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Systems 2 - Head and Neck > Rhinology > Flashcards

Rhinology Flashcards

1
Q

What symptoms should be screened for in a history regarding the nose?

A 
Nasal obstruction
Nasal discharge
Epistaxis
Facial pain 
Nasal deformity 
Anosmia
Sneezing
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2
Q

What aspects of past medical history are of importance when discussing the nose?

A 
Medical treatment 
Nasal surgery
Nasal trauma 
Asthma
Aspirin sensitivity
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3
Q

What occupation history may be of particular importance for rhinology?

A

Woodworkers

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4
Q

What social history may be of particular impotence for rhinology?

A

Cocaine use (degenerates nasal septum)

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5
Q

What instruments are used in a nasal examination?

A

Otoscope and endoscope for posterior cavity

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6
Q

What investigations can be carried out when a nasal pathology is suspected?

A

Bloods FBC, ANCA in small blood vessel damage, ESR, ACE, RAST

CT (gold standard)

Skin tests

Nasal smear

Rhinomanometry (not often used - assesses smell)

Flexible/rigid nasendoscopy

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7
Q

List some common nasal disorders:

Traumatic 
Vascular
Infections 
Malignant 
Congenital
A

Nasal trauma

Epistaxis (nose bleeds)

Rhinosinutsitis (very common)

Nasal polyps / tumour

Choanal atresia - nasal cavity not open in posterior aspect - leads to breathing issues

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8
Q

What is the treatment for nasal trauma?

A

Rhinoplasty

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9
Q

What is septal haematoma? How can it occur?

A

Swelling/bruising of the nasal septum. Can occur due to trauma of anterior nasal septum

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10
Q

What is the potential complication for septal haematoma?

A

If left untreated can become septic (therefore requires draining)

Can lead to chronic nasal congestion
Can cut off blood supply to cartilage -> necrosis -> saddle-nose deformity

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11
Q

What are the aetiologies of nasal polyps?

A 
Idiopathic
Chronic inflammation
Autonomic dysfunction
Genetic predisposition 
Allergic vs non-allergic
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12
Q

Nasal polyps are associated with what allergic conditions?

A

20-50% have asthma
8-26% have aspirin intolerance
50% have alcohol intolerance

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13
Q

What conditions may cause secondary polyposis to occur in the nose?

A 
Cystic fibrosis (6-48% have polyps)
Allergic fungal sinusitis (85% have polyps)
Churg-Strauss syndrome (autoimmune vasculitis)
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14
Q

What components are there to a nasal smear test; what can these reveal?

A

Microbiology - infection?
Eosinophils - allergic component
Neutrophils - chronic sinusitis

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15
Q

What is the treatment of polyps?

A

Oral and nasal steroids - high dose prednisolone

Surgical - polypectomy or microdebrider

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16
Q

What are the classifications and characteristics of adult sinusitis?

A

Acute - fast onset, duration of symptoms <12 weeks, completely resolves

Recurrent acute - 1-4 episodes of rhinosinusitis per year , complete recovery between episodes

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17
Q

What is the difference between sinusitis and rhinosinusitis?

A

Sinusitis is the inflammation of the paranasal air sinuses

Rhinosinusitis is the inflammation of the nasal cavity and paranasal air sinuses

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18
Q

What are the classifications and characteristics of adult rhinosinusitis?

A

Chronic - duration >12 weeks, persistent inflammation on imaging after a month of appropriate treatment

Acute exacerbation of chronic - worsening of existing symptoms/appearance of new symptoms

19
Q

What are the two most common microbes responsible for acute rhinosinusitis?

A

Strep. pneumoniae (31%)

H. influenzae (21%)

20
Q

New guidelines for the diagnosis of rhinosinusitis are based on:

A

Nasal blockige/discharge plus the addition of reduced sense of smell/headache

21
Q

What anitmicrobial therapy is available for the treatment of rhinosinusitis?

A

beta-lactams - penicillins, cephalosporins

Macrolides - erythromycin, clarithromycin

22
Q

What class of antibiotics shows greater penetration into the sinuses?

A

Macrolides

23
Q

What treatment options are there for sinusitis?

A

Nasal decongestants,

antibiotics (co-amoxiclav, clarithromycin), steroid nasal spray, steam inhalations

24
Q

What is Potts Puffy Tumour?

A

A life threatening complication of infectious sinusitis which develops into osteomyelitis of the frontal bone with associated subperiosteal abscess causing swelling and oedema over the forehead and scalp.

25
Q

What is the treatment protocol for PPT?

A

Emergancy referral

Frontal sinus surgery

26
Q

Sinusitis can lead to the development of mucous filled cysts in the ethmoid air sinus, what is this called? What complications can arise?

A

Ethmoidal mucocele; presses on orbit causing double vision

27
Q

What is the treatment for ethmoidal mucoceles?

A

Endoscopic Sinus Surgery (ESS)

28
Q

What is the commonest cause of epistaxis?

A

Idiopathic

29
Q

What are other common causes of epistaxis?

A

Infectious, traumatic, allergic, hypertension, hereditary haemorrhagic telangiectasia, tumour

30
Q

Outline the management of epistaxis

A 
ABCs
Compression of nose - soft tissue for 20-30mins + can use ice packs for vasoconstriction 
Vitals management - cannula + fluids
Bloods: Group + save, clotting
Physical exam of Little's area (anterior rhinoscopy or posterior endoscopy)
Cauterisation - silver nitrate
Nasal Packs
Surgery
31
Q

What are nasal packs?

A

Either anterior or posterior

Used when bleeding has not stoped despite first aid/therapy to stop bleeding

Nose balloon inflated to physically stop bleeding

32
Q

What is the surgical intervention for epistaxis?

A

Ligation of artery to stop bleeding

Usually sphenopalatine artery (main blood supply of the nose)

33
Q

What is hereditary haemorrhagic telangiectasia?

A

Autosomal dominant disorder causing abnormal blood vessel development around the face (including the nose)

34
Q

What is the treatment for HHT?

A

Not standard epistaxis treatment; laser treatment and skin grafts are indicated

35
Q

What causes are there of nasal obstruction?

A 
Foreign body
Septal deviation
Septal haematoma
Tumour
Chonal atresia
Nasal congestion - infection
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Systems 2 - Head and Neck (5 decks)

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