Nose & Sinus Disorders Flashcards
Functions of the Nose
Olfaction
Air filtration & warming
Something to hold up your glasses
Consequences of deficiency in ability to perceive smell
Impairs sense of taste Lead to nutritional deficiencies Impairs social interactions Depression May be dangerous (fires)
Define Anosmia
Inability to detect orders
Define Hyposmia
Decreased ability to detect odors
Define Dysosmia
Distorted identification of smell
3 Types of Dysosmia
Parosmia
Phantosmia
Agnosia
Define Parosmia
Altered perceptions of smell in the presence of an odor, usually unpleasant
Define Phantosmia
Perception of smell without an odor present
Define Agnosia
Inability to classify or contrast odors, although able to detect odors
Conductive Olfaction Defects Affects:
Transmission of an odorant stimulus to the olfactory neuroepithelium is disrupted
Sensorineural Olfaction Defects Involves:
The more central neural structures
The most common causes of olfactory deficits
Viral URI
Head trauma
Causes of Anosmia
Midline facial abnormalities
Neurosensory hearing loss
Causes of Dysosmia
Nasal & paranasal sinus disease Head trauma URI Medications Exposure to toxins
Causes of Parosmia & Hyposmia
Aging & neurodegenerative processes Nasal obstruction URI Head trauma Facial trauma Central olfactory damage
Main function of the mucociliary movement
Prevent infection & Subsequent problems
Chronic Nasal Congestion Affected by:
Allergic rhinitis
Vasomotor rhinitis
Mechanical obstruction
SE of certain drugs/meds
Define Rhinitis
Inflammation of the nasal mucosa which can be caused by infection, allergy, or environmental irritants
Types of Infection in Rhinitis
Viral
Bacteria
Fungal (rare)
Main type of drug/medication that causes rhinitis
Afrin addiction
Hormonal changes that causes rhinitis
Hypothyroidism
Pregnancy
Types of chronic inflammatory disease
Granulomatosis
Presentation of Rhinitis
Nasal congestion
Rhinorrhea/discharge
Epistaxis
Pain (nasal, sinus, pharyngeal, dental)
Define Infectious Rhinitis
Inflammation of the nasal passages commonly due to any number of respiratory viruses
Tissues Inflamed in a URI
Nasal & nasopharyngeal tissues
Oropharyngeal, laryngeal tissues
Bronchial mucosa
Incidence of the common cold in children
6-10 colds/year
Incidence of the common cold in kindergarteners
12/year
Incidence of the common cold in school aged children
7/year
Incidence of the common cold in adolescents/adults
2-4/year
Clinical Presentation of Infectious Rhinitis (cold)
Pharyngitis Nasal congestion Rhinorrhea Obstruction Sneezing Facial/ear pressure Loss of smell/taste Productive cough Hoarseness Headache Malaise Fever >100
Causes of the Common Cold
Weather Exercise & diet Englarrged tonsils/adenoids Psychological stressors Allergic disorders
Main types of Viral Rhinitis
Rhinoviruses Coronaviruses Adenoviruses Orthomyxoviruses Paramyxoviruses Echoviruses RSV Enteroviruses Coxsackieviruses
How to Transmit the Cold
Touching your skin or environmental surfaces
Inhaling drops of aerosolized mucous material
Differential Diagnosis of the Common Cold
Seasonal allergic rhinitis Sinusitis: bacterial Pharyngitis: Group A Strep CMV EBV Mumps Rubeola Influenza
Systemic Symptoms of Influenza
Fever >101 Myalgias Malaise Severe headache Lower respiratory tract congestion/cough
Treatment of the Common Cold
Rest Plenty of fluids Gargle with warm salt water Throat sprays, lozenges Petroleum jelly Aspirin, Ibuprofen, or acetaminophen
Why can you not use aspirin the children?
Reye’s Syndrome
What does aspirin promote in children?
N/V
Liver inflammation
Progressive mental changes
Management of Rhinitis
Antihistamines NSAIDs Decongestants Topical Decongestants Oral Decongestants
What are the best antihistamines for the common cold?
Chlorpheniramine (Chlor-Trimeton)
Diphenhydramine (Benadryl)
Brompheniramine (Dimetapp)
What NSAIDs are most frequently use for the common cold?
Ibuprofen
Naproxen
What do decongestants decrease and how?
Nasal congestion by causing vasoconstriction
Types of Decongestants for the Common Cold
Pseudoephedrine (Sudafed)
Phenylephrine
Oxymetazoline
What are some unwanted side effects of decongestants?
Narrow-angle glaucoma
Poorly controlled HTN
CAD
Types of Topical Decongestants for the Common Cold
Phenylephrine
Oxymetazoline
Types of Oral Decongestants for the Common Cold
Pseudophedrine
Phenylephrine
Symptoms from unintentional overdose in cough and cold medicines
Hives
Drowsiness
Unsteady walking
Patient Education for the Common Cold
Reassurance
Rest
Increase fluids
Discontinuation of tobacco & alcohol
Complications of the Common Cold
Lower respiratory infections Bronchial hyperreactivity Exacerbation of chronic lung diseases OM Acute sinusitis Rhinitis medicamentosa
Define Sinusitis
Inflammatory or infectious process in the paranasal sinuses caused by bacteria, viruses, fungi, allergies
Define Acute Rhinosinusitis
Symptoms that last less than 4 weeks
Define Subacute Rhinosinusitis
Symptoms for 4-12 weeks
Define Chronic Rhinosinusitis
Persists greater than 12 weeks
Define Recurrent Acute Rhinosinusitis
4+ episodes per year with interim symptoms resolution
Pathophysiology of Rhinosinusitis
Osteomeatal complex consisting of the outflow tracts of all of the sinuses into the nose
What conditions must be present for normal physiologic functioning of the sinuses?
Potency of the osteomeatal unit
Normal mucociliary transport
Normal quality/quantity of secretions
Factors which predispose one to recurrent sinus infections
Anatomical irregularities Infections Allergies Polyps Hormones Environment Foreign bodies Cystic fibrosis
Common Bugs in Bacterial Sinusitis
Strep Pneumo
H. Flu
M. cat
Common Bugs for Chronic Sinusitis
Staph aureus
Anaerobes
Symptoms of Sinusitis
Facial pain or tenderness Nasal congestion Purulent nasal & postnasal discharge Headache Maxillary tooth pain Malodorous breath Fever Eye swelling Pain/pressure in cheecks
What is the time frame for viral URI’s?
How long do symptoms need to last in order to be bacterial sinusitis?
Greater than 7 days
Touchdown or slam dunk symptoms for sinusitis
Headache
Facial pain
Fever
In order to diagnose sinusitis you need 2+ of the following symptoms
Colored nasal drainage Poor response to decongestant Facial pain/Sinus pain Headache Biphasic illness which cold symptoms
Distinguishing Symptoms for Frontal Sinusitis
Pain when forehead over frontal sinuses is touched
Pain exacerbated by leaning forward
Distinguishing Symptoms of Ethmoid Sinusitis
Pain behind eyes, between eyes
Distinguishing Symptoms of Sphenoid Sinusitis
Pain behind the eyes
Distinguishing Symptoms of Maxillary Sinusitis
Upper jaw & teeth to ache Cheeks tender to touch Purulent drainage Nasal mucosa erythematous & swollen Presence of mucoid pus
Diagnostics of Sinusitis
Plain films
CT scans
MRI
Sinus aspiration
Treatment of mild, recent onset sinusitis
Rest Plenty of fluids Gargle with warm salt water Throat sprays, lozenges Petroleum jelly Aspirin, Ibuprofen, or acetaminophen
Treatment for Bacterial Sinusitis
Amoxicillin (1st line)
Augmentin
Doxycycline
Zithromax
Self Care Measure for Sinusitis
Adequate hydration Steamy shower Increase humidity in home Warm facial packs Analgesics Decongestants Saline irrigation lavage Saline drops/sprays Adequate rest Sleep with head of bed elevated Avoid cigarette smoke/dry, cool air
Complications of a Bacterial Sinusitis
Meningitis Epidural abscess Subdural empyema Brain abscess High fever CNS symptoms Orbital cellulitis Orbital abscess Cavernous sinus thrombosis Mucocele formation
Presentation of Allergic Rhinitis
Clear rhinorrhea Sneezing Tearing Eye irritation Pruritis Cough Bronchospasm Eczemetous dermatitis
Treatment of Allergic Rhinitis
Antihistamines
Intranasal corticosteroids
Antileukotrienes
Immunotherapy
Define Nasal Airway Obstruction
Inability to inspire and expire through the nasal passage
Nasals Airway Obstruction
One or both nostrils Partial or complete block Always, intermittent Stable, worsening Impaired respiration, smell, and taste
Which population can nasal obstruction be life threatening?
Infants- obligate nose breathers
Differential Diagnosis for Nasal Airway Obstruction
Polyps Tumors Foreign bodies Septal deviations Trauma
Define Nasal Polyps
Intense inflammatory reaction of the sinonasal mucosa of unknown etiology
Polyps which block ______ can lead to chronic sinusitis?
Osteomeatal unit
Imaging to diagnose nasal polyps
Coronal sinus CT
MRI
Water’s view X-ray
Treatment for Nasal Polyps
Topical steroids (1st line) Antihistamines Oral steroids Leukotriene inhibitors Intrapolyp steroid injections Surgical removal
Define Septal Deviation
Displacement of the nasal septum
How do you obtain a septal deviation?
Trauma
Marfan syndrome
Homocystinuria
Ehlers-Danlos syndrome
Symptoms of Septal Deviation
Infections of the sinus Sleep apnea Snoring Change in smell Frequent sneezing Difficulty breathing
Treatment of Septal Deviation
Decongestants
Anti-histamines
Nasal spray
Septoplasty
Define Septal Perforation
Hole or fissure in the nasal septum
Causes of Septal Perforation
Cocaine
Nasal Sprays
Piercing
Symptoms of Septal Perforation
Whistling when breathing
Bloody discharge
Nasal pressure
Discomfort
Treatment of Septal Perforation
Usually heal without surgery
