Rhinology

Question 1

What signs and symptoms are of note in relation to Rhinology?

Answer 1

Nasal obstruction, nasal discharge, epistaxis, facial pain, nasal deformity, sneezing

Question 2

What aspects of a PMH are of note in relation to Rhinology?

Answer 2

Medical treatment, nasal surgery, nasal trauma

Question 3

What features of a SH are of not in relation to Rhinology?

Answer 3

Alcohol, smoking, cocaine

Question 4

What is the key Ix for nasal symptoms?

Answer 4

Nasal endoscopy

Question 5

Other Ix for nasal symptoms

Answer 5

Bloods - FBC, ANCA, ESR
CT
MRI
Skin tests
Rhinomanometry

Question 6

What are some nasal disorders?

Answer 6

Nasal trauma, epistaxis, rhino sinusitis, polyps, deformity, tumours

Question 7

What are the causes of nasal polyps?

Answer 7

Unknown
Chronic inflammation
Autonomic nervous system dysfunction

Question 8

What is the pathophysiology of nasal polyps?

Answer 8

Allergy associated

• 20-50% have asthma
• allergic rhinitis
• 8-26% have aspirin intolerance
• 50% have alcohol intolerance

Question 9

Comment on nasal polyps found in children

Answer 9

Polyps are highly abnormal in children, and cystic fibrosis should be suspected

Question 10

Ix for nasal polyps?

Answer 10

Sweat test - CF, RAST/ skin testing, Nasal smear, coronal CT, MRI, nasal endoscopy

Question 11

Medical Tx for nasal polyps?

Answer 11

Oral and nasal steroids - high dose prednisolone and nasal steroid for 20 days
Immunotherapy

Question 12

Surgical Tx for nasal polyps?

Answer 12

Microdebrider, endoscopic sinus surgery, traditional polypectomy

Question 13

Tx for acute sinusitis?

Answer 13

Antibiotics, nasal decongestants, (steroid spray), analgesics

Question 14

Are X-rays indicated for ENT Ix?

Answer 14

No - poor visualisation, high rate of false positives etc

Question 15

What is the definition of chronic sinusitis?

Answer 15

Duration of symptoms >12 weeks

Persistent inflammatory changes on imaging >4 weeks

Question 16

What is the definition of acute sinusitis?

Answer 16

Acute onset of symptoms, duration of symptoms

Question 17

What are the main microbial causative agents in acute rhino sinusitis?

Answer 17

S. pneumonia - 31%

H. influenzae - 21%

Question 18

What are the major symptomatic factors for rhinosinusitis?

Answer 18

Facial pain/pressure, hyposmia/anosmia, olfactory disturbance, nasal congestion/obstruction

Question 19

Antibiotic Tx for acute rhinosinusitits?

Answer 19

Co-amoxiclav

Clarithromycin

Question 20

Antibiotic Tx for chronic rhinosinusitis?

Answer 20

Amoxicillin, Clarithromycin

Question 21

Give a complication of chronic sinusitis

Answer 21

Ethmoidal mucocele - treatment ESS

Question 22

What is the commonest cause of epistaxis?

Answer 22

Idiopathic

Question 23

What are other causes of epistaxis?

Answer 23

Anticoagulants, trauma, hereditary haemorrhagic telangiectasia (HHT)

Question 24

Short term Tx of epistaxis?

Answer 24

ABC’s, medical history/medications, vital signs - need IV?, physical exam, lab exam

Question 25

Surgical Tx of epistaxis?

Answer 25

Endoscopic sphenopalatine artery ligation, anterior/posterior ethmoidal ligation, ECA ligaiton

Question 26

Tx of HHT?

Answer 26

Laser coagulation
Young’s procedure
Septodermoplasty

Question 27

Tx of Angiofibroma?

Answer 27

Preoperative embolisation, surgery

Question 28

Tx of nasopharyngeal tumour? (carcinoma)

Answer 28

Radiotherapy, and/or surgery (combines therapy)

Question 29

What is an angiofibroma?

Answer 29

A histologically benign but locally aggressive tumour occurring only in men