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Head and Neck > Rhinology > Flashcards

Rhinology Flashcards

1
Q

What are some symptoms for the nose?

A

Nasal obstruction, discharge, epistaxis, facial pain, deformity, anosmia, and sneezing

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2
Q

What is involved in the history?

A

Medical treatment, surgery, trauma, asthma/aspirin sensitivity
OH - woodworkers
SH - alcohol, smoking and cocaine abuse

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3
Q

What are some nasal disorders?

A

Nasal trauma, rhinosinusitis, nasal polyps, epistaxis, nasal deformity, nasal tumours, and choanal atresia

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4
Q

What is mainly used for examination of the nose?

A

Endoscopy - rigid or flexible

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5
Q

What investigation can be done in rhinology?

A

Blood tests - FBC, ANCA, CRP, ACE, RAST
CT and MRI scan
Skin tests
Rhinomanometry

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6
Q

What is the treatment for nasal trauma?

A

If within 2 weeks then under local anaesthetic can tweak bones into place
Rhinoplasty needed if after 2 weeks where nose is corrected

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7
Q

What complications can occur in nasal trauma?

A

Can develop haematoma in septum
If not drained then can reduce blood supply to area of cartilage so necrosis of septum can occur
Leading to septal perforation giving saddle deformity

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8
Q

What are the symptoms of acute sinusitis?

A

Nasal blockage, PN (posterior nasal)drip, loss of some sense of smell, and facial pain
Lasts less than 4 weeks

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9
Q

What is the treatment for acute sinusitis?

A

Symptomatic relief is given
If symptoms increase after 5 days then may need topical steroids and should work in 48hrs, if no effect in 48hrs then refer
Antibiotics not indicated as viral usually

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10
Q

What are signs of referral for acute sinusitis?

A

Periorbital oedema, displaced globe, double vision, ophthalmoplegia, reduced visual ability, severe headache, frontal swelling or signs of meningitis

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11
Q

What are the main causes for acute bacterial rhinosinusitis?

A

S. pneumoniae
H. influenzae

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12
Q

What is the treatment for acute rhinosinusitis?

A

Conservative treatment
Antibiotics rarely given
B-lactams - penicillin and cephalosporins
Macrolides - erythromycin, clarithromycin

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13
Q

Describe chronic sinusitis

A

Lasts more than 12 weeks
Presence of at least 2 symptoms - nasal obstruction, drainage, facial pain, hyposmia/anosmia
Objective evidence on physical exam or radiography

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14
Q

What is the treatment for periorbital abscess?

A

Drain from outside or endoscopically
Emergency referral, ophthalmic opinion, urgent CT, IV antibiotics, and emergency surgery

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15
Q

What is the treatment for frontal sinusitis?

A

Frontal sinus surgery and ESS. Needs drainage of pus and IV antibiotics
Neurosurgeons involved as may spread intracranially
Emergency referral

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16
Q

What is an ethmoidal mucocele?

A

Ethmoid sinus is not draining so mucus is collecting and can get double vision - diplopia

17
Q

What is the treatment for ethmoidal mucocele?

A

FESS - functional endoscopic sinus surgery

18
Q

What conditions can predispose to polyps?

A

CF
AFS
Churg-strauss syndrome
Asthma

19
Q

What can be symptoms of polyps in nose?

A

Constant blocked nose, PN drip and hyposmia

20
Q

What are the investigations for polyps?

A

Sweat test if suspect CF
RAST/ skin testing
Nasal smear (can show infection) - microbiology, eosinophils and neutrophils
CT and MRI
Flexible or rigid endoscopy more used

21
Q

Describe a CT scan of sinuses of patient with CF

A

Thick mucus so sinuses don’t drain properly and can develop chronic inflammation and polyps

22
Q

What is the treatment for polps?

A

Oral and nasal steroids
Low bioavailability in nasal steroids - less systemic side effects
Can offer immunotherapy - aspirin desensitization and treat allergic rhinitis/asthma
Diet

23
Q

What is the surgical treatment for polyps?

A

Polypectomy - Endoscopic sinus surgery - if meds not working so can reach nasal lining
Medical treatment is long term to prevent polyps

24
Q

What are some causes of epistaxis?

A

Infection
Trauma
Allergy
Hypertension and atherosclerotic vascular disease
Heredity
Blood dyscrasias
Tumour
Congenital

25
Q

What is the initial management for epistaxis?

A

ABC’s
Medical history and meds
Vital signs as may need IV
Physical exam - anterior and endoscopic rhinoscopy
Lab exam

26
Q

Describe nasal packs

A

Needed to stop profuse bleeding
Anterior and posterior nasal packs

27
Q

What surgical treatment is there for epistaxis?

A

Endoscopic sphenopalatine artery ligation
Anterior/Posterior ethmoidal ligation
External carotid artery ligation
HHT - laser coagulation, young’s procedure, septodermoplasty
Embolization

28
Q

Describe angiofibroma

A

Tumour only in males and teenagers (12-25)
Severe nosebleed if biopsy - so don’t biopsy

29
Q

What is the treatment for angiofibroma?

A

Preoperative embolisation - embolise blood vessel supplying tumour, done by angiogram
Surgery and have a lot of blood available

30
Q

What symptoms can show if tumour in post-nasal space?

A

Fluid to collect in ear - hearing loss
Bleeding from nose

31
Q

What is the treatment for post-nasal tumour?

A

RT
Surgery
Combined therapy

Head and Neck (14 decks)

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