Nose: nasal polyps, sinusitis

Question 1

Define nasal polyps?

Answer 1

Benign swellings of nasal mucosa in the nose.

Question 2

Presentation of nasal polyps?

Answer 2

nasal obstruction
anosmia (partial or complete loss of smell)
cough
rhinorrhoea

Question 3

Diagnosis/IVx of nasal polyps?

Answer 3

Otoscope

If not visualised, nasal endoscopy and biopsy.

Consider CT scan of sinuses for neoplasm.

Question 4

Management of nasal polyps?

Answer 4

1ST LINE:
- intranasal corticosteroids (take daily for 3 months then re-evaluate, again review in 6 months)
- nasal saline irrigation

2ND LINE:
- surgical polyectomy

Question 5

Define sinusitis?

Answer 5

Aka rhinosinusitis.

Inflammation of the paranasal sinuses in the face.

Accompanied with inflammation of the nasal cavity.

Can be acute or chronic.
Chronic if it lasts >12wks

Question 6

Causes of sinusitis?

Answer 6

viral infection URTI

can be bacterial, allergies, immune system disorders

Question 7

Presentation of sinusitis?

Answer 7

recent URTI
bilateral intense pain
facial pressure
fever
headache worse when leaning forward
nasal congestion
nasal purulent discharge
anosmia (loss of smell)

chronic: nasal obstruction due to mucosal hypertrophy and purulent discharge.

Question 8

Diagnosis/IVx of sinusitis?

Answer 8

Clinical diagnosis

If persistent:
- nasal endoscopy
- microbiological studies
- CT scan

Question 9

Management of sinusitis?

Answer 9

No improvements after 10 days:
- high dose steroid nasal spray for 14 days
- delayed abx prescription if no improvement within 7days (phenoxymethylpenicillin)

Chronic sinusitis:
- saline nasal irrigation
- steroid nasal sprays or drops (e.g. mometasone, fluticasone)

Analgesia -pain relief

Surgery -severe cases (functional endoscopic sinus surgery -FESS)