Rhinology Flashcards
What are the possible nasal symptoms?
Nasal obstruction Nasal discharge Epistaxis Facial pain Nasal pain Anosmia Sneezing
What history should be taken for nasal obstruction?
Degree of obstruction
Intermittent vs continuous
What history should be taken for nasal discharge?
Colour, thickness
What history should be taken for facial pain?
Degree
Associated symptoms
What are the causes of anosmia?
Obstruction
Nerve problems
What past medical history should be checked with nasal symptoms?
Medical treatment Nasal surgery Nasal trau,a Asthma Aspirin sensitivity
What social history should be checked for nasal symptoms?
Alcohol
Smoking
Cocaine abuse
What does cocaine abuse cause?
Chronic irritation of nose
Can cause erosion and perforation of nasal septum
What nasal examinations can be done?
Rhinoscope
Otoscope
Nasal endoscope
What does the nasal endoscope allow you to look at?
3 turbinates
What investigations can be done for the nose?
Bloods CT MRI Skin tests Rhinometry
What bloods can be done for nasal symptoms?
FBC ANCA ESR ACE RAST
When is a CT used for the nose?
Pre op
What are the complications of nasal trauma?
Eustachian tube obstruction, loss of sense of smell
Haematoma- can cause necrosis
Predisposition to sinusitis
How is a nasal haematoma treated?
Drained
What are the causes of epistaxis?
Idiopathic Infection Trauma Allergy Hypertension and atherosclerosis Hereditary haemorrhage telangiectasia Blood dycrasias Atropic rhinitis Tumour Congenital or acquired defect
What is the initial management of epistaxis?
ABCs
Vital signs
Nasal packing if nothing else is working
What history and examinations should be done with epistaxis?
Medical history and medication
Anterior and/or endoscopic rhinoscopy
Vital signs
Wat surgical treatment can be done for epistaxis?
Ligation
Embolisation
What is classed as acute rhinosinusitis?
Symptoms resolve completely in less than 12 weeks
What is classed as recurrent acute rhinosinusitis?
1-4 episodes of acute rhino sinusitis per year
Symptom free episodes of >8 weeks between episodes
What is classed as chronic rhinosinusitis?
> 12 weeks
Persistent inflammatory changes
Acute exacerbations
How is chronic rhino sinusitis diagnosed?
xray or CT
What are the symptoms of rhinosinusitis?
Facial pain and pressure Hyposmia/anosmia Nasal congestion/obstruction Purulent postnasal drain Olfactory disturbance Cough Headache fever Fatigue Halistosis Dental pain
How is sinusitis treated?
Antibiotics- B lactase or macrolides
What are the complications of sinusitis?
Invasion of optic nerve
Frontal sinusitis
What is the management of optic nerve invasion in sinusitis?
CT
IV antibiotics and surgery
What is the management of frontal sinusitis?
Emergency frontal sinus surgery
What are nasal polyps associated with?
Asthma Allergic rhinitis Aspirin intolerance Alcohol intolerance Cystic fibrosis AFS
What can nasal polyps cause?
Airway/sinus blockage
How is recurrence of nasal polyps prevented?
Resection and lifelong topical steroids
What should be done for a unilateral single polyp?
Send to histology to rule out malignancy
What investigations can be done for nasal polyps?
RAST, skin test Nasal smear Coronal CT MRI Flexible nasendoscopy Rigid nasendoscopy
What is done in a nasal smear?
Mocrobiology
Eosinophils
Neutrophils
What is the treatment of nasal polyps?
Steroids- nasal or oral
Immunotherapy
Surgery- polypectomy, microdebrider or endoscopic sinus surgery
Who do angiofibromas affect?
Young males
What does angiofibroma causes?
Profuse epistaxis
What is the treatment of angiofibroma?
Preop embolisation and surgical resection
How is nasal cancer treated?
Radiotherapy, surgery or combined therapy
What is chantal stress?
Bony/soft tissue growth in the back of the nasal package
