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Respiratory 4 > Rhinitis/Sinusitis-ENT > Flashcards

Rhinitis/Sinusitis-ENT Flashcards

1
Q

Symptoms of rhinitis?

A
  • Nasal Obstruction
  • Nasal Drainage
  • Itchy, watery eyes
  • Facial Pressure and Pain
  • Sneezing
  • Asthma
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2
Q

Types of Rhinitis?

A
  • Allergic Rhinitis: Seasonal and Perennial
  • Acute Rhinitis
  • Vasomotor Rhinitis
  • Smoker’s Rhinitis
  • Allergic Fungal Rhinitis (cover with fungal rhinosinusitis)
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3
Q

Allergic Rhinitis is what?

A
  • Afebrile, clear nasal drainage, may have polyps
  • Allergy tests positive
  • IgE positive
  • Family History Positive
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4
Q

Symptoms of Allergic Rhinitis?

A
  • Seasonal symptoms. –Pollen
  • Bluegrass, Timothy, Ragweed
  • Perennial symptoms: –Household allergens
  • Dust mites, molds, feathers, animal dander
  • Sensitive to chemical irritants
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5
Q

Seasonal allergic rhinitis?

A

• Ideal for medical treatment

– Antihistamines

– Decongestants

– Nasal Steroids • (Flonase, Nasonex, Nasocort AQ, Rhinocort Aqua)

– Singulair (montelukast) • 10 mg po daily • Selectively binds to cysteinyl leukotriene receptors

• Allergy desensitization: SCIT or SLIT

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6
Q

Perennial allergic rhinitis causative factors?

A
  • Animals outside
  • No smoking in house
  • Molds are found in: – Houseplants – Basements – Showers – Humidifiers (also increases house mites)
  • Minimize use of rugs
  • House Mites: a fecal antigen –Live off of skin flakes –Wash bed linen in 140 degree water –Plastic pillow liner and and water bed
  • Electric HEPA air filters
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7
Q

Common cause of acute rhinitis?

A

• Most common cause viral.

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8
Q

Factors of vasomotor rhinitis?

A
  • Afebrile, clear nasal drainage.
  • Allergy tests negative.
  • IgE negative
  • Family history negative.
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9
Q

Pathophysiology/triggers of Vasomotor rhinitis?

A

Pathophysiology: rhinitis secondary to overactive parasympathetic activity a from wide variety of triggers.

–Environmental triggers: humidity and temperature changes, dust, smoke, and pollution

–Endocrine and metabolic: pregnancy, oral contraceptives (estrogen inhibits anticholinesterases)

  • Medications: antihypertensives, antipsychotics, cocaine
  • Psychotropic: anxiety, stress, exercise
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10
Q

Treatment of Vasomotor rhinitis?

A
  • Chemical cautery
  • Anticholinergic nasal sprays (ipratopium bromide) – Atrovent Nasal 2 sprays each nostril tid/qid
  • Azelastine (Astelin) Nasal Spray – 2 sprays each nostril bid
  • Oral antihistamines and nasal steroids DO NOT give symptomatic relief in most patients.
  • Surgical Management:

–Surface turbinate cautery: Electrocautery, chemical cautery, cryotherapy

–Septoplasty removes mechanical points of irritation

–Partial Turbinectomy

–Division of parasympathetic fibers

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11
Q

Explain smoker’s rhinitis?

A
  • Chronic rhinitis
  • Resistant to medications and surgery
  • Hypertonic saline rinses help
  • Smoking cessation may transiently worsen symptoms if goblet cell activity and secretions recover without recovery in cilliary clearance.
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12
Q

Pathogens for sinusitis?

A

–Haemophilus influenzae

–Moraxella catarrhalis

–Streptococcus pneumoniae

–Anaerobic organisms

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13
Q

Major factors and minor factors related to sinusitis?

A
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14
Q

When do we refer to otolaryngology for sinsusitis?

A
  • 3-4 infections per year
  • An infection that does not respond to two three-week courses of antibiotics
  • Nasal polyps
  • A complication of sinusitis
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15
Q

Diagnosis of sinusitis in the primary care setting

A

In a primary care setting, a good history and physical examination to detect the presence of most or all of the commonly presenting signs and symptoms can provide a reliable diagnosis of acute sinusitis.

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16
Q

Radiographic diagnosis of sinusitis?

A

• CT of the paranasal sinuses is the imaging study of choice.

– Cost is similar to that of plain radiographs as many centers do limited axial views.

– MRI not recommended for evaluating acute sinusitis because it does not distinguish air from bone.

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17
Q

Endoscopically cultures for sinusitis?

A

Endoscopically Directed Middle Meatal (EDMM) Cultures are more sensitive than the old fashioned maxillary sinus tap.

18
Q

What to do once you have established the diagnosis for sinusitis?

A

Classify and treat

19
Q

Acute Vs. Subacute Vs. Chronic sinusitis?

A
  • Acute: symptom duration less than 4 weeks
  • Subacute: duration between 4-12 weeks.
  • Chronic: duration greater than 12 weeks.
  • Recurrent acute: 4 or more episodes in one year.
20
Q

Treatment of Rhinosinusitis?

A
  • In the absence of allergic symptoms oral antihistamines have a questionable role in the treatment of rhinosinusitis.
  • Topical nasal steroids are better for prevention in allergic patients, but can be used as an adjunct to care.
21
Q

adjunct treatments for recurrent and chronic sinusitis?

A
  • Moisturizer such as saline nasal spray.
  • Decongestants –Be careful with hypertensive patients.
22
Q

Treatment of chronic bacterial sinusitis?

A
  • Antibiotics: 3-6 week regimen with broad spectrum agents
  • Medical management often fails with chronic sinus disease, surgical management frequently required.
23
Q

Allergic fungal rhinosinusitis is also called?

A

–Intrinsic rhinitis.

–Hyperplastic rhinitis

–Eosinophilic Nonallergic rhinitis

24
Q

Allergic fungal rhinosinusitis is what?

A
  • Accounts for 5-10% of chronic rhinosinusitis –Marked variability in incidence by geographical location
  • Allergic rhinitis seen in 67% of these patients
  • Asthma seen in 50% of these patients
25
Q

Profile of allergic fungal rhinosinusitis?

A
  • Analogous to Allergic Bronchopulmonary Aspergillosis (ABPA)
  • Alternaria, Exserohilum, Curvularia, Dreschlera, and Biploaris are all also reported to cause allergic fungal sinusitis.
  • Aspergillus fumigatus
26
Q

Symptom progression of allergic fungal rhinosinusitis?

A
  • Early symptoms: nasal airway obstruction
  • Late symptoms: extensive nasal polyposis
  • Pain is uncommon (pain suggests a bacterial infection)
27
Q

Diagnosis of allergic fungal rhinosinusitis?

A
  • Afebrile, clear nasal drainage, intranasal polyps
  • IgE positive
  • eMBP antigen (Eosinophil Major Basic Protein)
  • Alt-1 antigen (Alternaria)
28
Q

Allergic fungal rhinosinusitis treatment?

A
  • Surgical Debridement of obstructed sinuses to remove fungal debris.
  • Itraconazole – 200 mg po bid (studies have used 400 mg bid, but this is above the recommend max of 600 mg/day)
  • Antifungal nasal washes
  • SinuNEB: Nasal nebulizer
  • Intranasal steroids
  • Marple 2001: Immunotherapy (Laryngoscope)
  • Three pronged-attack –Immunotherapy must be initiated postoperatively –Remove antigenic burden with a FESS –Halt inflammatory cascade: Topical and systemic steroids
  • Monitor disease with total serum IgE
29
Q

Chronic invasive fungal sinusitis pathogens? diagnosis? treatment?

A
  • Pathogens: Aspergillus, Mucor, Rhizopus, Absidia
  • Diagnosis: biopsy and culture, MRI (best) and CT of paranasal sinuses
  • Treatment: surgical debridement and long-term amphotericin B and itraconazole.
30
Q

Fulminent fungal sinusitis and mucormycosis?

A
  • Mucormycosis invades vessel walls causing local vascular occlusion, thrombosis, infarction, and tissue necrosis.
  • Pathogens: Aspergillus most common as well as the Saprophytics
  • Manifest almost exculsively in an immunocompromised host. – DKA, HIV, chemotherapy, bone marrow transplant.
31
Q

Diagnosis of Mucormycosis?

A
  • Necrotic, black turbinates
  • Biopsy and culture
  • Cranial nerve involvement
  • MRI best: enhancement in T2weighted images from fungal elements
32
Q

Treatment of mucormycosis?

A

Aggressive and urgent surgical debridement and long-term amphotericin B, maximal medical management of underlying derangements.

33
Q

What is Samter’s Triad?

A

• Nasal Polyposis • ASA intolerance • Asthma

34
Q

Antihistamine nasal spray?

A

• Astelin (Azelastine) nasal spray. –Inhibits secretions, serotonin, leukotrienes, and histamine. –No sedation.

35
Q

Rhinitis Medicamentosa is brought on by?

A
  • Do not use intranasal decongestant sprays (such as oxymetazoline )for more than 5 days!!!
  • This stuff can be very addicting.
  • Mucosal damage.
  • Rebound hypertension.
  • Treatment: use nasal steroids and nasal saline
36
Q

Nasal septum perforation symptoms and treatment?

A
  • Whistling • Nasal deformity. • Bleeding.
  • Treatment: –Septal button –Surgery has high failure rate. –Moisturizers
37
Q

Allergy testing types?

A
  • Prick testing: – Well tolerated – Not as accurate as SET, cannot be on beta-blockers.
  • SET (Skin End Point Titration) – Gold standard. – Uncomfortable, cannot be on beta-blockers.
  • RAST testing – Great for kids, can be on beta-blockers. – Not as accurate as SET
38
Q

surgical treatments of sinusitis?

A
  • Endoscopic sinus surgery
  • Turbinate surgery
  • Septoplasty
39
Q

what is this?

A

Septal spur protruding into middle meatus

40
Q

What if we see unilateral sinusitis?

A
  • RED FLAG!!!!
  • Consider inverting papilloma, Squamous cell carcinoma, lymphoma, angiofibroma.
41
Q

Nasal forgein bodies? More common in? Presentation? Treatment?

A

• More common in children • Unilateral obstruction and discharge • Treatment—removal. You must do an exam with a headlight and a nasal speculum before you call the specialist.

Respiratory 4 (18 decks)

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