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ENT > Rhinitis + Rhinosinusitis > Flashcards

Rhinitis + Rhinosinusitis Flashcards

1
Q

What type of reaction is allergic rhinitis?

A

IgE mediated type 1 hypersensitivity

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2
Q

How is allergic rhinitis categorised?

A

Intermittent (seasonal) - hayfever

Persistent - dust mites, cats etc

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3
Q

What are the clinical features of allergic rhinitis?

A 
Rhinorrhoea, nasal irritation/itching
Sneezing
Nasal obstruction
Itchy/watery eyes
Allergic crease on nose
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4
Q

What might be seen on rhinoscopy in allergic rhinitis?

A

Inflamed nasal turbinates/hypertrophy

Watery discharge

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5
Q

Which investigations can be done for allergic rhinitis?

A

Diagnosis clinical +
Skin prick allergy testing
Serum RAST test can be done

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6
Q

How is skin prick testing done?

A

Common allergens applied to skin
+ve result is wheal response after 20 minutes
Cheap + easy to do in clinic

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7
Q

What is a RAST test and what are its advantages/disadvantages?

A

Blood test for specific IgE to antigens
More expensive + time to get results
But no risk of anaphylaxis

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8
Q

What are the options for treatment of allergic rhinitis?

A

Avoidance
Nasal douching + barrier ointments/creams
Oral non-sedating antihistamines (mild symptoms)
Intranasal steroids (if nasal blockage)
Combo steroid + anti-histamine nasal spray
Leukotriene antagonist
Immunotherapy

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9
Q

Which oral non-sedating antihistamine are used in allergic rhinitis?

A

Loratidine

Cetirizine

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10
Q

Which steroids are used intra-nasally in allergic rhinitis?

A

Fluticasone
Mometasone
Beclomethasone (not as good)

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11
Q

Which combination nasal spray is used in allergic rhinitis?

A

Fluticasone + azelastine

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12
Q

Which treatment for allergic rhinitis is particularly good if the patient also has asthma?

A

Leukotriene antagonist e.g. montelukast

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13
Q

How do nasal polyps present?

A

Nasal blockage +/- change in smell

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14
Q

What is the medical management for nasal polyps?

A

Steroids + intranasal rinses:

  • short course of oral steroid –> 7 days prednisolone + PPI
  • then intranasal steroid drops for 4-6 weeks
  • then maintenance intra-nasal steroid spray e.g. Mometasone
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15
Q

When and which operation is indicated for management of nasal polyps?

A

For polyps + chronic rhinosinusitis

–> Functional endoscopic sinus surgery (FESS)

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16
Q

What are the complications of FESS?

A 
Pain
Infection
Bleeding
CSF leak
Meningitis
Intra-orbital complications
Recurrence
17
Q

What is rhino sinusitis?

A

Inflammation of the mucosal linings of nasal passage + paranasal sinuses

18
Q

What causes rhinosinusitis?

A

Viral (most commonly): rhinovirus, coronavirus, parainfluenza, RSV
Bacterial: S. pneumoniae, H. influenzae, M. catarrhalis

19
Q

What are the risk factors for rhinosinusitis?

A 
Smoking, air pollution
Septal deviation, nasal polyps, sinus hypoplasia
Anxiety, depression
Asthma
Diabetes
20
Q

What is the diagnostic criteria for rhinosinusitis?

A

Sudden onset of 2 or more of:

  • nasal obstruction
  • discoloured nasal discharge (from nose or drip at back of throat)
  • facial pain or pressure, usually unilateral over maxillary or frontal sinus
  • altered sense of smell
21
Q

Which features of rhinosinusitis would suggest a bacterial cause rather than viral?

A

Severe local pain
Discoloured discharge
Fever
Worsening after initial improvement (post viral)

22
Q

What is the management of simple rhinosinusitis?

A

Analgesia + nasal decongestants
(most cases do not require antibiotics)

Add topical nasal steroids if symptoms > 10 days or worsening after 5 days

23
Q

Give two examples of nasal decongestants and how long as they taken for?

A

Xylometazoline
Pseudo-ephidrine
–> take for 1 week only

24
Q

What would be considered severe bacterial rhinosinusitis?

A

3 or more of:

  • coloured discharge
  • severe pain
  • fever
  • raised ESR/CRP
  • worsening after initially improvement
25
Q

What is the treatment for severe bacterial rhinosinusitis?

A

Antibiotics + intranasal steroids

  • first line = penicillin
  • second line = doxycycline (not in children)
26
Q

What are the red flags for rhinosinusitis complications?

A

Periorbital swelling/erythema, displaced globe, visual changes, ophthalmoplegia
Severe unilateral headache, bilateral frontal headache or frontal swelling
Neurological or reduced consciousness

27
Q

When should rhinosinusitis be referred to ENT?

A

Recurrent, persistent or chronic

Any red flag symptoms

28
Q

Which investigations will be done on referral to ENT for rhinosinusitis?

A

Nasal endoscopy + culture of discharge

CT scan of paranasal sinuses

29
Q

What are the complications of sinusitis?

A 
Preseptal cellulitis, orbital cellulitis or abscesses
Osteomyelitis
Pott's puffy tumour
Intracranial abscess
Venous sinus thrombosis
30
Q

What is Pott’s puffy tumour?

A

Osteomyelitis of frontal sinus –> soft boggy swelling on forehead

31
Q

What is considered ‘chronic’ rhinosinusitis?

A

Symptoms > 12 weeks

32
Q

What are the risk factors for chronic rhinosinusitis?

A 
Asthma/atopy
Aspirin sensitivity
Ciliary impairment
Smoking
Immunosuppression
33
Q

What will be seen on nasal endoscopy in a patient with chronic rhinosinusitis?

A

Swelling
Discharge
Occlusion of the middle meatus
Polyps (around the middle meatus)

34
Q

What is the non-surgical management of chronic sinusitis?

A

Nasal douching + intranasal steroids

If more severe –> long term antibiotics + intranasal steroids

35
Q

What is the surgical management of chronic sinusitis?

A

If refractory to conservative management –>

Functional endoscopic sinus surgery (FESS)

36
Q

What is the aim of FESS?

A

Remove any polyps and open up sinuses, reduce obstruction + drain mucus
This allows topical treatments to reach all areas –> must continue post-op

37
Q

What is a complication of chronic rhinosinusitis?

A

Mucocele

  • occurs rarely in frontal sinus
  • can erode bone + local structures

ENT (14 decks)

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