Nose Conditions Flashcards
What are nasal polyps
Soft, painless, non-cancerous growths on the lining of the nasal passages
What are nasal polyps often associated with
Non-allergic asthma
What do you need to consider in a young patient with nasal polyps
Cystic fibrosis
Histology of nasal polyps
Lined by respiratory or squamous epithelium
Oedematous stroma containing mixed inflammatory cells +/- eosinophils
Clinical presentation of nasal polyps
Blocked nose, runny nose, reduced sense of taste or smell
Investigation for nasal polyps
Nasoendoscopy
Management of nasal polyps
Intranasal topical steroid
What is allergic rhinitis
IgE mediated type 1 hypersensitivity reaction
How do we classify allergic rhinitis
Intermittent and persistent
What causes intermittent allergic rhinitis
Grass pollen, tree pollen, fungal spores
Intermittent allergic rhinitis
Symptoms <4 days per weeks OR symptoms for <4 weeks
Persistent allergic rhinitis
Symptoms >4 dats per week AND >4 week duration
What causes persistent allergic rhinitis
House dust mite, cat, dog
Clinical presentation of allergic rhinitis
Sneezing, nasal itching, nasal congestion and discharge
Sign of allergic rhinitis
Allergic crease indicates repeated itching of the nose
What investigations can be done for allergic rhinitis
Skin prick test, measure blood IgE
Management of allergic rhinitis
ALLERGEN AVOIDANCE
1. Antihistamines
2. Topical corticosteroids
3. immunotherapy e.g. montelukast
What is non-allergic rhinitis
Inflammation of the inside of the nose that is not caused by an allergy
Causes of non-allergic rhinitis
Viral infection
Vasomotor
Occupational
Hormonal
Drug induced
Name some drugs that can cause non-allergic rhinitis
ACEi, b-blockers, NSAIDs, cocaine
What is vasomotor rhinitis caused by
Dysfunction of blood vessels and nerves in the nasal passages
Pathophysiology of non-allergic rhinitis
Lining of the nose becomes swollen and inflamed blocking the nasal passage and stimulating the mucous glands in the nose
Clinical presentation of non-allergic rhinitis
Rhinorrhoea, sneezing, itchy nose, nasal congestion
Management of vasomotor rhinitis
Consider anticholinergics e.g. ipratropium
Management of non-allergic rhinitis
Avoidance of triggers
Topical nasal steroids
Antihistamine for itch and sneeze
Complications of non-allergic rhinitis
Sinusitis, nasal polyps
What is acute sinusitis
Symptomatic inflammation of the paranasal sinuses lasting less than 12 weeks
What usually causes acute sinusitis
Most commonly preceded from rhinitis but can spread from dentition
Common organisms that cause acute sinusitis
Strep.pneumo
H.influenzae
Moraxella catarrhalis
Clinical presentation of acute sinusitis
Nasal blockage or discharge with facial pain/pressure and reduction in sense of smell
Management of acute sinusitis
Analgesics and nasal decongestants
Saline irrigation
Management of acute sinusitis after 10 days
Nasal corticosteroids for symptoms
Antibiotics: phenoxymethylpenicillin
Doxycycline second line
Complications of acute sinusitis
Spread from sinuses to orbit: cellulitis, periosteal abscess, orbital abscess
Thrombosis of retinal vein or cavernous sinus
What is granulomatosis with polyangitis
Characterised by a small vessel vasculitis and necrosis, usually limited to the resp tract and kidneys
When do patients usually present with granulomatosis with polyangitis
> 40
Name some ENT features of granulomatosis with polyangitis
Sinusitis, nasal crushing, epistaxis, mouth ulcers, sensorineural deafness, otitis media, subglottic inflammation
Investigation for granulomatosis with polyangitis
cANCA positive
What is ANCA
Cytoplasmic Anti-neutrophil cytoplasmic antibodies
Management of granulomatosis with polyangitis
IV steroids and cyclophosphamide
Name the most common benign lesion of the nose
Squamous cell papilloma
Name 4 benign lesions of the nose
Squamous cell papilloma
Sinonasal papillomas
Recurrent respiratory papillomatosis
Angiofibroma
Who tends to get sinonasal papillomas
Men over 50
Clinical presentation of sinonasal papilloma
Blocked nose
What is recurrent respiratory papillomatosis
Papilloma form along the aerodigestive tract
What is recurrent respiratory papillomatosis associated with
HPV
How does recurrent respiratory papillomatosis present
In children with hoarse voice and progressive SOB
What is the most common malignant lesion of the nose
Squamous cell carcinoma
Where is nasopharyngeal carcinoma usually seen geographically
Far east and parts of Africa
Which gender has a higher incidence of nasopharyngeal carcinoma
Males
What does nasopharyngeal carcinoma have a strong association with
EBV, volatile nitrosamines in food
Name 2 EBV genes which affect normal signalling pathways and how they do it
LMP-1 acts as an oncogene
EBNA-2 promotes transition from G0 to G1
What is subglottic stenosis
Narrowing of the airway below the vocal chords and above the trachea
Most common cause of subglottic stenosis
Idiopathic
What has subglottic stenosis been associated with in adults
Vasculitis
Clinical presentation of subglottic stenosis
Progressive difficulty breathing made worse by exertion
Management of subglottic stenosis
Division of the stenosis
If recurrent: resection and reconstruction
