Rhinology Flashcards
What are the common presenting symptoms in Rhinology?
- Nasal obstruction
- Rhinorrhoea
- Facial pain (ie. in sinusitis)
- Post-Nasal drip
- Sense of smell (anosmia)
- Nasal deformity
- Sneezing/Allergy
- Trauma/surgery
What are the common tests performed for allergies in Rhinology?
- RAST/skin prick
- Nasal Endoscopy
- CT scan
- > (nb. NOT sinus XRs!!!)
What are the common (benign) Rhinology disorders?
- Nasal trauma
- Rhinitis/Rhinosinusitis
- Nasal polyps
- Nasal deformity
- Nasal benign tumours
- Unilateral choanal atresia
What are the common dangerous Rhinology disorders?
Emergencies:
- Epistaxis (!!!)
- Fracture/Septal Haematoma
- Malignant Nasal tumours
- Bilateral choanal atresia
- Complications:
- Orbital
- Neurological
What is the most common PMH in Rhinology disorders?
- Medical treatment
- Nasal surgery
- Nasal trauma
- Asthma/Aspirin sensitivity
What is the most common OH in Rhinology disorders?
- Woodworkers
What is the most common SH in Rhinology disorders?
- Alcohol
- Smoking
- Cocaine abuse
What are the standard nasal examination techniques?
- Nb. majority of pts don’t need investigations - treatment is based on hx and examination!!*
- Blood tests: FBC, CRP, ANCA, ACE, RAST
- Anterior Rhinoscopy: nasal speculum, headlight
- Nasal endoscopy
- CT scans: bony delineation
- MRI scans: soft tissues
- Skin Tests: allergic rhinitis
- Rhinomanometry (rare)
What is the management of a Nasal Fracture?
- Uncomplicated Fractures:
- > ice packs + regular painkillers
- > outpatient follow-up to Nasal Fracture clinic within 6-14 days -> where reduction (resetting) of broken nose takes place (AFTER the initial soft tissue swelling has calmed down!)
- If septal haematoma has been identified O/E:
- > nasal lancing and drainage
- > abx cover
What are the possible complications of a Nasal fracture?
- Septal Haematoma -> septal abscess -> vascular necrosis -> Saddle nose
- Deviated Septum
- Cartilage fracture
What are the most common causative bacteria in acute bacterial rhinosinusitis?
- S. Pneumoniae
- H. Influenzae
What is the management of Acute Rhiosinusitits?
- <4 weeks*
- Conservative treatment (symptomatic relief)
- abx. rarely given
- > beta lactams: ie. penicillins, cephalosporins
- > macrolides: ie. erythromycin, clarithromycin
What are the clinical features of acute rhinosinusitis?
- <4 week history
- constant nasal blockage
- post-nasal drip (nasal drainage)
- sino-facial pain (lasts 1-2 weeks)
- coryza/catarrh
- sino-facial pain
What are the clinical features of chronic rhinosinusitis?
- presence of at least 2 of the following cardinal symptoms for at least 12 consecutive weeks*
- Nasal obstruction
- Nasal drainage (post-nasal drip)
- Facial pain/pressure
- Hyposmia/anosmia
- and*
- Objective evidence on physical examination (ie. mucopurulent drainage, oedema, polyps in the middle meatus) or radiography (preferably sinus CT)
What is the diagnosis of chronic rhinosinusitis?
CLINICAL!!
