Rhinitis Flashcards
what is the definition of rhinititis?
Inflammation in the nose and paranasal sinuses with >2 symptoms, one of which must be nasal blockage/obstruction/congestion or nasal discharge +/ facial pain or pressure, reduction or loss of smell and either endoscopic or CT signs.
what are the different types of Rhinitits?
Allergic - intermittent, persistent
Non Allergic - vasomotor, polyps
Rhinosinusitis
what are the causes of allergic rhinitis?
o Intermittent – grass pollen, tree pollen, fungal
o Persistent – house dust mite, cat, dog
what is the pathophysiology of allergic rhinitits?
o Type I Hypersensitivity
o IgE mediated inflammation from allergen exposure to nasal mucosa causing inflammatory mediator release from mast cells
what are the clinical features
o Sneezing
o Pruritis
o Nasal discharge (bilateral & variable) and congestion
o Bilateral itchy red eyes
o Asthma
o Signs: turbinate may be swollen and mucosae pale or mauve, nasal polyps
what is the definition of intermittent allergic rhinitis?
symptoms < 4 days per week or < 4 weeks
what is the definition of persistent allergic rhinitis?
symptoms >4 days per week or >4 weeks duration
what is the definition of mild allergic rhinitis?
normal sleep, no impairment of daily activities, sport or leisure, normal work and school, no troublesome symptoms
what is the definition of moderate/severe allergic rhinitis?
abnormal sleep, impairment of daily activities, sport or leisure, missing work or school, troublesome symptoms
what investigations are done for allergic rhinitis?
Allergy testing, nasal endoscope
What is the management of allergic rhinitis?
o Allergy avoidance o Nasal irrigation o 1. Antihistamine o 2. Topical Steroids (steroids) o 3. Topical steroids and antihistamines o Occasionally surgery or immunotherapy
what is the pathophysiology of vasomotor rhinitis?
swelling of blood vessels + build up of fluid in tissues of the nose – non allergic
what are the causes of vasomotor rhinitis?
o Infection o Environmental o Medications o Hormonal Imbalance o Tissue damage
what are the environmental causes of vasomotor rhinitis?
smoke, perfume, paint fumes, change in weather, alcohol, spicy food, stress
what are the medication causes of vasomotor rhinitis?
ACE inhibitors, beta blockers, NSAIDs, nasal decongestants
what are the clinical features of vasomotor rhinitis?
o Blocked nose
o Running nose
o Sneezes
o Irritation around nose, reduced smell, cast formation
how is vasomotor rhinitis diagnosed?
exclude allergens
how is vasomotor rhinitis diagnosed?
avoidance, corticosteroids
what the management of acute rhinosinusitis?
- If symptoms persist >5 days, consider non-systemically bioavailable intranasal corticosteroids (e.g. momentasone, fluticasone)
- Avoid antibiotics unless severe or worsening (most resolve in 14days)
what is the pathophysiology of chronic rhinosinusitis with polyps?
simple nasal polyps are swellings of the nasal or sinus mucosa prolapsing into the nasal cavity
what is the cause of chronic rhinosinusitis with polyps?
unknown
o Associations: allergic rhinitis, non-allergic rhinitis, chronic ethmoid sinusitis, cystic fibrosis, aspirin hypersensitivity, asthma
what are the clinical features of chronic rhinosinusitis with polyps?
o Watery anterior rhinorrhoea o Sneezing o Purulent post nasal drip o Nasal obstruction o Sinusitis o Mouth breathing o Snoring o Headaches
how is chronic rhinosinusitis with polyps diagnosed?
anterior rhinoscopy or nasal endoscopy
o Consider allergy testing
what is the medical management of chronic rhinosinusitis with polyps?
topical steroids (betamethasone, fluticasone), consider long term antibiotic (doxycycline)
what is the surgical management of chronic rhinosinusitis with polyps?
endoscopic sinus surgery
what is the management of Chronic Rhinosinusitis without Nasal Polyps?
- Intranasal corticosteroids and nasal saline irrigation are central
- If no improvement >4 weeks and mucosa disease at subsequent endoscopy is moderate or severe consider microbiological cultures + add long term (>12 weeks) antibiotics (if IgE is not elevated)
- Perform CT scan and if poor response to treatment consider surgery
what are the acute causes of sinusitis?
o Viral – rhinovirus + influenza virus
o Bacterial – streptococcus pneumoniae, H influenza, M catarrhalis, Staph Aureus
o Fungal
o Chemical irritation – cigarettes + chlorine
what are the chronic causes of sinusitis?
multifactorial inflame disorder
what are the risk factors to developing bacterial sinusitis?
Follow viral
Direct spread: dental root infection or diving/swimming in infected water
Odd anatomy – septal deviation, large ethmoidal bulla, polyps, large uncinate processes
ITU causes – mechanical ventilation, recumbency, use of nasogastric tubes
what is the pathophysiology of sinusitis?
- Swelling of the sinuses
- Sinuses normally sterile and secretions unilateral
- Obstruction of the outflow tract stasis of secretions with negative pressure, leading to infection by bacterial
what are the clinical features of sinusitis?
- Dull constant ache over frontal or maxillary sinuses with tenderness +/- post nasal drip
- Pain worse bending over
- Ethmoid or sphenoid pain is felt deep in midline root of nose
- Blocked nose
- Reduced smell
- Temperature
- Bad breath and toothache
what is the time periods for acute and chronic sinusitis
Acute < 4 weeks, chronic > 4 weeks
how is sinusitis diagnosed?
clinical, CT of paranasal sinusitis and nasal endoscopy
what is the management of sinusitis?
- Self resolving – analgesia, nasal saline irrigation, intranasal decongestants
- Antibiotics if bacterial – 1st amoxicillin, 2nd doxycycline
- Recurrent – if medical fails ESS
