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!!
What is the treatment of chronic rhinosinusitis?
- Medical
- > nasal saline irrigation +
- > intranasal corticosteroid sprays
- +/- surgery
- > ie. if pus localised in one particular sinus
What is the management of Peri-orbital cellulitis/oedema?
- Mild: abx
- Moderate-severe:
REFER: if suspicion of IC involvement
- > unable to fully assess eye movements due to swelling
- > any pt. not responding to treatment for peri-orbital cellulitis
- > abnormality of visual acuity, colour vision, abnormality of CN examination
- > drainage of lid abscess required
TREATMENT:
- > May need IV therapy
- > If suspicion of orbital cellulitis or physical examination not reassuring = CT scan of brain + orbits
