Rhinology Flashcards
What/where is Little’s area?
Antero-inferior nasal septum 4 anastomoses (90% epistaxis originates from here)
What type of tissue covers the turbinate bones?
Mucoperiostium
Which structure(s) drain into the middle meatus? (3)
Maxillary, frontal + anterior ethmoid
Which structure(s) drain into the inferior meatus?
Nasolacrimal duct
Which structure(s) drain into the superior meatus? (2)
Sphenoid + posterior ethmoid
What is the name of the structure where the 2 nasal cavities meet?
Choanae
What are the different types of rhinitis? (8)
Allergic: seasonal + perennial
Non-allergic: infective, vasomotor, hormonal, old age, medicamentosa, atrophic
How is rhino sinusitis diagnosed?
Inflamm of nose / sinuses with ≥2 of: Congestion Anosmia Anterior/post-nasal discharge Facial pain
AND
Endoscopy findings of meatus obstruction or oedema/discharge (e.g. polyps)
OR
CT mucosal changes
What pathogens may cause infective rhinitis?
Usually viral URTI
OR
TB, syphillis, Klebsiella (scleroma)
What would be seen O/E in allergic rhinitis? (3)
Allergy symps: vasc congestion/ oedema/ rhinorrhoea/ irritation
Damp
Pale nasal linings
Swollen oedematous turbinates
What treatment for allergic rhinitis? (4)
+ what other type of rhinitis is treated the same
Allergen avoidance
Nasal douche
Antihistamines
Steroid spray
Same as treatment fir vasomotor (when failed to test +ve for any allergens)
List some provoking factors for epistaxis? (6)
Trauma NSAIDs Anticoagulants Clotting disorders Hypertension URTIs
What general first aid measures should be done for epistaxis?
Press fleshy part (not bridge)
Sit forward
Ice pack on nasal bridge
How is severe epistaxis managed (resuscitation)? (3 steps)
Assess blood loss (BP, IV access, FBC/G&S/Crossmatch) Examine for point of bleeding (use 5% cocaine) Nasal cautery (+ packing if fails)
What must NOT be done when surgically managing a deviated nasal septum?
Removal of anterior/dorsal septum
What 3 things must be considered when managing injury of external nasal skeleton?
When/what is done to treat it?
? Legal action
? cervical/head/facial injury
? Septal haematoma
Manipulation under GA if resp blockage / bothers pt
Describe the physiology behind infective/allergic sinusitis
Describe the physiological changes that occur as a consequence of chronic sinusitis
Causes ↓ ciliary function
→ oedema of nasal/sinus opening mucosa + ↑ nasal secretions
Cystic/polypoid changes in sinuses
Swollen mucosa further narrow ostia
What pathogens involved in chronic sinusitis?
Streptococcus / haemophilus
How is sinusitis Dx / managed?
Hx/Ex + XRay/CT
Decongestants (e.g. ephedrine)
Abx/analgesics
If fails → aspiration / washout
List the complications of acute sinusitis (Face Cavities Infected with Phlegmy Mucus)
Frontal sinusitis Chronic sinusitis Intracranial complications Peri-Orbital cellulitis Mucocoeles (late complication)
What intracranial complications can occur from sinusitis?
Meningitis
Cavernous sinus thrombosis
Brain abscess
Extra-dural abscess (secondary to frontal sinusitis)
Subdural abscess (secondary to frontal sinusitis)
How are most complications of sinusitis managed?
High-dose/broad spec Abx
± surgical drainage (neuro drainage if brain abscess)
What is vasomotor rhinitis?
What are some of the triggers? (3)
Same as allergic (+ same Tx) but failed to test +ve for any allergens
Climate (sudden change in temp)
Alcohol
Emotional
What is rhinitis medicamentosa?
Acquired sensitivity of nasal lining in response to prolonged use of topical decongestants
