Rhinology Flashcards
What are some of the questions that should be asked on initial presentation of a nasal complaint?
Nasal obstruction nasal discharge epistaxis facial pain nasal deformity anosmia - due to obstruction or nerve issues potentially sneezing
What PMH is relevant in nasal problems?
MEDICAL TREATMENT
NASAL SURGERY
NASAL TRAUMA
ASTHMA/ASPIRIN SENSITIVITY
What social history is particularly relevant in nasal problems?
ALCOHOL
SMOKING
COCAINE ABUSE
Work - woodworkers etc.
How is a nasal examination carried out?
Use of otoscope (particularly in children)
Can even just lift the front of the nose.
Use of fixed endoscope (children don’t tolerate this)
What does a nasal endoscopy look at?
Eustachian tube
Turbinates and Meatuses
Olfactory Region
What are nasal polyps?
Noncancerous growths within the nose or sinuses.
The exact cause of this is not known.
What investigations are usually carried out in Nasal conditions??
Blood tests-FBC, ANCA, ESR, ACE, RAST CT SCAN MRI SCAN SKIN TESTS RHINOMANOMETRY (not routinely done)
With what patients in particular will a skin test be carried out (in regards to nasal conditions) ?
Those with allergic rhinitis.
What is the imaging modality of choice in nasal conditions?
High Resolution CT (mostly used as a preoperative tool, rather than a diagnostic tool)
What is nasal trauma?
Damage to the nose, very common, usually as a result of assaults etc.
What is septal haematoma and what are some of the potential complications of this?
Absecess and subsequent necrosis.
What are some of the debated causes of nasal polyps?
Unknown Chronic inflammation Autonomic nervous system dysfunction Genetic predisposition Allergic verses non-allergic
What are some of the non allergic causes of nasal polyps?
Cystic Fibrosis 6-48% have polyps
AFS 85% have polyps
Churg-Strauss syndrome
What are the investigations used in Nasal polyps?
Sweat test
RAST / skin testing
Nasal smear
- Microbiology
- Eosinophils (allergic component)
- Neutrophils (chronic sinusitis)
What imaging techniques can be used in nasal polyps?
Coronal CT scan
MRI scan
Flexible nasendoscopy
Rigid nasendoscopy
What is the medical treatment of nasal polyps?
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
What are the surgical treatments of nasal polyps?
Traditional polypectomy
Microdebrider
Endoscopic sinus surgery
Recurrence
- Multiple small polyps common
Large and antro-coanal less so
What is acute adult sinusitis?
Acute onset of symptoms
– Duration of symptoms <12 weeks
– Symptoms resolve completely
What is recurrent acute sinusitis?
– >1 to <4 episodes of acute rhinosinutitis per year.
– Complete recovery between episodes.
– Symptom-free period of >8 weeks between acute attacks in
absence of medical treatment.
What is Chronic adult rhinosinusitis?
Duration of sysmptoms >12 weeks
– Persistent inflammatory changes on imaging >4 weeks
after starting appropriate therapy
What are acute exacerbations of chronic rhinosinusitis?
Worsening of existing symptoms or appearance of new
symptoms
– Complete resolution of acute (but not chronic)
symptoms between episodes
What are the most common microbiological causes of acute rhinosinusitis?
S. pneumoniae 31%
H. influenzae 21%
S. pneumoniae +H. influenzae 5%
etc (SLIDE 48)
What are the “Major” factors in rhinosinusitis symptoms?
Facial pain and pressure Hyposmia/anosmia Nasal congestion/obstruction Purulent postnasal drain Olfactory disturbance Cough not due to asthma (children only)
What are the minor factors in rhinosinusitis symptoms?
Headache Fever Fatigue Halitosis Dental Pain Cough (adults)
What are the Antimicrobial Choices for
Rhinosinusitis?
β-lactams – penicillins, cephalosporins
Macrolides - e.g erythromycin,clarithromycin
What are some of the bad complications of rhinosinusitis?
Orbital swelling (this is an emergency) look this up
Periorbital Absces
What is ethmoidal mucocele?
If there is no drainage of the ethmoidal air cell it expands and presses on the orbital area.
Treatment is through Endoscopic Sinus Surgery.
What is the commonest cause of epistaxis?
Idiopathic
What are the various causes of epistaxis?
- Infection
a. Rhinitis
b. Nasopharyngitis
c. Sinusitis - Trauma
a. Accidental or self-induced
b. Iatrogenic - Allergy
- Hypertension and atherosclerotic vascular disease
- Hereditary hemorrhagic telangiectasia
- Blood dyscrasias
a. Iatrogenic (drug induced)
b. Disease mediated
c. Alcoholism - Atrophic rhinitis
- Tumor
a. Primary
b. Secondary - Congenital or acquired nasal defects.
What are some of the management techniques than can be used in Epistaxis?
ABC’s
Medical history/Medications
Vital signs—need IV?
Physical exam
- Anterior rhinoscopy
- Endoscopic rhinoscopy
Laboratory exam
What is a nasal pack?
Nasal packing is the placement of an intranasal device that applies constant local pressure to the nasal septum.
What are some of the surgical treatment options for nasal packing?
Endoscopic Sphenopalatine artery ligation
Transmaxillary IMA ligation
Intraoral IMA ligation
Anterior/Posterior Ethmoidal ligation
External carotid artery ligation
Septodermoplasty/Laser ablation
Embolisation
What is hereditary haemorrhagic telangiectasia? (HHT)
A rare autosomal dominant genetic disorder that leads to abnormal blood vessel formation in the skin, mucous membranes, and often in organs such as the lungs, liver, and brain.
What is an Angiofibroma?
Nasopharyngeal angiofibroma (also called juvenile nasopharyngeal angiofibroma) is a histologically benign but locally aggressive vascular tumor that grows in the back of the nasal cavity. It most commonly affects adolescent males.
Treated by preoperative embolisation and surgery.
DO NOT BIOPSY.
