Rhinology

Question 1

Rhinosinusitis

Answer 1

Inflammation of the sinuses with inflammation of the nasal cavity

Question 2

Sinusitis exam

Answer 2

Anterior rhinoscopy
Flexible nasendoscopy

Question 3

Acute sinusitis definition

Answer 3

Up to 4 weeks of purple t discharge accompanied by nasal obstruction, facial pain, facial pressure or fullness

Question 4

Viral sinusitis

Answer 4

Symptoms of acute rhinosinusitis are present less than 10 days, symptoms do not worsen

Question 5

Bacterial sinusitis

Answer 5

10 days+ beyond onset or URTI symptoms
Symptoms worsen within 10 days after initial improvemtcommon bacteria are the same for otitis media (Strepococcus pneumoniae, H.influenzae, ,oraxella catarrhalis)

Question 6

Bacterial sinusitis Mangement

Answer 6

Abx - Co-amoxiclav for 7 days
Sinus rinse

Question 7

Chronic sinusitis

Answer 7

12 weeks or longer of 2+ of the following
-mucopurulent discharge
Nasal obstruction
Facial pain/pressure/fullness
Decreased sense of smell

Inflammation as seen by
Prudent mucus or oedema I. The middle meats or ethmoid region
Polyps
Imaging - CT

Question 8

Mangement chronic sinusitis

Answer 8

Abx
Anti-inflammatory (intranasal and steroids)
Mechanical (nasal saline irrigation
Surgery (performed medical symptoms remain despite maximal medixL therapy for 4-6 weeks

Question 9

Complication of sinusitis

Answer 9

Orbital
- periorbital oedema
- orbital cellulitis
- Subperiosteal abscess
- cavernous sinus thrombosis

Intracranial
- meningitis
- epidural abscess
- Potts puffy tumour

Question 10

Allergic rhinitis

Answer 10

One of the most common ENT diseases and a differential diagnosis for sinusitis.

It is the inflammation of the nasal mucous membrane caused by an IgE-mediated reaction to one or more allergens

Question 11

Management allergic rhinitis

Answer 11

Antihistamine
Intanasal corticosteroids
Systemic corticosteroids
Decongestants

Question 12

Epistaxis causes

Answer 12

Infection
Trauma
Medications
Often idiopathic

Question 13

Epitaxis locations

Answer 13

Anterior - littles area (Kiesselbach plexus)
Position nose bleeds

Question 14

Key Hx points

Answer 14

Start unilaterally or bilaterally - anterior tends to start unilaterally and can become bilateral whereas posterior bleeds tend to be bilateral from beginning

General medical Hx - systemic conditions, anticoagulants, smoking

Hx of easy bruising, prolonged bleeding or recurrent epitomised - xoncider systemic conditions

Family Hx

Question 15

Epistaxis exam

Answer 15

Headlight
Nasal speculum
Suctioning or blood or clot

Question 16

Epitaxsis investigations

Answer 16

FBC
Coagulation screen
BP

Question 17

Mangement epitaxis

Answer 17

1. Pinch nose for ten mins
   Cotton balls soaked in mixture of lignocaine and adrenaline
2. Cautery
3. Packing nasal cavity with Rapid Rhino or Merocel
4. If all else fails
5. Very rarely arterial ligation and embolisation are preformed when the above do not work