be required if medical intervention fails
What is the assessment and treatment of nasal fracture?
Exclude significant head injury or c-spine
Nasal fractures do not require x rays
Examine from behind and above looking at the nose, may be associated with facial swelling black eyes.
Look for septal haematoma, if present requires urgent incision and drainage.
Treat epistaxis and advise on analgesia and ice. Reassess at 5-7 days post injury once swelling has gone down
If manipulation under anaestheisa is required it can be performed 10-14 days post injury (before nasal bones set)
What are the investigations for CSF rhinorrhoea?
Tests +ve for glucose to tell it is CSF
If not from trauma ask if it is a tumour
If traumatic from ethmoid fracture then often spontaneously resolves
What are the types of epistaxis?
Anterior or posterior
What is the management of epistaxis?
Put on goggles, gloves and gown
Resuscitate the patient as needed
Ask the patient to apply pressure to the lower part of the nose for 20 mins sitting forward and spitting any blood into a bowl
Place an ice pack on the dorum of the nose
If this does not work:
-remove clots with suction and place two cotton balls soaked in adrenaline for 2 mins to cause vasoconstriction or local anestetic spray e.g. lidocaine
-find bleeding point and apply silver nitrate cautery for 2 secs at a time
-This will burn everything it touches, dont use with active bleeding as will be washed into throat
If bleeding continues:
-Anterior nasal pack, insert horizontally not up
