Rhinology Flashcards
What is a typical history of someone with a rhinological disease?
Nasal obstruction
Nasal discharge
Epistaxis
Facial pain
Nasal deformity
Anosmia
Sneezing
What is a PMH of someone with rhinological disease?
Medical treatment
Nasal surgery
Nasal trauma
Asthma/ aspirin sensitivity
What occupation an predispose rhinological disease?
Woodworkers
What social factors ca contribute to a rhinological disease?
Alcohol
Smoking
Cocaine abuse
What are some nasal disorders?
Nasal trauma
Rhinosinusitis
Nasal polyps
Epistaxis
Nasal deformity
Nasal tumours
Choanal atresia
What investigations can be done for nasal disorders?
Blood tests- FBC, ANCA, CRP, ACE, RAST
CT scan
MRI scan
Skin tests
Rhinomanometry
What is the treatment for a broken nose?
Within 2 weeks- reduce in clinic- give local anaesthetics- tweak bone back into position
After 2 weeks - septa-rhinoplasty operation to correct nose inside and outside
What can be caused by nasal trauma?
Septal haematoma
What is septal haematoma?
Blood clot between the periosteum and septum
What can a septal haematoma cause?
If not drain, can lead to blood supply to cartilaginous part of septum not getting enough blood -> necrosis -> septic perforation -> deformity
What can nasal polyps predispose?
Asthma
Which symptoms should be present to diagnose acute sinusitis?
One of either:
Nasal blockage/ obstruction/congestion
Or nasal discharge: anterior/ post nasal drip:
+/- facial pain/ pressure
+/- reduction or loss of smell
What symptoms suggest an immediate referral/ hospitalisation?
Periorbital oedema
Displaced globe
Double vision
Ophthamoplegia
Reduced Vision acuity
Severe unilateral or bilateral frontal headache
Frontal swelling
Signs of meningitis or focal neurological signs
What is the most common bacteria causing acute bacterial rhinosinusitis?
S. Pneumoniae
What is the second most common bacteria causing rhinosiusitis?
H. Influenzae
What is the treatment for acute rhinosinusitis?
Conservative treatment
Antibiotics rarely given in CRS
-B-lactams- penicillins, cephalosporins
-macrolides- e.g. erythromycin, clarithromycin
What criteria needs to be met to diagnose chronic rhinosinusitis?
The following of at least 2 of the following symptoms for at least 12 consecutive weeks:
Nasal obstruction
Nasal drainage
Facial pain/ pressure
Hypos is/ ansomia
And
Objective evidence on physical exam ( e.g. mucopurulent drainage, oedema, polyps in the middle meatus) or radiography (preferably sinus computed tomography)
A 10YR old presents with acute periorbital swelling and acute URI, what are the treatment options?
Emergency referral
Ophthalmic opinion
Urgent CT
IV antibiotics
Emergency surgery
What is the first line management for frontal sinusitis/ Potts puffy tumour?
Emergency referral
Frontal sinus surgery
ESS
How does frontal sinusitis present?
Acute onset fever
Frontal headache
Nasal discharge
What occurs in mucocele?
Sinus not draining
Swollen sinus
Mucous collecting-> pushing eye downwards
How is ethmoidal mucocele treated
FESS
How does nasal polyps present?
Constant blocked nose
PN drip
Hyposmia
(History of asthma and aspirin sensitivity)
What is the cause of nasal polyps?
Unknown
Chronic inflammation?
Autonomic nervous system dysfunction?
Genetic predisposition?
What is nasal polyps secondary to?
Cystic fibrosis
AFS
Churn-Strauss syndrome
What is the investigation of nasal polyps?
Sweat test
RAST/ skin testing
Nasal smear
-microbiology
-eosinophils
-neutrophils
CT scan
MRI scan
Flexible nasendoscopy
Rigid nasendoscopy
What is the treatment of nasal polyps?
Oral and nasal steroids
Immunotherapy
Diet
What is the surgical treatment of nasal polyps?
Traditional polypectomy
Endoscopic sinus surgery
Medical treatment long term
What factors should you consider with nose bleeds?
Congenital
Traumatic
Inflammatory
Infective
Neoplastic
What are the causes of epistaxis
Idiopathic
Infection
Trauma
Allergy
Hypertension and atherosclerotic vascular disease
Hereditary hemorrhagic telangiectasia
Blood dyscrasia
Strophic rhinitis
Tumour
Congenital or acquired nasal defects
What are infective causes of epitaxis?
Rhinitis
Nasopharyngitis
Sinusitis
What are traumatic causes of epitaxis?
Accidental or self induced
Iatrogenic
What are blood dyscrasias causes of epitaxis?
Iatrogenic (drug induced)
Disease mediated
Alcoholism
What is the treatment of epitaxis?
ABCs
Medical history/ medications
Vital signs -need if
Physical exam (anterior rhinoscopy and endoscopic rhinoscopy_
Lab exam
What is the surgical treatment for epitaxis?
Endoscopic sphenopalatine artery ligation
Transmaxillary IMA ligation
Intraoral IMA ligation
Anterior/posterior ethmoidal ligation
External carotid artery ligation
Laser coagulation
Youngs procedure
Septodermoplasty
Embolisation
How is angiofibroma treated?
Preoperative embolisation
Surgery
What is the treatment for nasal tumour?
Radiotherapy and surgery combined
How does a nasal tumour present?
Left/ right sided hearing loss and mild epitaxis - 3 months
