Rhinology Flashcards
what are the common presenting symptoms in rhinology cases?
nasal deformity nasal obstruction/ blockage epistaxis facial pain halitosis anosmia sneezing PN drip
what are the standard nasal examinations?
nasal examination otoscopy nasondoscopy bloods; FBC, ANCA, CRP, RAST, ESR, ACE CT / MRI rhinomanometry skin tests
what are the different nasal disorders?
nasal trauma nasal polyps tumours choanal atresia rhinosinusitis epistaxis nasal deformity
what is the RAST test?
rhinoallergosorbent test for specific IgE
how do u assess someone with nasal trauma?
assess whether it is the bone or the cartilage
if <7 days then manipulation
if >7 days then requires surgery - rhinoplasty
cartilage that isn’t manipulated within 7 days won’t return to its original position
what are the complications from nasal trauma?
septal abscess / haematoma
septal necrosis and perforation
what is samter’s triad?
AERD which involves
aspirin sensitivity
recurrent rhinitis with nasal polyps
asthma
what is AERD?
aspirin exacerbated respiratory disease
chronic condition consisting of asthma, recurrent rhinitis and nasal polyps and a sensitivity to aspirin and other NSAIDS.
what does congested sinuses look like on a CT scan?
opacification - pale grey
black = air
what is the aetiology of nasal polyps?
unknown chronic inflammation autonomic nervous system dysfunction genetic predisposition allergic vs non allergic
what is associated with nasal polyps ?
asthma aspirin sensitivity allergic rhinitis alcohol intolerance cystic fibrosis Allergic fungal sinusitis (AFS) chrug-strauss syndrome
what investigations are used to diagnose/ investigate polyps?
RAST test Sweat test (if CF is suspected) nasal smear - microbiology, eosinophils & neutrophils coronal CT scan MRI flexible nasoendosocpy rigid nasoendoscopy
what is the treatment for polyps?
oral and nasal steroids surgical; - polpectomy - microdebrier - endoscopic sinus surgery
doesn’t cure the polyps as they will return, it just reduces the inflammatory load to enhance the medical treatment
what is the recurrence rates for nasal polyps?
multiple small polyps is common
larger and antro-coanal less common
what is catarrh?
excessive discharge or buildup of mucous in the nose or throat
what imaging modality is good for diagnosing sinusitis?
sinus radiograph
coronal CT
what is the classification of adult acute sinusitis?
acute onset
duration < 12 weeks
symptoms fully resolve
what is the classification of recurrent acute sinusitis?
> 1 to <4 episodes of acute sinusitis per year
symptom free >8 week between episodes
absence of medical treatment
complete recovery between attacks
what is the adult classification of chronic sinusitis?
symptoms > 12 weeks
persistant inflammatory changes on imaging >4 weeks
may have acute execrations where symptoms get worse or there are new symptoms
still chronic symptoms between episodes
what are the most common pathogens responsible for sinusitis?
h. influence
strep. pneumonia
what are the symptoms of rhino sinusitis?
facial pain and pressure nasal congestion/ blockage PN drip halitosis catarrh anosmia / hyposmia headache fever fatigue dental pain cough
what is the antibiotic treatment given for rhino sinusitis?
beta lactams i.e.penicillin & cephalosporins
macrocodes i.e. erythromycin and clarithromycin
what can occur as a complication from frontal sinusitis?
pots puffy tumour
what is ethmoidal mucocele and what does it present like?
present with diplopia (double vision) / visual disturbances
build up of mucous is ethmoidal sinus which swells and becomes blocked
sinus expands into surrounding structures such as the orbit causing it to be pushed down
