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H+N - C > Rhinology > Flashcards

Rhinology Flashcards

1
Q

What may come up on a rhinology history?

A 
Nasal obstruction
Nasal discharge
Epistaxis
Facial pain
Nasal deformity
Anosmia
Sneezing
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2
Q

What investigations may you carry out in rhinology?

A

Blood tests:

  • FBC
  • ANCA (antineutrophil cytoplasmic antibodies
  • ESR
  • ACE
  • RAST (for allergy)

CT Scan
MRI Scan
Skin Tests
Rhinomanometry (airflow)

Skin Tests

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3
Q

What is the aim of CT imaging in rhinology?

A

To identify the anatomical relationship of the key structures (optic nerve, orbital contents and carotid artery)
Nature and extent of disease
Anatomical abnormality

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4
Q

Name some nasal disorders

A 
Nasal trauma
Epistaxis
Rhinosinusitis
Nasal Polyps
Nasal Deformity
Nasal tumours
Choanal atresia
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5
Q

What causes nasal polyps?

A 
Unknown
Chronic inflammation
Autonomic nervous system dysfunction
Genetic predisposition
Allergic vs. non-allergic
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6
Q

What is the pathophysiology of nasal polyps?

A

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
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7
Q

What are the investigations for nasal polyps?

A 
Sweat test
RAST/ SKIN TESTING
Nasal Smear
-Microbiology
-Eosinophils (allergic component)
-Neutrophils (chronic sinusitis)

CORONAL CT SCAN
MRI scan
Flexible nasendoscopy
Rigid nasendoscopy

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8
Q

What is the medical treatment for nasal polyps?

A

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

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9
Q

What is the surgical treatment of nasal polyps?

A
  • Traditional polypectomy
  • MICRODEBRIDER
  • ENDOSCOPIC SINUS SURGERY
  • Recurrence
  • –Multiple small polyps common
  • –Large and antro-coanal less so
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10
Q

How do you diagnose rhinosinusitis?

A

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

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11
Q

What are positive findings of rhinosinusitis on sinus radiographs?

A

Air-fluid levels
Mucosal thickening
Sinus opacification

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12
Q

What is the clinical classification of adult sinusitis?

A

Acute
Recurrent Acute
Chronic
Acute exacerbations of chronic

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13
Q

Describe acute adult sinusitis

A
  • Acute onset of symptoms

- Duration of SYMPTOMS

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14
Q

Describe recurrent acute adult sinusitis

A

->1 TO 8 weeks between acute attacks in absence of medical treatment

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15
Q

Describe chronic adult sinusitis

A
  • DURATION OF SYMPTOMS >12 WEEKS
  • Persistent inflammatory changes on imaging >4 weeks
  • After starting appropriate therapy
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16
Q

Describe acute exacerbations of chronic

A
  • Worsening of existing symptoms or appearance of new symptoms
  • Complete resolution of acute (but not chronic) symptoms between episodes
17
Q

What is the microbial aetiology of acute rhinosinusitis?

A
  • S. pneumoniae (31%)
  • H. influenzae (21%)
  • S. pneumoniae + H. influenzae (5%)
  • Anaerobes (6%)
  • M. catarrhalis (2%)
  • S. aureus (4%)
  • S. pyogenes (2%)
  • Gram negatives (9%)
18
Q

What are the major factor in the rhinosinusitis symptom complex?

A
  • Facial pain and pressure
  • Hyposmia/anosmia
  • Nasal congestion/ obstruction
  • Purulent postnasal drain
  • Olfactory disturbance
  • Cough not due to asthma (children only) cough (adults)
19
Q

What are the minor factors in rhinosinusitis symptom complex?

A 
Headache
Fever
Fatigue
Halitosis
Dental pain
20
Q

What are the antimicrobial choices for rhinosinusitis

A
  • B-lactams = penicillins, cephalosporins

- Macrolides = e.g. erythromycin, clarithromycin

21
Q

What is the aetiology of epistaxis?

A
  • Infection
  • TRAUMA
  • Allergy
  • Hypertension and atherosclerotic vascular disease
  • Hereditary haemorrhagic telangiectasia
  • IATROGENIC (drug induced)
  • Atrophic rhinitis
  • Tumour
  • Congenital or acquired nasal defects
22
Q

What is the initial management of epistaxis?

A
  • ABC’s
  • Medical history/ Medications
  • Vital sign’s (need IV?)
  • Physical exam
  • –Anterior rhinoscopy
  • –Endoscopic rhinoscopy
  • Laboratory exam
23
Q

What is the surgical treatment of epistaxis?

A
  • ENDOSCOPIC SPHENOPALATINE ARTERY LIGATION
  • Transmaxillary IMA ligation
  • Intraoral IMA ligation
  • ANTERIOR/POSTERIOR ETHMOIDAL LIGATIONS
  • EXTERNAL CAROTID ARTERY LIGATION
  • Septodermoplasty/Laser ablation
  • Embolisation
24
Q

What is the treatment for hereditary hemorrhagic telangiectasia?

A

Laser coagulation
Young’s procedure
Septodermoplasty

H+N - C (17 decks)

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