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HEAD & NECK > Rhinology > Flashcards

Rhinology Flashcards

1
Q

name some rhinological symptoms

A 
Nasal obstruction
nasal discharge
epistaxis
facial pain
nasal deformity
anosmia
sneezing
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2
Q

in a history with a patient what should you specifically ask about

A

pmh

  • medical treatment
  • nasal surgery
  • nasal trauma
  • asthma/aspirin sensitivity

oh
- woodworkers

sh

  • alcohol
  • smoking
  • cocaine abuse
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3
Q

what investigations can be done

A

blood tests
-fbc, anca, esr, ace, rast

CT scan
MRI scan
skin tests
rhinomanometry

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4
Q

list some nasal disorders

A 
Nasal trauma
Epistaxis
Rhinosinusitis
Nasal polyps
Nasal Deformity
Nasal tumors
Choanal atresia
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5
Q

what complication can nasal trauma commonly cause and why is this an emergency

A

septal haematoma - mucoperichondrium sheared away from septal cartilage and haematoma forms in potential space

because cartilage is avascular and gets all its nutrients from the perichondrium - necrosis can start within 24 hrs

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6
Q

how is septal haematoma treated

A

drain - wide bore needle aspiration

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7
Q

what are the causes of nasal polyps

A 
Unknown
Chronic inflammation
Autonomic nervous system dysfunction
Genetic predisposition
Allergic verses non-allergic
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8
Q

what allergic conditions are nasal polyps associated with

A

20-50% have asthma

Allergic rhinitis

8-26% have aspirin intolerance

50% have alcohol intolerance

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9
Q

what non-allergic conditions are nasal polyps associated with

A

Cystic Fibrosis 6-48% have polyps

AFS 85% have polyps

Churg-Strauss syndrome (autoimmune condition that causes vasculitis in a person with airway allergic hypersensitivity)

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10
Q

what investigations can be done for nasal polyps

A

Sweat test

**RAST / skin testing

Nasal smear

  • Microbiology
  • Eosinophils (allergic component)
  • Neutrophils (chronic sinusitis)
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11
Q

what imaging investigations can be done for nasal polyps

A

**Coronal CT scan
MRI scan
Flexible nasendoscopy
Rigid nasendoscopy

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12
Q

what are the 4 main treatment types for nasal polyps

A

oral and nasal steroids - high dose prednisolone

immunotherapy

diet (little affect)

surgery

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13
Q

what are the surgical treatments available for nasal polyps

A

traditional polupectomy

microdebrider

endoscopic sinus surgery

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14
Q

what imagine technique is usually used to diagnose rhinosinusitis

A

sinus radiographs

BUT high rate of positive findings e.g. air-flid levels, mucosal thickening, sinus opacification

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15
Q

what is classified as acute sinusitis

A

acute onset of symptoms

duration <12 weeks

symptoms resolve completely

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16
Q

what is classified as a recurrent acute

A

> 1 to <4 episodes of acute per year

symptoms free period of >8 weeks in between
absence of medical treatment

17
Q

what is classified as chronic sinusitis

A

symptoms >12 weeks
persistent inflammatory
changes on imaging >4 weeks after starting appropriate therapy

18
Q

what is classified as an acute exacerbation go chronic sinusitis

A

worsening of existing symptoms or the appearance of new

complete resolution of acute (but not chronic) symptoms between episodes

19
Q

what are the 2 most common microbial aetiology of rhinosinusitis

A

S. pneumoniae

H. influezae

20
Q

what are some major factor symptoms of rhinosinusitis

A

facial pain and pressure

hyposmia/anosmia

nasal congestion/obstruction

purulent postnasal drainage

olfactory disturbance

cough not due to asthma (children)

21
Q

what are some minor factor symptoms of rhinosinusitis

A

headache

fever

fatigue

halitosis

dental pain

cough (adults)

22
Q

what are the treatments for rhinosinustis

A

antibiotics

B-lactams - penicillins, cephalosporins,

macrolides eg erythromycin, clarithromycin

23
Q

how should you treat acute peri-orbital swelling

A

emergency referral

ophthal opinion

urgent CT

IV antibiotics

emergency surgery

24
Q

what are the symptoms of frontal sinusitis (potts puffy tumour)

A

acute onset fever, frontal headache, nasal discharge, frontal swelling

25
Q

what is the treatment for acute frontal sinusitis

A

emergency referral
frontal sinus surgery
endoscopic sinus surgery (ESS)

26
Q

what is ethmoidal mucocele

A

mucous build up in the ethmoid sinus - cystic mass

27
Q

what is the treatment for ethmoidal mucocele

A

endoscopic sinus surgery

28
Q

what is the commons cause of epistaxis

A

idiopathic

29
Q

what are some other causes of epistaxis

A
  • infection
  • TRAUMA
  • allergy
  • hypertension & atherosclerotic disease
  • HEREDITARY HAEMORRHAGIC TELANGIECTASIA
  • blood dycrasias - DRUG INDUCED
  • atrophic rhinitis
  • tumour
  • congenital or acquired nasal defects
30
Q

what is the initial management of epistaxis

A 
ABCs
medical history/medications
vital signs - need IV?
physcial exam 
lab exam
31
Q

what physical examinations can be done for epistaxis

A

anterior rhinoscopy

endoscopic rhinoscopy

32
Q

what can be used to stop epistaxis

A

anterior and posterior nasal packs - go into nose and inflate to stop block bleeding

33
Q

what is the surgical treatment for epistaxis

A

endoscopic sphenopalatine artery ligation

Anterior/Posterior Ethmoidal ligation

External carotid artery ligation

34
Q

what is hereditary haermorrhagic telangiectasia

A

abnormal blood vessel formation in the skin, mucous membranes, and organs such as the lungs, liver, and brain

35
Q

how may HHT present

A

recurrent epistaxis

telangiectasia - small vascular malformations

36
Q

what is the treatment for HHT

A

laser coagulation
youngs procedure
septodermoplasty

37
Q

what is the treatment for angiofibroma

A

preoperative embolisation

surgery

HEAD & NECK (13 decks)

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