Nose Disease Flashcards
What are the symptoms of allergic rhinitis?
sneezing
pruritus
bilateral nasal discharge
bilateral itchy red eyes
What are the characteristics of intermittent allergic rhinitis?
symptoms <4 days per week
OR
symptoms <4 weeks duration
What are the characteristics of persistent allergic rhinitis?
symptoms >4 days per week
AND
symptoms >4 weeks duration
What causes intermittent allergic rhinitis?
grass pollen
tree pollen
fungal spores
What causes persistent allergic rhinitis?
house dust mite
cat
dog
What makes allergic rhinitis moderate-severe?
one or more of: abnormal sleep impairment of daily activities , sport or leisure missing work or school troublesome symptoms
What is the treatment of allergic rhinitis?
allergen avoidance
1 - antihistamines e.g. loratadine
2 - intranasal corticosteroid spray e.g. mometasone, fluticasone
3 - intranasal corticosteroid spray + antihistamines
4 - short course of prednisolone can help reduce severe symptoms
5 - immunotherapy for selected patients with IgE mediated disease, surgery for specific indications for relief of obstruction
What is the treatment for nasal polyps?
1 - oral steroids
2 - topical steroids
3 - surgery
small + bilateral = can be managed in primary care
causing significant obstruction = routine ENT referral
bilateral = urgent ENT referral - possible malignancy
What are the symptoms of acute infective rhinosinusitis?
facial pain - typically frontal pressure which is worse on bending forward
nasal discharge - usually thick and purulent
nasal blockage - mouth breathing
post-nasal drip - may produce a chronic cough
What is the main cause of acute infective rhinosinusitis?
viruses
What is the treatment for acute infective rhinosinusitis?
1 - analgesics and decongestants or nasal saline
2 - if persisting or worsening add antibiotic
What complication can arise from acute infective rhinosinusitis?
orbital cellulitis - emergency ENT referral
What can cause a unilateral nasal discharge in a young child?
foreign body in nose
What can cause a unilateral nasal discharge in an adult?
nasal or paranasal tumour
What is the management of a unilateral nasal discharge?
urgent ENT referral
What indicates bacterial acute sinusitis?
severe pain and tenderness with purulent nasal discharge
When should antibiotics be prescribed for acute sinusitis?
severe/deteriorating cases
significant co-morbidities that pre-dispose them to complications e.g. COPD
What are the antibiotics used in acute sinusitis?
1st line - phenomethylpenicillin
2nd line - doxycycline (not in children)
What can cause nasal polyps?
allergy infection non-allergic asthma aspirin sensitivity nickel exposure
What should be considered if a child has nasal polyps?
cystic fibrosis
What is granulomatosis with polyangiitis/Wegnerer’s granulomatosis?
autoimmune disorder of unknown aetiology characterised by a small vessel vasculitis and necrosis
What systems is granulomatosis with polyangiitis/Wegnerer’s granulomatosis usually limited to?
respiratory tract
kidneys
What is the age of onset of granulomatosis with polyangiitis/Wegnerer’s granulomatosis?
> 40
How does granulomatosis with polyangiitis/Wegnerer’s granulomatosis present?
pulmonary disease
renal disease
nasal symptoms of perforation (septal perforation etc)
What disease is characterised by high levels of anti-neutrophil cytoplasm antibodies (ANCA)?
granulomatosis with polyangiitis/Wegnerer’s granulomatotis
How is granulomatosis with polyangiitis/Wegnerer;s granulomatosis diagnosed?
cANCA +Ve
cytoplasmic-staining anti-neutrophil cytoplasm antibodies
What is a Schneiderian papilloma?
benign tumour of the nose
What is the aetiology of a Schneiderian papilloma?
HPV (low risk)
smoking
organic solvents
welding
What are the symptoms of a Schneiderian papilloma?
blocked nose
What is the pathology of a Schneiderian papilloma?
inverted and oncocytic on lateral walls and paranasal sinuses
exophytic on nasal septum
What does oncocytic mean?
epithelial cell characterised by an excessive number of mitochondria, resulting in acidophilic, granular cytoplasm
What does exophytic mean?
grow outward beyond the surface epithelium from which it originates
What is rhinitis medicamentosa?
rebound nasal congestion brought on by extended use of topical decongestants
Why should topical nasal decongestants not be used long term?
increasing doses required to achieve the same effect - tachyphylaxis
rebound hypertrophy of nasal mucosa may occur upon withdrawal
What are the clinical features of nasal polyps?
nasal obstruction
rhinorrhoea
sneezing
poor sense of taste and smell
What is Samter’s triad?
asthma + aspirin sensitivity + nasal polyposis
Why drugs should be avoided in asthma and why?
aspirin and other NSAIDs
precipitate an asthma exacerbation
What is sinusitis?
inflammation of the mucous membranes of the paranasal sinuses
sinuses are usually sterile - most common infectious agents are Strep. pneumonia, Haemophilus influenzae and rhinoviruses
What are the predisposing factors for sinusitis?
nasal obstruction - e.g. septal deviation, nasal polyps
recent local infection e.g. rhinitis, dental extraction
swimming
diving
smoking
What is the management of a patient that presents with unilateral nasal symptoms?
referral to ENT
When should sinusitis be treated with intra-nasal corticosteroids?
severe symptoms
lasted for 10 days or more
