Nose part 1 Flashcards
Functions of the nose
Breathing Smell Humidifying + filtering air 85% taste Defence against pathogens Equalisation + ventilation of middle ear Drainage of paranasal sinuses + NLD
Where are the nasal vestibular bodies
Inferior to the inf nasal turbinates
What is the upper 1/3 of the external nose made of?
Bone
What is the lower 2/3 of the external nose made of
Cartilage
What is the vestibule?
The nasal entrance
What is the nasal vestibule enclosed by?
Ala
What important pathologies are common at the vestibule
BCC/SCC
What bones form the nasal septum posteriorly (2)
Ethmoid
Vomer
What important structure does the nasal septum contain?
Little’s area
What structures drain into the middle meatus?
NLD
Sinuses
Why is the inferior turbinate blocked by autonomic control?
To prevent drying and allow regeneration
What structures do the nasal cavities end in?
Choanae
What is the line between the nasopharynx and oropharynx called?
Soft palate
Key features to ask about in a nose Hx (6)
Obstruction Bleeding Pain Discharge Smell Snoring/OSA
Red flags nasal Hx
Nasal bleeding Polyps Neck lumps Numb face Eye Sx - unilateral , proptosis, Diplopia, eye displacement
Causes of nasal obstruction
Infectious Allergy Developmental (septal deviation) Traumatic Iatrogenic Drugs Neoplastics Inflamm/systemic disease
What is Rhinitis
Inflammation nasal lining
Common Sx rhinitis (4)
Nasal congestion
Rhinorrhoea
Post-nasal drip
Sneezing + irritation
Diagnosis of rhinorrhoea made by?
Nasal Hx features + allergy test. 2+ of:: Blockage/congestion Facial pain/P Decr smell Presence endoscopic features
What type of reaction is allergic rhinitis?
T1HS
causes of allergic rhinitis
Int - grass/pollen
Persistent - house dust mite, mould, cat/dog
Food allergen rhinitis
Signs allergic rhinitis (3)
Inflamed nasal turbinates + mucosa
Watery discharge
Gross turbinate hypertrophy
Mx allergic rhinitis
Avoid allergy
Dx (PO/TO anti H, Na cromoglycate spray)
Secondary effects of infective rhinitis (2)
OM
Long standing rhinosinusitis
Acute Sx infective rhinitis (4)
Systemic upset
Pyrexia
Rhinorrhoea
Pus
Chronic Sx infective rhinitis
PN drip
Decr concentration
Facial pain
Which non-allergic rhinitis is a diagnosis of exclusion?
Vasomotor
What is medicamentosa due to?
Overuse of meds
Mx medicamentosa
Stop decongestant
Steroids
Surgery
What is atrophic rhintiis
Thickened secretions dry –> large crust + unpleasant odor
Req bleeding
Mx atrophic rhinitis
Soften crust w/ steam inhal + glycerine
Surgically close
Def acute rhinosinusitis
<4 w
Def subacute rhinosinusitis
4-12w
Def chronic rhinosinusitis
> 12w
Where does the posterior ethmoid sinuses drain
superior meatus
Which sinuses drain into the middle meatus
Ethmoid
Frontal
Maxillary
Which sinus is most commonly affected by acute rhinosinusitis?
Maxillary
Features acute rhinosinusitis
Severe unilateral pain over infected sinus
Malaise
Pyrexia
Tx acute rhinosinusitis
Simple analgesia
Steam inhalation
>10days - nasal CCS
TO xylometolazine - 5 days max
Who to Rx for surgery - rhinosinusitis (3)
Progressive pain
Headache
Focal neurology
Chronic sinusitis
Longstanding mucosal inflammation leading to cystic polypoid changes
Swollen mucosa narrows ostia –> cycle
Features of chronic sinusitis (4)
Usually painless
Hx sinogenic pain - exaccerbated during URTI
Purulent secretions
DDx chronic sinusitis (3)
Midfacial segment pain
Migraine
Cluster headaches
Tx chronic sinusitis
Beclomethasone 2m (take lying down)
BS Abx
Nasal douching
Surgery?
Which sinusitis is life threatening?
Frontal
PS frontal sinusitis
Tender forehead especially when percussed
Worse on bending over
How can frontal sinusitis progress
into orbit –> blindness
Into cranial cavity –> abscess
Tx frontal sinusitis
BS Abx
Decongestants
Complications of rhinosinusitis (7)
Pre-orbital cellulitis Mucoceles Meningitis Cavernous sinus thrombosis Brain abscess Extradural abscess Subdural abscess
Which sinus does pre-orbital cellulitis come from
Ethmoidal
Which is the most ocmmon rhinosinusitis complication?
pre-orbital cellulitis
Tx pre-orbital cellulitis
High dose Abx
Obseve
PS mucocoele (2)
Facial swelling
Changes to eye orientation
Tx mucocele
Surgical drainage
PS cavernous sinus thrombosis (6)
Orbit swells Fever Rigors Headache Change in consciousness CN III, IV, VI palsies
Tx cavernous sinus thrombosis
High dose Abx
