RHINOLOGY Flashcards
Classification of Rhinosinusitis?
Predisposing Diseases that can lead to acute/chronic Rhinosinusitis?
Sinus pain may be localised or refer to other parts of the cranium:
- Sphenoid sinus pain?
- Ethmoidal sinus pain?
- Maxillary sinus pain?
- Frontal sinus pain?
Sinus pain may be localised or refer to other parts of the cranium:
- Sphenoid sinus pain radiated to the vertex
- ethmoidal pain medial and lateral to eyes
- Maxillary sinusitis may radiate to the teeth
- frontal sinus pain directly over the affected sinus
Diagnosis of Rhinosinusitis?
Infectious vs. Allergic Rhinosinusitis?
Infectious Rhinosinusitis: associated w/ pyrexia and deterioration over days
Allergic Rhinosinusitis associated w/ sneezing, nasal itching, conjunctivitis, and asthma.
Allergic rhinitis symptoms result from a __________________ reaction to allergens mediation by __________________. Symptoms occur after a given period of time following exposure to an allergen.
Allergic rhinitis symptoms result from a Type 1 hypersensitivity reaction to allergens mediation by IgE antibodies. Symptoms occur after a given period of time following exposure to an allergen.
COMPLICATIONS OF ACUTE RHINOSINUSITIS?
Red Flags?
- Ophthalmologic: Periorbital cellulitis
- Neurologic: Meningitis, epidural abscess, subdural abscess, brain abscess, cavernous sinus thrombosis
- Bone: Osteomyelitis, Pott’s puffy tumor (subperiosteal abscess)
- Nasal: Mucocele / mucopyocele
________________________: infection of the skin and soft tissue around the eye. It is most common in children and most often through direct spread of infection through the ___________________. Other causes include trauma, insect bites and dacryocystitis.
Periorbital Cellulitis: This is infection of the skin and soft tissue around the eye. It is most common in children and most often through direct spread of infection through the lamina papyracea. Other causes include trauma, insect bites and dacryocystitis.
__________________ is an infection within the orbital compartment and if left untreated can lead to serious complications including _________________ and _________________________.
Suspect if:
- reduced visual acuity (especially _________)
- ____________ (ophthalmoplegia)
- ___________ (exophthalmos)
- lateral displacement of eye
- _____________ (conjunctival oedema)
- optic neuritis.
Post-Septal “orbital cellulitis” is an infection within the orbital compartment and if left untreated can lead to serious complications including blindness and cavernous sinus thrombosis. (formation of a blood clot within the cavernous
sinus, a cavity at the base of the brain which drains deoxygenated blood from the brain back to the heart)
Suspect if:
- reduced visual acuity (especially color vision)
- diplopia (ophthalmoplegia)
- proptosis (exophthalmos)
- lateral displacement of eye
- chemosis (conjunctival oedema)
- optic neuritis.
What do these signs/symptoms suggest?
Treatment?
Cavernous sinus thrombosis (CST) is the formation of a blood clot within the cavernous sinus, a cavity at the base of the brain which drains deoxygenated blood from the brain back to the heart. Usually a late complication of an infection of the central face or paranasal sinuses
Red flag – life threatening condition
Presentation of Chronic Rhinosinusitis?
Examination?
___________________: multisystem disease characterised by necrotising granulomas of the respiratory tract, widespread vasculitis and glomerulonephritis.
Etiology
Investigations
Organ Involvement
Treatments
Wegner’s Disease (Granulomatosis with Polyangitis): multisystem disease characterised by necrotising granulomas of the respiratory tract, widespread vasculitis and glomerulonephritis.
______________________: Triad of asthma, systemic vasculitis (small-to-medium-sized blood vessels), and eosinophilia.
Presentation
Diagnosis
Histological
Treatments
Churg Strauss Syndrome: Triad of asthma, systemic vasculitis affecting small-to-medium-sized blood vessels, and eosinophilia.
______________________: multisystem inflammatory disease that manifests as noncaseating granulomas, predominantly in the lungs and intrathoracic lymph nodes.
Etiology
Presentation
Sarcoidoisis: multisystem inflammatory disease OF UNKONN ETIOLOGY that manifests as noncaseating granulomas, predominantly in the lungs and intrathoracic lymph nodes.
RARE INFLAMMATORY SINONASAL DISEASES WITH ASSOCIATED SYSTEMIC ILLESS?
- Granulomatosis with polyangiitis (Wegner’s)
- Churg Strauss
- Sarcoidosis
Differences between Anterior and Posterior Epistaxis
- Plexuses?
- Management?
How to control Epistaxis?
Apply manual compression on the soft cartilaginous part of the nostrils for 10 minutes, pressing firmly with fingers while the patient is sitting upright and leaning forward.
Cotton wool soaked w/ Co-phenylalanine (lidocaine and phenylephrine) could be used, if available.
If Anterior Bleed – cautery with silver nitrate applicator could be attempted under LA.
In some situations – nasal packing is required
- Rapid Rhino/ Nasal Tampon)
- Haemostatic agents such as Floseal (gelatine-thrombin matrix sealants) or Surgicel (Absorbable oxidized cellulose mesh)
Prescribe PO amoxicillin to prevent toxic shock syndrome if packing nose for 24+ hours.
