Rhinology Flashcards
history questions
nasal obstruction sneezing rhinorrhoea post-nasal drip anosmia facial pain epistaxis
anatomy
functions: warm and humidify, resp, smell (85% of taste)
external nose: bone and cartilage; nasal vesitbule and valve (with vibrissae); columella
septum (+Little’s area); lateral walls and turbinates
nasopharynx/postnasal space; choanae, ET tube opening,
nasal symptoms
bleeding: trauma, infection, HTN, blood disorder, Osler Wber Randau (hereditary haemagioma), tumours obstruction pain rhinorrhea trauma itch/irritation sneezing apnoea stertor: UAO; adenoids, septum, tongue;
unilateral = ?tumour
epistaxis, bloody d/c, obstruction, pain, swelling, smell
acute rhinosinusitis
inflammation: congestion, rhinorrhoea, PND, sneezing, irritation/itch
Dx - inflammation + 2 from:
blockage/congestion; facial pain/pressure;
anterior or posterior discharge; reduced/lost sense of smell;
endoscopy: polyps, mucopurulent discharge, oedema, middle meatus obstruction; or CT changes
infective rhinitis
may have 2o effects e.g. OM or sinusitis
can be syphilis, TB, scleroma
viral: commonest; peaks d1-3, resolves 3 days
- Rx:anti-histamines, ABx (augmentin, 2w), decongestants, analgesia, fluids
fungal: rare; predisposed/tropical
allergic rhinitis
commonest; seasonal (pollen) or perennial (dust, mites, pets, food); IgE TI reaction
congestion, oedema rhinorrhoea, irritation; swollen pale or red turbinates (?hypertrophy)
Rx: stepwise;
avoidance, antiH (non-sed), local steroids (3-6 cycles; restart on relapse), cromoglicate,
short term PO steroids
sinusitis (a/i)
acute: 4/52; inflammation (i/a/ciliary); cystic polypoid mucosa - ostial narrowing;
PND, blocked/fuzzy head, concention; ?discoloured d/c, systemically well
Rx: cause, steroid +/- ABx, ?surgical drainage
non-allergic RS
vasomotor: exclusion
other: hormones (esp. PG/pregnancy), heat, weather, sexual arousal
iatrogenic: vasodilators (anti-HTN, or BB)
idiopathic
atrophic: loss of cilia + abnormal patency; thick dried secretion, crust + smell + bleeding;
-RX: toilet, steam/glycerine (soften crusts), surgery (closure)
RMM: overused decongestants (>5d), rebound vdil and congestion; turbinate hypertrophy
-RX: stop meds; Nasal CST, ?turbinate surgery
ipratropium good for watery d/c; cromoglicate steroid-saving mast stabiliser
RS complications
chronic sinusitis; osteomyelitis; facial cellulitis (orbital/maxillary/frontal/Pott’s puffy tumour)
frontal sinusitis: life/sight threat (orbit/cranium spread); tender percussion, h/a worse leaning forward; aggro ABx
periorbital cellulitis: commonest; from ethmoid (direct/blood); ENT referral; HD ABx + check CN II
mucocoele: late complication; sterile mucous in obstructed sinus; often aSx; Rx: drain
intracranial: meningitis (common), cav sinus thrombosis, brain/SD/ED abscess (meningism/fits, ICP, headache) smell/CN I affected;
infective vs. allergic vs. non-allergic RS
infective: systemic, mucopurulent, URTI; severe unilateral pain, obstruction, smell
- Rx: analgesia, decongestants, ?ABx
allergic: triggers, clear d/c, sneezing, itchy eyes, chronic, pale/red oedema (turbinate/mucosa)
- Rx: anti-H, topical CST, allergens
non-allergic: decongestants, no/less sneezing/itching, few Sx, may have crusting/bleeding
RS vs. structural
RS hard Sx: unilateral pain, purulent d/c, obstruction, hyposmia/taste
RS soft Sx: catarrh/PND, headache, facial pain/pressure, bilateral/general Sx, lethargy
structural: anosmia common; crusting, bleedingl whistling; unilateral polyp + blood mucoid d/c (?tumour); unilateral obstruction + epistaxis (angiofibroma); abnormal examination
deviated septum
trauma; obstructed air flow
surgery: septoplasty (mobilise and reposition) or removal (except anterior or dorsal - nose shape)
broken nose
trauma: c-spine, head, face, ?legal action (assault)
rule out septal haematoma: blue tinge, soft, bilateral swollen septum; ABx, drain, refer ENT same day
confirm deformity: pre-swelling, or 5-10d later (swelling settles)
re-set
epistaxis - history/anatomy
history: trauma, HTN, NSAIDs, anticoags, clotting
drugs, cocaine, tumours, URTIs
infection, endometriosis, HHT (GI Sx), angiofibroma, liver
anterior: Little’s/Kiesselbach’s; trauma/infection
posterior: Woodruff’s; HTN +/- anticoags
nasal trauma management
exclude head injury exclude septal haematoma exclude zygomatic/middle third fracture exclude CSF leak exclude blow out fracture
