Rhinology Flashcards
name some rhinological symptoms
Nasal obstruction nasal discharge epistaxis facial pain nasal deformity anosmia sneezing
in a history with a patient what should you specifically ask about
pmh
- medical treatment
- nasal surgery
- nasal trauma
- asthma/aspirin sensitivity
oh
- woodworkers
sh
- alcohol
- smoking
- cocaine abuse
what investigations can be done
blood tests
-fbc, anca, esr, ace, rast
CT scan
MRI scan
skin tests
rhinomanometry
list some nasal disorders
Nasal trauma Epistaxis Rhinosinusitis Nasal polyps Nasal Deformity Nasal tumors Choanal atresia
what complication can nasal trauma commonly cause and why is this an emergency
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
how is septal haematoma treated
drain - wide bore needle aspiration
what are the causes of nasal polyps
Unknown Chronic inflammation Autonomic nervous system dysfunction Genetic predisposition Allergic verses non-allergic
what allergic conditions are nasal polyps associated with
20-50% have asthma
Allergic rhinitis
8-26% have aspirin intolerance
50% have alcohol intolerance
what non-allergic conditions are nasal polyps associated with
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)
what investigations can be done for nasal polyps
Sweat test
**RAST / skin testing
Nasal smear
- Microbiology
- Eosinophils (allergic component)
- Neutrophils (chronic sinusitis)
what imaging investigations can be done for nasal polyps
**Coronal CT scan
MRI scan
Flexible nasendoscopy
Rigid nasendoscopy
what are the 4 main treatment types for nasal polyps
oral and nasal steroids - high dose prednisolone
immunotherapy
diet (little affect)
surgery
what are the surgical treatments available for nasal polyps
traditional polupectomy
microdebrider
endoscopic sinus surgery
what imagine technique is usually used to diagnose rhinosinusitis
sinus radiographs
BUT high rate of positive findings e.g. air-flid levels, mucosal thickening, sinus opacification
what is classified as acute sinusitis
acute onset of symptoms
duration <12 weeks
symptoms resolve completely
what is classified as a recurrent acute
> 1 to <4 episodes of acute per year
symptoms free period of >8 weeks in between
absence of medical treatment
what is classified as chronic sinusitis
symptoms >12 weeks
persistent inflammatory
changes on imaging >4 weeks after starting appropriate therapy
what is classified as an acute exacerbation go chronic sinusitis
worsening of existing symptoms or the appearance of new
complete resolution of acute (but not chronic) symptoms between episodes
what are the 2 most common microbial aetiology of rhinosinusitis
S. pneumoniae
H. influezae
what are some major factor symptoms of rhinosinusitis
facial pain and pressure
hyposmia/anosmia
nasal congestion/obstruction
purulent postnasal drainage
olfactory disturbance
cough not due to asthma (children)
what are some minor factor symptoms of rhinosinusitis
headache
fever
fatigue
halitosis
dental pain
cough (adults)
what are the treatments for rhinosinustis
antibiotics
B-lactams - penicillins, cephalosporins,
macrolides eg erythromycin, clarithromycin
how should you treat acute peri-orbital swelling
emergency referral
ophthal opinion
urgent CT
IV antibiotics
emergency surgery
what are the symptoms of frontal sinusitis (potts puffy tumour)
acute onset fever, frontal headache, nasal discharge, frontal swelling
