Otolaryngology Flashcards
intranasal glucocorticoids
first line for AR
beclomethasone, flunisolide, budesonide, fluticasone, propionate, mometasone furoate
1st gen antihistamines
use after steriods and 2nd/3rd Gen for AR
diphenhydramine, chlorpheniramine, hydroxyzine
2nd gen antihistamine
loratadine, cetirizine, azelastine, olopatadine
3rd gen antihistamines
metabolistes of 2nd gen - fexofenadine, desloratadine, levocetirizine
antihistamine nasal sprays
azelastine, olopatadine
antihistamine+ decongestant
loratadine or cetirizine/pseudophedrine
decongestant - incr. in BP and insomnia
cromolyn sodium
mast cell stabilizer, not 1st line for AR, nasal spray
montelukast
pts with AR and asthma
ipratropium bromide
anticholinergic, rhinorrhea, nasal spray (usually COPD)
nasal decongestant sprays
vasoconstrictor decongestants - phenylephrine, oxymetazoline, xylometazoline
chronic use - rhinitis medica mucosa (rebound)
systemic glucocorticoids
used with severe s&s short-term for AR, adverse side effects risk
Management of AR in mild cases over 2 yrs old
- 2nd gen oral/topical antihistamine, regularly or prn
- intranasal steriod regularly or prn (most cost effective)
- intranasal antihistamine - azelastine (5-12 yo), olopatadine (12+ yo)
- intranasal cromlyn, regularly or prn for pts w/asthma
rhinitis medicamentosa
rebound nasal congestion due to overuse of intranasal alpha-adrenergic decongestants or cocaine
must stop using offending agent while useing topical or oral corticosteriods to tx s&s
vasomotor rhinitis
chronic, (most common)nonallergenic rhinitis not associated with nasal eosinophilia
avoid irritants and use intranasal corticosteriod or antihistamines
samter triad
nasal polyps, bronchial asthma, aspirin sensitivity that can be dangerous in some cases
nasal polyps
inflammatory conditions of nasal and sinus mucosa, may be in conjunction (not causative) with chronic rhinitis or sinusitis
40+ yo
Hx - rhinorrhea, nasal congestion, anosmia
PE - pale, edematous, mucousally covered masses
Tx - intranasal steroids, severe - oral prednisone, surgical resection in rare cases
acute bacterial rhinosinusitis dx
- onset with persistent s&s w/o clinical improvement over 10+ days
- onset of severe symptoms of a. >102F AND b. purulent nasal discharge or facial pain for 3-4 consecutive days at beginning of illness
- onset of worsening s&s after initially improving with new onset of fever, headache or increase in discharge
acute bacterial rhinosinusitis tx
first line - amoxicillin + clavulanate for 5-7 days
- 500 mg / 125 orally TID or 875 / 125 mg BID
high dose - 2mg BID when in geographic region of high endemic rate of PNS OR severe infection OR pt > 65 yo OR pt has recent hospitalization/ antibiotic use in past month
penicillin allergy - doxycycline or respiratory fluoroquinolone
adjunctive - hydration, analgesics, saline irrigation and intranasal glucocorticoids if also AR
refer ABRS
early - severe infection, suspected fungal or granulomatous disease, nosocomial infection
less-urgent - >4 cases annually, chronic rhinosinusitis with recurrent exacerbation with ABRS, immunotherapy candidates that have concurrent AR
also - anatomic defects causing obstruction, immunocompromised or resistnt pathogens, fail second-line tx
chronic rhinosinusitis (CRS) Dx
12+ wks of 2+ - mucopurulent drainage - nasal obstruction/congestion - facial pain, pressure, fullness - dysnosmia or anosmia AND 1+ doccumentation of - purulent mucus or edema in middle meatus or ethmoid region - polyps - CT image showing inflammation of paranasal sinuses
CRS tx
ENT consultation
tx inflammation and infection
- long term antibiotics, topic or oral glucocorticoids, nasal saline lavage
- surgery if indicated
