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Head and Neck Physiology/Clinical > Rhinology > Flashcards

Rhinology Flashcards

1
Q

what are the common presenting symptoms in rhinology cases?

A 
nasal deformity
nasal obstruction/ blockage
epistaxis 
facial pain
halitosis 
anosmia 
sneezing 
PN drip
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2
Q

what are the standard nasal examinations?

A 
nasal examination
otoscopy 
nasondoscopy 
bloods; FBC, ANCA, CRP, RAST, ESR, ACE
CT / MRI 
rhinomanometry 
skin tests
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3
Q

what are the different nasal disorders?

A 
nasal trauma 
nasal polyps 
tumours 
choanal atresia 
rhinosinusitis 
epistaxis 
nasal deformity
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4
Q

what is the RAST test?

A

rhinoallergosorbent test for specific IgE

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5
Q

how do u assess someone with nasal trauma?

A

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

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6
Q

what are the complications from nasal trauma?

A

septal abscess / haematoma

septal necrosis and perforation

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7
Q

what is samter’s triad?

A

AERD which involves
aspirin sensitivity
recurrent rhinitis with nasal polyps
asthma

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8
Q

what is AERD?

A

aspirin exacerbated respiratory disease
chronic condition consisting of asthma, recurrent rhinitis and nasal polyps and a sensitivity to aspirin and other NSAIDS.

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9
Q

what does congested sinuses look like on a CT scan?

A

opacification - pale grey

black = air

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10
Q

what is the aetiology of nasal polyps?

A 
unknown 
chronic inflammation
autonomic nervous system dysfunction 
genetic predisposition 
allergic vs non allergic
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11
Q

what is associated with nasal polyps ?

A 
asthma 
aspirin sensitivity 
allergic rhinitis 
alcohol intolerance 
cystic fibrosis
Allergic fungal sinusitis (AFS)
chrug-strauss syndrome
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12
Q

what investigations are used to diagnose/ investigate polyps?

A 
RAST test
Sweat test (if CF is suspected)
nasal smear - microbiology, eosinophils &amp; neutrophils
coronal CT scan 
MRI 
flexible nasoendosocpy 
rigid nasoendoscopy
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13
Q

what is the treatment for polyps?

A 
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

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14
Q

what is the recurrence rates for nasal polyps?

A

multiple small polyps is common

larger and antro-coanal less common

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15
Q

what is catarrh?

A

excessive discharge or buildup of mucous in the nose or throat

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16
Q

what imaging modality is good for diagnosing sinusitis?

A

sinus radiograph

coronal CT

17
Q

what is the classification of adult acute sinusitis?

A

acute onset
duration < 12 weeks
symptoms fully resolve

18
Q

what is the classification of recurrent acute sinusitis?

A

> 1 to <4 episodes of acute sinusitis per year
symptom free >8 week between episodes
absence of medical treatment
complete recovery between attacks

19
Q

what is the adult classification of chronic sinusitis?

A

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

20
Q

what are the most common pathogens responsible for sinusitis?

A

h. influence

strep. pneumonia

21
Q

what are the symptoms of rhino sinusitis?

A 
facial pain and pressure
nasal congestion/ blockage 
PN drip 
halitosis 
catarrh 
anosmia / hyposmia
headache 
fever 
fatigue 
dental pain 
cough
22
Q

what is the antibiotic treatment given for rhino sinusitis?

A

beta lactams i.e.penicillin & cephalosporins

macrocodes i.e. erythromycin and clarithromycin

23
Q

what can occur as a complication from frontal sinusitis?

A

pots puffy tumour

24
Q

what is ethmoidal mucocele and what does it present like?

A

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

25
Q

what is the treatment for ethmoidal mucocele?

A

endoscopic sinus surgery

26
Q

what are the causes of epistaxis?

A 
idiopathic 
trauma - self or iatrogenic
infection i.e. rhino sinusitis, rhinitis, nasopharyngitis 
blood dycrasias 
hereditary haemorrhagic telangiectasia 
hypertension / atherosclerotic disease 
allergy 
tumour i.e. angiofibroma tumour 
atrophic rhinitis 
congenital or acquired nasal defects
27
Q

what is the initial management of someone with epistaxis?

A 
ABC'S
medical history/medication 
vital signs -need IV ?
examination - anterior and/or endoscopic rhinoscopy
labs
nasal packing if persistent 
ice cold bag onto of head
pinch cartilage and tilt head forward
28
Q

what is th surgical treatment for epistaxis?

A 
endoscopic sphenopalatine artery ligation 
external carotid ligation 
anterior/posterior artery ligation 
septodermoplasty / laser ablation 
embolisation
29
Q

what does hereditary haemorrhage telangiectasia present like?

A

recurrent epistaxis with lesions

30
Q

what is the treatment for HHT?

A

laser coagulation
youngs procedure
septodermoplasty

31
Q

what could one sided epistaxis indicate?

A

angiofibroma

highly vascular nasal tumour

32
Q

what is the treatment for angiofibroma?

A

pre operative embolisation and surgery

33
Q

what could epistaxis plus hearing loss indicate?

A

tumour in the back of the nose pressing on the eustachian tube resulting in glue ear causing the hearing loss

34
Q

what are the risk factors for allergic rhinitis?

A 
FH
atopy
environmental 
allergy levels
dietary changes
35
Q

what could be the cause of one sided glue ear?

A

nasopharyngeal carcinoma

36
Q

what is the presentation of nasopharyngeal carcinoma?

A

epistaxis

one sided glue ear = hearing loss

Head and Neck Physiology/Clinical (17 decks)

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