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Ear, Nose, and Throat Diseases > Nose Conditions > Flashcards

Nose Conditions Flashcards

1
Q

Nasal Polyps: Definition

A

Benign swellings of nasal mucosa of paranasal sinus - associated with chronic sinusitis

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2
Q

Nasal Polyps: Risk Factors

A

Asthma
Aspirin sensitivity
Genetics

Cystic fibrosis
Often associate with chronic sinusitis

Not associated with allergy

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3
Q

Nasal Polyps: Symptoms

A

Nasal obstruction&raquo_space; usually bilateral
Nasal discharge
Reduced sense of smell
Cough

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4
Q

Nasal Polyps: Signs

A

Visualization of nasal polyps during physical examination

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5
Q

Nasal Polyps: Investigation

A

Clinical diagnosis based on examination.

Nasal endoscopy: Useful if polyps are not visualized via anterior rhinoscopy.
CT scan of the sinuses: Indicated if polyps are unilateral (requires a 2-week referral for evaluation).

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6
Q

Nasal Polyps: Management

A

First-Line Treatment- Intranasal corticosteroids
Daily use for 3 months followed by re-evaluation.
Continue indefinitely with reviews every 6 months.

Second-Line Treatment- Surgical polypectomy

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7
Q

Allergic Rhinitis: Definition

A

Seasonal allergies

Acute phase&raquo_space; minutes&raquo_space; sneezing and nasal secretion or 15-20 minutes
Late phase&raquo_space; nasal obstruction for 6-12 hours

Seasonal (hay fever), perennial (persistent), occupational (due to exposure to allergens at work)

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8
Q

Allergic Rhinitis: Epidemiology

A

It affects approximately 26% of UK adults and 10% of 6- and 7-year-olds.

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9
Q

Allergic Rhinitis: Aetiology

A

Allergic rhinitis is an IgE-mediated inflammatory disorder of the nasal mucosa.

When sensitized to allergens, the nasal mucosa releases histamines, causing typical symptoms of allergic rhinitis.

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10
Q

Allergic Rhinitis: Risk Factors

A

Genetic Predisposition

Environmental Triggers-
House dust mites
Grass, tree, weed pollen
Moulds
Animal dander

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11
Q

Allergic Rhinitis: Symptoms

A

Seasonal or perennial presentation
Sneezing
Nasal itching
Rhinorrhoea&raquo_space; runny nose
Postnasal drip&raquo_space; mucus drips down throat
Nasal congestion
Cough
Bilateral eye itching, watering, redness

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12
Q

Allergic Rhinitis: Signs

A

Oedematous nasal mucosa with greyish discoloration
Nasal discharge
Nasal polyps
Hypertrophic nasal turbinates&raquo_space; enlarged turbinates
Transverse nasal crease&raquo_space; across the bridge of the nose&raquo_space; pushing nose up to clean
Allergic shiners&raquo_space; darkened, swollen shadows under the eyes
Bilateral eye redness with clear discharge

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13
Q

Allergic Rhinitis: Investigation

A

Clinical Examination
Allergy test
Immunotherapy

Refer to ENT&raquo_space; unilateral symptoms, blood-stained discharge, epistaxis (nose bleed)

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14
Q

Allergic Rhinitis: Management

A

General Measures-
Nasal irrigation with saline
Allergen avoidance

Mild Persistent or Intermittent Symptoms-
Intranasal corticosteroids&raquo_space; anti inflammatory and immunosuppressive
Intranasal or non-sedating oral antihistamines&raquo_space; reduce inflammation

Moderate-Severe Persistent Symptoms or Unresponsive Cases-
Daily intranasal corticosteroid with or without intranasal antihistamine&raquo_space; full effectiveness up to 2 weeks
For eye symptoms: Antihistamine or chromone eye drops&raquo_space; sodium cromoglycate

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15
Q

Allergic Rhinitis: Further Management

A

Consider stepping-up treatment-

Nasal congestion- add intranasal decongestant x5-7 days
Rhinorrhoea- add intranasal anticholinergic (ipratropium bromide)&raquo_space; blocks acetylcholine reducing secretion from nasal passage.
Nasal itching, sneezing- add regular oral antihistamine or combination intranasal antihistamine with corticosteroid (Dymista)
Concurrent asthma- add leukotriene receptor antagonist (montelukast)

Severe symptoms affecting QOL-
Short-course oral corticosteroid (prednisolone)

Refer for immunotherapy-
Objective confirmation of IgE sensitivity to predominantly one allergen
Expose patient to increasing amounts of allergen over several weeks to induce tolerance

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16
Q

Allergic Rhinitis: Complications

A

Poor asthma control
Sinusitis
Nasal polyps
Chronic otitis media

Negatively affecting quality of life
Impaired school performance

Atopy: asthma, eczema, hay fever, allergies

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17
Q

Acute Sinusitis: Definition

A

Acute sinusitis, commonly known as a sinus infection.
Symptomatic inflammation of the paranasal sinuses and nasal cavity lasting less than 12 weeks.

18
Q

Acute Sinusitis: Aetiology

A

Often follows a viral upper respiratory tract infection (URTI)

Bacterial infection occurs in 0.5-2% of cases, commonly caused by:
» Streptococcus pneumoniae
» Haemophilus influenzae
» Moraxella catarrhalis

19
Q

Acute Sinusitis: Risk Factors

A

Allergy rhinitis
Asthma
Smoking
Anatomical variations&raquo_space; deviated nasal septum, nasal polyps

20
Q

Acute Sinusitis: Symptoms

A

Upper respiratory tract infection (URTI) symptoms&raquo_space; sore throat, cough, malaise
Nasal blockage or congestion
Nasal discharge
Facial pain or pressure
Reduction or loss of smell

21
Q

Acute Sinusitis: Signs

A

Maxillofacial sinus swelling, erythema, or tenderness
Discoloured or purulent nasal discharge
Oedematous nasal mucosa&raquo_space; nasal mucosa becomes inflamed&raquo_space; oedema
Fever

22
Q

Acute Sinusitis: Investigation

A

Diagnose using symptoms-

Acute viral (common cold)&raquo_space; symptoms less than 10 days

Post-viral acute sinusitis&raquo_space; symptoms more than 10 days or worsening symptoms after 5 days

Acute bacterial sinusitis&raquo_space; at least 3 present-
Symptoms more than 10 days
Discoloured or purulent nasal discharge
Severe localized pain
Fever
Double sickening

23
Q

Acute Sinusitis: Treatment

A

Acute:
Symptoms less than 10 days: no antibiotics, paracetamol, nasal decongestant, saline spray

Symptoms more than 10 days: high dose nasal corticosteroid for 14 days
Consider back-up antibiotic prescription -evidence shows little effects on symptoms
» phenoxymethylpenicillin
» doxycycline if allergic to penicillin (not for pregnant women)

Chronic:
Supportive care, control underlying condition, stop smoking, avoid allergic triggers, nasal saline irrigation, intranasal corticosteroid for 3 months

24
Q

Chronic Sinusitis: Definition

A

Symptomatic inflammation of the paranasal sinuses lasting for 12 weeks or more.

25
Q

Chronic Sinusitis: Aetiology

A

Inflammatory and typically multifactorial

Bacterial aetiology different from acute:
» Staphylococcus aureus
» Enterobacteriaceae
» Pseudomonas

26
Q

Chronic Sinusitis: Risk Factors

A

Allergic rhinitis
Asthma&raquo_space; atopy
Smoking
Immunocompromised
Ciliary impairment&raquo_space; ciliary in sinuses cant clear pathogens&raquo_space; cystic fibrosis
Aspirin sensitivity&raquo_space; associated with nasal polyp formation

27
Q

Chronic Sinusitis: Symptoms

A

SAME AS ACUTE&raquo_space; LONG-TERM AND CHRONIC

Upper respiratory tract infection (URTI) symptoms&raquo_space; sore throat, cough, malaise
Nasal blockage or congestion
Nasal discharge
Facial pain or pressure
Reduction or loss of smell

28
Q

Chronic Sinusitis: Signs

A

SAME AS ACUTE&raquo_space; LONG-TERM AND CHRONIC

Fever
Maxillofacial sinus swelling, erythema, or tenderness
Discoloured or purulent nasal discharge
Oedematous nasal mucosa&raquo_space; nasal mucosa becomes inflamed&raquo_space; oedema

29
Q

Chronic Sinusitis: Investigation

A

Clinical diagnosis

CT scan of sinuses&raquo_space; only if ENT orders

30
Q

Chronic Sinusitis: Management

A

Supportive care-
Control underlying condition
Stop smoking, avoid allergic triggers, good dental hygiene
Nasal saline irrigation
Intranasal corticosteroid&raquo_space; x3 months

ENT referral if-
Considering antibiotic therapy
Persistent symptoms after 3 months
Immunocompromised

31
Q

Epistaxis: Definition

A

Nosebleed
80-95% in anterior nasal septum&raquo_space; Kisselbach’s Plexus

32
Q

Epistaxis: Aetiology

A

Trauma&raquo_space; nose picking, fracture, ulcers
Inflammations
Topical drugs&raquo_space; cocaine, decongestants, corticosteroids
Systemic drugs&raquo_space; anticoagulants
Tumours
Nasal oxygen therapy&raquo_space; hospital oxygen not well humidified&raquo_space; dries out nose and makes tissue delicate.
Clotting disorders
Excessive alcohol consumption&raquo_space; affect on liver&raquo_space; clotting
Environmental factors

33
Q

Epistaxis: Investigation

A

Anterior rhinoscopy&raquo_space; visualise bleed
FBC&raquo_space; check coagulation factors

Suspect posterior bleed if-
Unable to visualise bleed
Bleeding going down throat&raquo_space; profuse bleeding
Bilateral bleeding

34
Q

Epistaxis: Management

A

Anterior bleed-
First aid&raquo_space; sit upright, lean forward, pinch nose.
If bleeding stops&raquo_space; prescribe topical antiseptic, avoid trauma to nose.
If bleeding doesn’t stop&raquo_space; nasal cautery, nasal packing.

Posterior bleed-
Refer to ENT

35
Q

Nasal Fracture: Definition

A

Broken nose

36
Q

Nasal Fracture: Symptoms and Signs

A

Nasal deformity
Nasal obstruction
Painful palpation
Swelling and discolouration
Epistaxis

37
Q

Nasal Fracture: Investigation

A

Clinical and visual
Typically no X-ray needed

38
Q

Nasal Fracture: Management

A

Refer to Manipulation Under Anasthesia (MUA)
» to be seen within 7 days

Refer immediately if-
Gross displacement
Compound
Uncontrolled bleed
CSF rhinorrhoea
Septal haematoma&raquo_space; collection of blood around fracture&raquo_space; swelling and tender

39
Q

Nasal Foreign Body: Definition

A

Obstruction

40
Q

Nasal Foreign Body: Symptoms and Signs

A

Nasal discharge&raquo_space; usually unilateral
Halitosis&raquo_space; bad breath
Epistaxis
Septal perforation
Ingestion or aspiration of foreign body

41
Q

Nasal Foreign Body: Investigation

A

Clinical and Visual

42
Q

Nasal Foreign Body: Management

A

Topical vasoconstrictors to reduce swelling
Mother’s kiss&raquo_space; parent hold nostril and blows into child’s mouth to push out FB
Crocodile forceps
Balloon catheter&raquo_space; pass behind FB, inflate and withdraw
Suction catheter
Magnet

Ear, Nose, and Throat Diseases (2 decks)

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