Nose Disease Flashcards by Lucy Irvine

What are the symptoms of allergic rhinitis?

sneezing
pruritus
bilateral nasal discharge
bilateral itchy red eyes

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What are the characteristics of intermittent allergic rhinitis?

symptoms <4 days per week
OR
symptoms <4 weeks duration

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What are the characteristics of persistent allergic rhinitis?

symptoms >4 days per week
AND
symptoms >4 weeks duration

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What causes intermittent allergic rhinitis?

grass pollen
tree pollen
fungal spores

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What causes persistent allergic rhinitis?

house dust mite
cat
dog

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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

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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

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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

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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

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What is the main cause of acute infective rhinosinusitis?

viruses

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What is the treatment for acute infective rhinosinusitis?

1 - analgesics and decongestants or nasal saline

2 - if persisting or worsening add antibiotic

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What complication can arise from acute infective rhinosinusitis?

orbital cellulitis - emergency ENT referral

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What can cause a unilateral nasal discharge in a young child?

foreign body in nose

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What can cause a unilateral nasal discharge in an adult?

nasal or paranasal tumour

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What is the management of a unilateral nasal discharge?

urgent ENT referral

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What indicates bacterial acute sinusitis?

severe pain and tenderness with purulent nasal discharge

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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