Rhinitis

Question 1

What is Allergic Rhinitis?

Answer 1

Inflammatory disorder of the nos
Nose becomes sensitized to allergens such as house dust mites, animal epithelia, grass, tree and weed pollens

Question 2

What type of hypersensitivity reaction is allergic rhinitis?

Answer 2

IgE mediated type 1 hypersensitivity reaction in mucous membranes of nasal airways

• common: 30% of western population
• strong association with asthma

Question 3

Outline the pathophysiology of an allergic reaction in allergic rhinits

Answer 3

Allergic rxn leads to synthesis and release of arachidonic acid metaboliutes (prostaglandin D + leukotrienes) and mast cell degranulation to release hisatmine.

Effect:
increased capillary permeability > congestions > oedea > rhinorrhea > sneezing > irritation

Question 4

Classification of Allergic Rhinitis?

Answer 4

Seasonal: symptoms occur around the same time every year e.g. summer hayfever
Pereniial: symptoms occur throughout the year
Occupational: symptoms follow exposure to particular allergens within the work place

Question 5

There is a new classification of Allergic Rhinitis according to its Impact on Asthma (ARIA)
based on duration and severity of symptoms

what is it?

Answer 5

Duration of symptoms:
* Intermittent: symptoms < 4days per week, less than 4 weeks
* Perisistent: symptoms > 4 days a week, more than 4 weeks

Severity of symptoms
* Mild: normal daility acitvities + sleep, no troublesome symptoms
* Mod - severe: impairment of daily activities and selep - troublesome symptoms

Question 6

Features of allergic rhinitis?

Answer 6

Sneezing
Bilateral nasal obstruction
Clear nasal discharge
post-nasal drop
nasal pruritus

Question 7

Investigations for allergic rhinitis?

Answer 7

Question 8

Management of allergic rhinitis?

Answer 8

Conservative : Allergy avoidance / nasal douching

Medical : Mild to moderate intermittent, or mild persistent symptoms: oral or intranasal antihistamines

Moderate- to- severe persistent symptoms, or initial drug treatment is ineffective: Intranasal corticosteroids

Short course of oral corticosteroids are occasionally needed to cover important life events / immunotherapy drugs

Question 9

Presentation of non-allergic Rhinitis?

Answer 9

Blocked or runny nose
sneezing
irritation in nose
poor sense of smell

Question 10

management of non-allergic rhinitis?

Answer 10

Rinsing nasal passage
Nasal spray with steroids

Question 11

Complications of non-allergic rhinitis?

Answer 11

Nasal polyps
Sinusitis
Acute otitis media

Question 12

What is the definition of Rhinosinisitis?
(What features are needed for a diagnosis)

ENT workbook

Answer 12

Inflamamtion of the nose and paranasal sinuses charachterised by 2 or more symptoms. 1 which should be:

• nasal blockage / obstruction / congestion/ discharge
• anterior / posterior nasal drip
• +/- facial pain / pressure
• +/- reduction or loss of smell

And either:
* Endoscopic signs of polyps, mucopurulent discharge or oedma in middle meatus

And / or:
* CT chnages- mucosal changes within the osteomeatal complex or sinuses

Question 13

How do you classify rhinosinisitis?

Answer 13

Actue (ARS)
Chronic (CRS)

Question 14

What is the definition of acute rhinosinisitis?

Answer 14

• < 12 weeks, complete symptom resolution
• viral or non viral

Question 15

What is the definition of chronic rhinosinisitis?

Answer 15

• 12 weeks without complete resolution of symptoms

Divided into:
* CRS WITH nasal polyps
* CRS without nasal polyps

Question 16

What most commonly causes rhinosinisitis?

Answer 16

• viral cause (common cold)
• rhinovirus, unfluenza virus
• symptoms resolve within 5 days

Question 17

What causes non viral acute rhinosinisitis?
what can presidpose you to it?

Answer 17

• non viral if symptoms persist past 5 days

Cause:
* super added bacterial infections e.g. Strep pneumoniae, Haemophilus influenzar and Morazella catarrhalis

Predisposing factors:
* allergy
* ciliiary impairment

Question 18

How do you manage acute rhinosinisitis?

Answer 18

• Analgesia
• nasal decongestants
• if longer than 5 syas, consider topical nasal steroidsand oral antibiotics

Question 19

What are predisposing factors for chronic rhinosinisitis - CRS (with or without nasal polyps)

Answer 19

Question 20

What are nasal polyps
what type of nasal polyps do you see with CRS (chronic rhinosinisitis)
are they bilateral?

Answer 20

Polyps = abonormal mass found in any part of the body

CRS and polyps
* Polyps associated with CRS are inflammatory polyps - represent extreme end of inflammation seen in CRS

Bilateral?
* Yes normally bilateral.
* as long as no worrying signs in hx and exam no need to biopsy for histology
* all unilateral polyps need biopsy and histology

Question 21

What investigations for rhinosinisitis?

Answer 21

Skin prick test if allergy suspected

Imaging
* CT sinuses
* if surgery is planned / atypical features in history or exam
* not good for diagnosis as many asymptomatic pts have changes in the sinuses on CT scanning

Question 22

What is manageemnt of rhinosinisitis?

Answer 22

Conservative
* majority of pts to improve symptoms
* avoid possible allergens
* nasal douching

Medical
* antihistamines
* topical nasal steroids
* oral steroids (1 week course) in severe cases
* oral antibioitcs

Surgical
* nasal polypectomy (high rate of reocurrance)
* functional endoscopic sinus surgery - improves ventillation / drainage of sinuses
* other procedure e.g. septoplasty, and reduction of inferior turbinates may be considered