Rhinology Flashcards
What is chronic rhinosinusitis?
Inflammatory disorder of paranasal sinuses and linings of nasal passages for over 12 weeks.
Risk factors for chronic rhinosinusitis?
Atopy - Hay fever, asthma.
Nasal obstruction - Septal deviation or nasal polyps.
Recent local infection - rhinitis or dental extraction.
Swimming/diving.
Smoking
Presentation of chronic rhinosinusitis?
Facial pain - frontal pressure, worse when leaning forward.
Nasal discharge - usually clear if allergic. If thick and purulent then secondary infection.
Nasal obstruction - mouth breathing.
Post nasal drip - may produce chronic cough
Management of chronic rhinosinusitis?
Avoid allergen.
Intranasal corticosteroids,
Nasal irrigation with saline solution.
Red flag symptoms for chronic rhinosinusitis?
Unilateral symptoms,
Persistent symptoms despite 3 months of treatment.
Epitaxis
Causes of Epitaxis?
Nose picking/blowing,
Trauma to nose,
Insertion of foreign bodies,
Bleeding disorders - immune thombocytopenia, waldenstrom’s macroglobinaemia.
Juvenile angiofibroma - benign tumour which is high vascularised.
Cocaine use - nasal septum may look abraded/atrophied.
Hereditary haemorrhagic telangiectasia.
Granulomatosis with polyangiitis.
Two types of epitaxis?
Anterior bleeds - Kiesselbach’s plexus.
Posterior haemorrhages - more profuse and originate from deeper structures. Occur more frequently in older adults
What is the management of epitaxis?
If haemodynamically stable - Sit forward, open mouth and pinch cartilaginous (soft) area of the nose for at least 20 mins. If successful then give Naseptin (Avoid in peanut allergy). Consider admitting if comorbid, underlying cause suspect or under age 2.
If bleeding doesn’t stop with pressure then cautery if bleed visible or packing if bleed cannot be visualized.
If haemodynamically unstable then admit to A&E. If all emergency management failed then may need sphenopalatine ligation in theater.
What are nasal polyps associated with?
Asthma (particularly late onset),
Aspirin sensitivity,
Infective sinusitis,
Cystic fibrosis,
Kartagener’s syndrome,
Eosinophilic granulomatosis with polyangiitis.
What is Samter’s triad?
Associated of aspirin sensitivity, asthma and nsal polyposis
What are the features, investigations and management of nasal polyps?
Presentation - nasal obstruction, rhinorrhoea, poor sense of smell/taste.
Ix - investigate if symptoms unilateral or bleeding.
Rx - All patients should get referred to ENT. Treat with topical corticosteroids.
What is the presentation, investigations and management of nasopharyngeal carcinoma?
Presentation - cervical lymphadenopathy, otalgia, unilateral serous otitis media, nasal obstruction, discharge/ epitaxis and CN palsies.
Imaging - Combined CT and MRI.
Rx - radiotherapy
Differential diagnosis for facial pain?
Trigeminal neuralgia - lancinating pain.
Sinusitis - accompanied with nasal discharge/congestion.
Dental problems.
Tension-type headaches - band-line type pressure extending into facial regions.
Migraine
Giant cell arteritis.
Explain what allergic rhinits is and the presentation
Inflammatory disorder of the nose. either seasonal, perennial (all year) or occupational.
Presentation - sneezing, bilateral nasal obstruction, clear nasal discharge, post-nasal drip and nasal pruritis
Features of Nasal fracture?
Assessment occurs 5-7 days after injury once swelling has gone down.
Associated with epitaxis and septal haematoma (must look for haematoma as it can lead to destruction of cartilage - deformities)
