Nose Conditions

Question 1

What is implied if symptoms are unilateral?

Answer 1

More likely to be an anatomical abnormality

Question 2

Rhinitis - definition

Answer 2

Irritation and inflammation of the mucous membranes inside the nose

Question 3

Rhinitis - 2 main types

Answer 3

Infective

Non-infective

Question 4

Rhinitis - infective cause

Answer 4

URTI

Question 5

Rhinitis - non-infective causes

Answer 5

Allergic

• intermittent
• persistent

Non-allergic
- nasal polyps

Question 6

Rhinitis - clinical features

Answer 6

Nose blockage 
Lots of mucous is produced 
Loss of smell 
Nasal discharge 
Facial pain
Secondary symptoms
- dry mouth 
- sore throat 
- hallitosis
- snoring 
- loss of taste

Question 7

Rhinitis - non infective, allergic rhinitis

Answer 7

Skin prick test

RAST

Question 8

Rhinitis - management (infective)

Answer 8

Nasal decongestant

Analgesia

Question 9

Rhinitis - management (noninfective - allergic)

Answer 9

Allergen avoidance 
Anti-histamines 
Topical steroids 
Immunotherapy 
Surgery

Question 10

Rhinitis - complications

Answer 10

Nasal polyps

Question 11

Sinusitis - definition

Answer 11

Inflammation of the mucosa of the paranasal sinuses

Sinus becomes filled of infected mucous

Question 12

Sinusitis - which sinus is most commonly affected?

Answer 12

Maxillary sinuses

- the maxillary sinus ostia is located superiorly which means that the mucous has to drain against gravity

Question 13

Sinusitis - causes

Answer 13

Infection
Allergy
Autoimmune issues
Dental abscesses

Question 14

Sinusitis - clinical features

Answer 14

Sinus pain
Mild discomfort over frontal and maxillary sinuses due to congestion
May have referred pain to the teeth (if maxillary sinusitis due to the common sensory nerve supply from CNV)

Question 15

Sinusitis - which CN’s are responsible for the pain?

Answer 15

Sensation provided by CNV1 and CNV2

Question 16

Sinusitis - management

Answer 16

Most are self limiting
Reserve antibiotics for severe cases over 10 day duration
- amoxicillin
- doxycycline

Question 17

Sinusitis - complications

Answer 17

Infections from the ethmoid sinus can give rise to orbital cellulitis

Question 18

Nasal polyps - who gets it?

Answer 18

Common in adults

NOT common in children

Question 19

Nasal polyps - children

Answer 19

If found in children, further investigations are required and think about cystic fibrosis

Question 20

Nasal polyps - what is more worrying: unilateral or bilateral nasal polyps?

Answer 20

Unilateral

Question 21

Nasal polyps - cause

Answer 21

Allergy
Infection
Asthma 
Aspirin sensitivity 
Nickel exposure

Question 22

Nasal polyps - clinical features

Answer 22

Painless

Very oedematous and inflammatory

Question 23

Nasal polyps - pathology

Answer 23

Lots of white areas (fluid)

Question 24

Nasal polyps - management

Answer 24

Oral steroids -> topical steroids

If this doesn’t work, refer for surgery

Question 25

Schneiderian papillomas

Answer 25

Recur often

Can potentially become malignant

Question 26

Nasopharyngeal carcinoma - association

Answer 26

Epstein Barr Virus (EBV)

- infects epithelial cells of oropharynx and B cells

Question 27

Nasopharyngeal carcinoma - investigations

Answer 27

Test for EBV (EBV stains blue)