Rhinology Flashcards
What is rhinosinusitis?
Defined as inflammation in the nose and paranasal sinuses with >/=2 symptoms, one of which must be nasal discharge or nasal congestion
What are features of rhinosinusitis?
- Facial pain/pressure
- Decreased olfaction
- Rhinorrhoea
- Nasal congestion
What would be classed as chronic rhinosinusitis?
Symptoms lasting >/= 12 weeks
What are causes of nasal congestion in children?
- Big adenoids
- Rhinitis/rhinosinusitis
- Choanal atresia
- Postnasal space tumour
- Foreign body
What are causes of nasal congestion in adults?
- Deflected nasal septum
- Granuloma
- Tricyclic antidepressants
- Topical vasoconstrictors/decongestants - rhinitis medicamentosa
What is the most comon cause of acute infective rhinitis?
Viral
How would you treat acute rhinosinusitis?
- Topical corticosteroids - nasal sprays
- Oral antibiotics
How would you treat chronic rhinosinusitis?
- Topical steroids - nasal sprays
- Nasal douching
What are red flag symptoms associated with nasal congestion?
- Numbness
- Tooth loss
- Bleeding
- Unilateral obstructing mass
When assessing nasal congestion, what would you want to ask about it?
- Symptom variation
- Uni/Bilaterality
- Affects speech, eating, smell, sleep
When examining someone with nasal congestion, what would you look for?
- Facial pain
- Nasal polyps
- Pus discharge from sinuses
- Post-nasal space
- Septal deviation/Nasal deflection
What is allergic rhinosinusitis?
IgE-mediated inflammation from allergen exposure to nasal mucosa causing inflammatory mediator release from mast cells
What substances are released by mast cells in allergic rhinosinusitis?
Histamines, prostaglandins
What are symptoms of allergic rhinitsinusitis?
- Sneezing
- Pruritis
- Rhinorrhoea (bilateral + variable)
What are signs of allergic rhinosinusitis?
- Swollen turbinates - pale mucosae
- Nasal polys
What is the following?
Nasal polyp
What are typical allergens implicated in allergic rhinosinusitis?
- Dust
- Pollen
- Moulds
- Pets
What investigation(s) might you perform in someone presenting with features of allergic rhinosinusitis?
Skin prick test/RAST
How would you manage allergic rhinosinusitis?
- Allergen avoidance
- Antihistamines
- Decongestants
- Nasal steroids
- Oral steroids - in severe attacks
What is perrenial allergic rhinitis?
Allergic rhinitis which is caused by allergens which are present all year round
What is seasonal allergic rhinitis?
Caused by seasonal allergens e.g. pollen
If nasal sprays were not working for someone diagnosed with allergic rhinitis, what could you consider using?
Montelukast
When allergic rhinitis co-exists with asthma, what would you consider giving as a part of your management?
- Nasal steroids
- Anti-leukotriene agent
What is the risk of allergic rhinitis in someone with asthma?
May trigger an asthma attack
What are causes of rhinorrhoea?
- Allergies
- Infection - bacteria, viruses
- Foreign body
- CSF
- Primary ciliary dyskinesia
- RA
- Pregnancy
- OCP
- NSAIDs
- Decongestant overuse
What are nasal polyps?
Descriptive term for a pedunculated swelling arising in the nose or paranasal sinuses. They can develop in both benign and malignant conditions