Rhinitis & Sinusitis

Question 1

What to ask in nasal history

Answer 1

• Nasal blockage • bilateral
• unilateral
• Discharge • bilateral
• unilateral
• Sense of smell • Facial pain
• Bleeding
• Itch
• Sneezing

Question 2

Describe the history of the nasal septum

Answer 2

Lined with ciliated psuedostratified columnar epithelium.

Question 3

Blood supply to the nose

Answer 3

Blood supply is an anastamosis between internal and external carotid artery
• Very rich blood supply!

Anterior ethmoid
Posterior ethmoid
sphenopalatine
Greater palatine

Superior labial (from facial )

Question 4

Describe the location of the Paranasal sinuses

Answer 4

• Infmeatus
• nasolacrimalduct
• Middle meatus
• frontalsinus,maxillarysinusand
anterior ethmoid sinuses
• Superiormeatus
• posterior ethmoid sinuses

Question 5

Management of Epistaxis

Answer 5

• ABC approach
• Oxygen/IV access/Bloods
• Pressure/ice
• Cautery
• Packing - Anterior Nasal pack • Posterior Nasal Pack
• Anterior/posterior
• Surgery
• Septoplasty
• Cautery
• SPA ligation

Question 6

Nasal Symptoms: Red Flags

Answer 6

• Unilateral Symptoms BEWARE

* Unilateral Masses ALWAYS malignant until proven otherwise • 10% H&N malignancy

Question 7

Inflammatory Nasal Polyposis (benign)

Answer 7

Benign nasal polyps are always bilateral, asensate and tend to be pale. Association with asthma and salicilate sensitivity

Question 8

Management of Benign nasal Polyps

Answer 8

• Nasal steroid
• Step ladder approach • Topical spray
• Topical drops
• PO
• Surgery

Question 9

Antrochoanal Polyp management

Answer 9

• Benign unilateral nasal mass • Smooth
• Come on after URTI
• Need removal
• Differential includes inverting papilloma/Ca • Need biopsy/excision
• Propensity to recur

Question 10

Angiofibroma presentation

Answer 10

Usually present with unilateral epistaxis/blockage in teenage boy

Question 11

Nasal Carcinoma/Ethmoid Ca risk factors

Answer 11

Risk factors • Smoking
• Age
• Woodworkers • Smokers
• Textile workers

Question 12

Nasal Carcinoma/Ethmoid Ca symptoms

Answer 12

• Unilateral nasal blockage • Doublevision
• Cheek swelling
• Altered bite
• Loose teeth

Question 13

Allergic Rhinitis diagnostic criteria

Answer 13

• Congestion • Rhinorrhoea • Itching
• Sneezing
Presentation
• 2 or more of the above on most days for >1hour is diagnostic • Intermittent/mod/severe

Question 14

Pathophysiology of Allergic Rhinitis

Answer 14

• Type 1 Hypersensitivity
• IgE mediated antigen specific
• TH2 response (TH1 cell mediated)
• One airway one disease
• 80% with asthma have AR
• 10-40% with AR have asthma
• Early treatment of allergic rhinitis may influence asthma.

Question 15

Management of Allergic Rhinitis

Answer 15

• Allergen avoidance
• Nasal steroid
• Antihistamine
• Oral steroid
• Ipratropium bromide

Question 16

Vasomotor Rhinitis presentations

Answer 16

• Elderly
• Clear streaming anterior rhinorrhoea • Change of temperature
• Eating
• Ipratropium bromide prn