Rhinology

Question 1

List some common symptoms involving the nose

Answer 1

Nasal obstruction
Rhinorrhoea
Facial pain
Epistaxis (nosebleed)
Problems with sense of smell
Sneezing/allergy
Trauma

Question 2

What examinations can be done to investigate the nose?

Answer 2

Nasal speculum (with light)
Nasal endoscopy (with light)
 - flexible vs rigid
Miscroscope examination
Allergy tests e.g. skin prick, RAST
FBC
CT/MRI

Question 3

Give five disorders of the nose

Answer 3

Epistaxis
Rhinitis
(Rhino)sinusitis
Nasal polyps
Tumours (benign and malignant)

Question 4

Give two conditions affecting the nose that are a medical emergency

Answer 4

Severe epistaxis

Fracture/spetal haematoma

Question 5

What is the major complication of a septal haematoma?

Answer 5

Affects blood supply to the nasal cartilage

Causes a perforation which can eventually cause the nose to collapse

Question 6

Give two systemic conditions that can affect the nose

Answer 6

Wegener’s

Sarcoidosis

Question 7

Describe the causes of epistaxis

Answer 7

Idiopathic (most common)
Infection
Trauma (accidental, nose-picking, iatrogenic)
Blood discrasias (drug induced, disease-mediated, alcohol)

Question 8

When does sinusitis become chronic?

Answer 8

When symptoms persist for more than 12 weeks

Question 9

Describe how to differentiate between (rhino)sinusitis and a neuroogical cause of facial pain

Answer 9

Nasal symptoms are always present in sinusitis. If there are no nasal symptoms, suspect a neurological cause.

Question 10

How is epistaxis treated?

Answer 10

Initial management; digital pressure
Surgical;
- heat cauterisation
- silver nitrate (chemical burn cauterisation)
- artery ligation (used for severe epistaxis)
Nasal packs

Question 11

What are the EPOS guidelines?

Answer 11

European Position on Sinusitis: guidelines for the management of chronic sinusitis and nasal polps

Question 12

Summarise the advice given in the EPOS guidelines

Answer 12

Steroids
- prednisolone 30mg od for 10 days, taken orally
- nasal drops
- nasal spray
Saline nasal douche - helps to wash out inspired allergens
Surgery

Question 13

Describe the appearance of nasal polyps

Answer 13

Yellowish, grey, pedunculated sacs
Usually bilateral - unilateral polyps should be assumed to be neoplastic until proven otherwise
Most originate from the ethmoid sinuses

Question 14

Describe the investigation and management of nasal polyps

Answer 14

Test for allergy and advise appropriately
In children, exclude cystic fibrosis by a sweat test, and a meningocoele by CT
Biopsy a unilateral polyp to exclude neoplasia
Decide upon:
- medical management: topical or systemic steroids
- surgery: nasal polypectomy or ethmoidectomy