Rhinology Flashcards
what may you look for in a past medical history?
> nasal surgery
nasal trauma
asthma
aspirin sensitivity
what is important in the social history?
> alcohol
smoking
cocaine abuse
when examining the nose with a nasal endoscope what three areas can be examined?
> Eustachian tube
middle meatus
superior meatus
what can be used to examine the nose?
> otoscope
torch
nasal endoscopy
what investigations may you carry out (depending on the problem)?
> blood tests > CT scan > MRI scan > skin tests > rhinomanometry
what blood test would be relevant?
> FBC > ANCA > ESR > ACE > RAST
what can cause a septal haematoma?
trauma
why must a septal haematoma be drained early on?
to prevent deformity and septal perforation
what may a patient with a constant blocked nose, PN drip and hyposmia with asthma and aspirin sensitivity have?
nasal polyps
what are nasal polyps?
chronic inflammation due to autonomic nervous system dysfunction. can be allergic or non-allergic.
what percentage of people with nasal polyps have alcohol intolerance?
50%
what allergic conditions are associated with nasal polyps?
> asthma
allergic rhinitis
aspirin intolerance
alcohol intolerance
what non-allergic conditions are associated with nasal polyps?
> cystic fibrosis
AFS
churg-strauss syndrome
what investigations would you carry out for nasal polyps?
> sweat test > RAST/skin testing > nasal smear: microbiology, eosinophils, neutrophils > coronal CT scan > MRI scan > Flexible nasendoscopy > rigid nasendoscopy
what is the treatment fro nasal polyps?
> oral and nasal steroids
immunotherapy
surgery
what is the surgical treatment for nasal polyps?
> traditional polypectomy
microdebrider
endoscopic sinus surgery
what sort of recurrence of polyps post surgery is common?
multiple small polyps
what are the cons of a sinus radiograph in the di\gnosis of rhinosinusitis?
> high false positive finding rate
> less accurate compared to other imaging techniques
describe acute adult sinusitis
> acute onset of symptoms
duration <12weeks
complete resolution of symptoms
describe recurrent acute adult sinusitis
> 1 to <4 episodes of acute rhinosinusitis per year with complete recovery between episodes and a symptoms free period of >weeks between acute attacks with absence of medical treatment
describe the classification of chronic adult sinusitis
symptoms last >12 weeks with persistent inflammatory changes on imaging >4 weeks
describe an acute exacerbation of chronic adult sinusitis
there is worsening of existing symptoms or appearance of new symptoms with resolution of the acute symptoms between episodes.
what is the most common microbial aetiology of acute rhinosinusitis?
> s. pneumonia
> h. influenza
what are the main factors in the symptoms for rhinosinusitis?
> facial pain and pressure > hyposmia/anosmia > nasal congestion/obstruction > purulent postnasal drainage > olfactory disturbance > cough
what are the minor factors in the rhinosinusitis symptom complex?
> headache > fever > fatigue > halitosis > dental pain
what are the antimicrobial choices for rhinosinusitis?
> beta lactams (penicillins and cephalosporins)
> macrolides (erythromycin and clarithromycin)
what is the treatment plan for a young boy with acute periorbital swelling and a history of acute URI?
> emergency referral with ophthal opinion
urgent CT
IV antibiotics
emergency surgery
how would you treat frontal sinusitis?
emergency referral and frontal sinus surgery
what can cause epistaxis?
> infection > trauma > allergy > hypertension > hereditary haemorrhagic telangiectasia > blood dyscrasias > atrophic rhinitis > tumour > congenital nasal defects
what are nasal packs used for?
to stop nasal bleeding if you cannot find the source and to stabilise the patient
what surgical treatment is there for epistaxis?
> endoscopic sphenopalatine artery ligation > transmaxillary IMA ligation > anterior/posterior ethmoidal ligation > external carotid artery ligation > intraoral IMA ligation
what treatment can be offered to a young man with profuse right sided epistaxis and an angiofibroma?
preoperative embolization and surgery
