Rhinology Flashcards
What may come up on a rhinology history?
Nasal obstruction Nasal discharge Epistaxis Facial pain Nasal deformity Anosmia Sneezing
What investigations may you carry out in rhinology?
Blood tests:
- FBC
- ANCA (antineutrophil cytoplasmic antibodies
- ESR
- ACE
- RAST (for allergy)
CT Scan
MRI Scan
Skin Tests
Rhinomanometry (airflow)
Skin Tests
What is the aim of CT imaging in rhinology?
To identify the anatomical relationship of the key structures (optic nerve, orbital contents and carotid artery)
Nature and extent of disease
Anatomical abnormality
Name some nasal disorders
Nasal trauma Epistaxis Rhinosinusitis Nasal Polyps Nasal Deformity Nasal tumours Choanal atresia
What causes nasal polyps?
Unknown Chronic inflammation Autonomic nervous system dysfunction Genetic predisposition Allergic vs. non-allergic
What is the pathophysiology of nasal polyps?
Associated with allergic conditions:
- 20-50% have asthma
- Allergic rhinitis
- 8-26% have aspirin intolerence
- 50% have alcohol intolerance
Non-allergic conditions:
- Cystic Fibrosis 6-48% have polyps
- AFS 85% have polyps
- Churg-Strauss syndrome
What are the investigations for nasal polyps?
Sweat test RAST/ SKIN TESTING Nasal Smear -Microbiology -Eosinophils (allergic component) -Neutrophils (chronic sinusitis)
CORONAL CT SCAN
MRI scan
Flexible nasendoscopy
Rigid nasendoscopy
What is the medical treatment for nasal polyps?
Oral and nasal steroids
- High dose prednisolone and nasal steroid for 20 days will eliminate 50% of polyps
- Lower bioavailability in modern nasal steroids
- Poor response in certain groups
- Intranasal injection not effective
Immunotherapy
What is the surgical treatment of nasal polyps?
- Traditional polypectomy
- MICRODEBRIDER
- ENDOSCOPIC SINUS SURGERY
- Recurrence
- –Multiple small polyps common
- –Large and antro-coanal less so
How do you diagnose rhinosinusitis?
SINUS RADIOGRAPHS
Poor visualisation of the osteomeatal complex and the anterior ethmoidal sinuses.
-High rate of false positive findings
-Less expensive, but not as accurate as newer imaging
What are positive findings of rhinosinusitis on sinus radiographs?
Air-fluid levels
Mucosal thickening
Sinus opacification
What is the clinical classification of adult sinusitis?
Acute
Recurrent Acute
Chronic
Acute exacerbations of chronic
Describe acute adult sinusitis
- Acute onset of symptoms
- Duration of SYMPTOMS
Describe recurrent acute adult sinusitis
->1 TO 8 weeks between acute attacks in absence of medical treatment
Describe chronic adult sinusitis
- DURATION OF SYMPTOMS >12 WEEKS
- Persistent inflammatory changes on imaging >4 weeks
- After starting appropriate therapy