Rhinology Flashcards by Grace Ella

What is rhinosinusitis?

inflammatory process involving the mucosa of the nose and sinuses

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What are the 3 stages of rhinosinusisits?

acute = <4 weeks
sub acute = 4-12 weeks
chronic = >12 weeks

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What are the factors contributing to chronic sinusitis?

bacterial infection
allergy
mucocilliary impairment
swelling of the mucosa

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What are the clinical features of acute rhinosinusitis?

acute viral URTI 
severe unilateral pain over infected sinus
malaise
pyrexia
nasal obstruction 
mucopurulent rhinorrhoea

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What investigations can be carried out on a patient with suspected rhinosinusitis?

rarely required

plain sinus xrays can be used

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What are the treatment options for rhinosinusitis?

simple analgesics
steam inhalation
decongestant
antibiotics in severe cases

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When is surgical treatment an option for rhinosinusitis?

when medical treatment fials and if periorbital cellulitis, severe headaches, focal neurological signs and meningitis symptoms are seen then refer to ENT

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What are the clinical features of chronic rhinosinusitis?

nasal obstruction
discoloured nasal discharge for more than 12 weeks
smell disturbance
intermittent frontal pain

diagnosis can be made from history

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What are the clinical features of allergic rhinitis?

nasal obstruction
hyposmia
nasal irritation
sneezing

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What are the treatment options for chronic sinusitis?

a course of broad spectrum antibiotics for 3 weeks
topical nasal steroids given for 2 weeks followed by steroid nasal spray
nasal douching
other coexisting pathologies should be treated - nasal polyps/allergic rhinitis, give steroid spray and antihistamines

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When should surgical intervention be considered for chronic rhinosinusitits?

refer to ENT after 8 weeks of no improvement
nasoendoscopy
CT
FESS surgery can be performed to help drain the sinuses

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What are the serious complications of infective sinusitis?

chronic sinusitis
peri-orbital cellulitis and orbital abscess
facial cellulitis
mucoceles

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What are the serious intracranial complications of infective sinusitis?

meningitis
cavernous sinus thrombosis 
brain abscess 
extradural abscess 
subdural abscess

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What is laryngotracheobronchitis?

common infective condition affecting the larynx in children

characterized by oedema and vascular engorgement of airways particularly subepiglottis

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What are important question to ask in a nasal history?

Nasal obstruction 
Sneezing 
Rhinorrhoea 
Nasal discharge 
Post nasal drip
Anosmia
Facial pain
Epistaxis
Snoring/OSA

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What do you have to look out for with a fractured nose?

Nasal examination for septal haematoma!

v important to spot

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What is needed if a nasal FB is suspected ?

Unilateral bloody or foul smelling discharge

examination under GA may be needed

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What are the symptoms of nasal perforation?

nasal obstruction
whistling
crusting
epitaxis

What are the causes of septal perforation?

Trauma
Avascular Necrosis
Granulomatous inflammation
T cell lymphoma of nasal cavity

What are the two types of allergic rhino sinusitis?

Perennial

Seasonal

Which sinuses does rhino sinusitis effect the most?

Maxillary>Ethmoid>Frontal>Sphenoid

How do nasal polps present?

Nasal obstruction
Anosmia
Ant rhinorrhoea

What do nasal polyps look like on examination?

usually bilateral
in m,iddle meatus
grey/white and slightly translucent
soft and mobile

What is a antrochoanal polyp?

benign solitary polyp originating from the maxillary antrum

seen in young men

obstructs posterior chonana and gives valve effect

surgical removal and avulsion needed

What are the 3 types of benign neoplasms of the nose?

simple papillomas (viral warts) Inverted papilloma Juvenile angiofibroma

What are the 5 types of malignant neoplasms of the nose?

``` SCC Adenocarcinoma Adenoid Cystic Carcinoma T Cell Lymphoma Nasopharyngeal Carcinoma ```

How does a deviated nasal septum present?

chronic nasal blockage symptoms (blockage, headache, post nasal drip, epistaxis, obstructive sleep apnoea)

How is a deviated septum managed?

Septoplasty

What is OSA?

Obstructive sleep apnoea

Define snoring

disruptive snoring without impact on sleep

Define upper airway resistance syndrome

sleep disturbance and daytime sleepiness

Define sleep apnoea hypopnoae syndrome

repeated collapse of airway during sleep, associated de sats ``` mild = 5-14 events per hour moderate = 15-30 severe = >30 ```

What are the RFs for obstructive sleep apnoea?

``` Age Obestiy Facial abnormalities Adenotonsilar hypertrophy smoking alcohol neuromuscular disease ```

What are the consequences of OSA?

sleepiness decreased cognition systemic HTN GORD

What is the treatment for OSA?

``` CPAP Lifestyle changes Conservative - nasal splints/elastic tapes/jaw advancement medication to reduce the amount of REM Adenotonsillectomy Polpectomy Septoplasty ```

What are adenoids?

collection of lymphoid tissues at eh back of the post nasal space on the posterior wall of the nasopharynx they gradually increase in size from birth up to 6 and are gone by 12

What happens if adenoids block the posterior choanae?

nasal voice mouth breathing which interfere with breathing runny nose can cause OSAS

What other difficulties can adenoids cause?

Eustachian tube blockage --> glue ear pr repeated AOM attacks snoring/sleep apnoea

What are local cause of epistaxis?

idiopathic trauma infection tumours

What are systemic causes of epistaxis?

HTN anti-coagulation coagulopathy hereditary haemorrhage telangiectasia

What is epistaxis?

Nose bleeds

What is the first aid management of nose bleeds?

lean forward pinch nose avoid swallowing apply icepack to nasal bridge

How should nose bleeds be managed in GP or hosp?

Thidcum speculum to examine Littles area. If bleeding point is found, numb with lidocaine spray and cauterise with silver nitrate

How should a nose bleed be managed in GP/hosp when the bleeding point cannot be seen?

If no bleeding point seen, pack nose with nasal pack for 24-48hrs. Usually prophylactic Abx also given. Many patients need to be admitted and lightly sedated for this.