Rhinology

Question 1

What is parosmia?

Answer 1

‘bad smell’ in nose, sign of chronic infection

Question 2

How does aspirin trigger the airways?

Answer 2

Aspirin metabolites break down to leukotrienes, triggering a huge inflammatory response

Question 3

What endoscopy is used for the nasal passage?

Answer 3

Flexible endoscopy

Question 4

When should a nasal poly be removed?

Answer 4

When it actively impedes breathing

Question 5

What investigations can be performed in a patient with nasal symptoms?

Answer 5

Blood tests 
CT 
MRI
Skin tests
Rhinomanometry

Question 6

What blood tests can be performed in patients with nasal symptoms?

Answer 6

FBC
ANCA
ESR
ACE
RAST

Question 7

What is the treatment for nasal polyps?

Answer 7

Give steroids/surgery with steroids (improves efficacy)

Question 8

How is septal hematoma treated?

Answer 8

Drainage to prevent deformity

Question 9

What is Samter’s triad?

Answer 9

Asthma
Aspirin Intolerance
Nasal polyps

Question 10

What is the cause of nasal polyps?

Answer 10

Idiopathic
Chronic inflammation
Autonomic NS dysfunction
Genetic predisposition
Allergic/non-allergic

Question 11

Nasal polyps are commonly comorbid with what allergic conditions?

Answer 11

20-50% asthma
Allergic rhinitis
8-26% aspirin intolerance
50% alcohol intolerance

Question 12

Nasal polyps are commonly comorbid with what non-allergic conditions?

Answer 12

Cystic fibrosis 6-48% have polyps
AFS 85% have polyps
Churg-Strauss syndrome

Question 13

What investigations should be performed on a child with polyps?

Answer 13

Sweat test - CF
RAST/Skin Testing
Nasal smear 
Coronal CT
Flexible nasendoscopy

Question 14

What investigations should be performed on someone with polyps?

Answer 14

RAST/Skin testing
Nasal smear
Coronal CT
Flexible nasendoscopy

Question 15

What should be tested for on a polyp nasal smear?

Answer 15

Microbiology
Eosinophils (allergy)
Neutrophils (chronic sinusitis)

Question 16

What is the pharmacological treatment for nasal polyps?

Answer 16

Oral/nasal steroids
(high dose prednisolone, 20 days, eliminated 50% of polyps)
Immunotherapy

Question 17

What is the surgical treatment for nasal polyps?

Answer 17

Traditional polypectomy
Microdebrider
Endoscopic sinus surgery

Question 18

What are the positives of sinus radiographs?

Answer 18

Able to find air-fluid levels
Mucosal thickening
Sinus opacification
Less expensive

Question 19

What are the negatives of sinus radiographs?

Answer 19

Poor visualisation of osteomeatal complex/ant. ethmoid sinuses
High rate of false positives
Less accurate

Question 20

How is acute sinusitis classified in adults?

Answer 20

Acute symptom onset
Duration <12 weeks
Symptoms resolve quickly

Question 21

How is recurrent acute sinusitis classified in adults?

Answer 21

> 1 to <4 episodes of acute rhinosinusitis per year
Complete recovery between episodes
Symptoms free >8wks (absence of Rx)

Question 22

How is chronic sinusitis classified in adults?

Answer 22

Symptomatic >12wks

Persistent inflammatory changes on imaging >4wks

Question 23

How are acute exacerbations ofchronic sinusitis classified in adults?

Answer 23

Worsening of existing symptoms
Appearance of new symptoms
Complete resolution of acute symptoms between episodes

Question 24

What are the microbial causes of acute rhinosinusitis?

Answer 24

S. pneumoniae (31%)

H. influenzae (21%)

Question 25

When are antibiotics indicated for acute rhinosinusitis?

Answer 25

Purulence from the nose

Question 26

What are the minor symptom factors in rhinosinusitis?

Answer 26

``` Dental pain Halitosis Fatigue Fever Headache ```

Question 27

What are the major symptom factors in rhinosinusitis?

Answer 27

``` Facial pain/pressure Hyposmia/anosmia Congestion Purulent postnasal drain Olfactory disturbance ```

Question 28

What are the antibiotics used for rhinosinusitis?

Answer 28

Beta-lactams | Macrolides

Question 29

Why are macrolides used for rhinosinusitis?

Answer 29

Penetrate well into the linings of the sinuses

Question 30

What is the management for a child with acute periorbital swelling secondary to rhinosinusitis?

Answer 30

``` (emergency referral) ENT consult CT Scan IV Antibiotics Emergency surgery ```

Question 31

What is frontal sinusitis?

Answer 31

Potts puffy tumour - inflammation and swelling of the frontal sinus

Question 32

How is frontal sinus treated/

Answer 32

Frontal sinus surgery and drainage

Question 33

What are the most common causes of epistaxis?

Answer 33

``` Trauma Iatrogenic Infection Allergy Hypertension ```

Question 34

What are the most common surgeries for epistaxis?

Answer 34

Arterial ligation (of different arteries)

Question 35

How does Hereditary Haemorrhagic Telangiectasia present?

Answer 35

Profuse epistaxis | Red spots on lip

Question 36

How is Hereditary Haemorrhagic Telangiectasia treated?

Answer 36

Laser coagulation Young's Procedure Septodermoplasty

Question 37

What is angiofibroma?

Answer 37

Highly vascularised benign tumour of the nose presenting almost always in males

Question 38

How is angiofibroma treated?

Answer 38

Preoperative Embolisation | Surgery