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Head and neck pathologies > Rhinology > Flashcards

Rhinology Flashcards

1
Q

What occupations are at risk of nasal disorders?

A

Woodworkers

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2
Q

What would a nasal endoscopy see?

A

The middle turbinate and back of the nose

Unlikely to see the sup turbinate

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3
Q

What bloods are appropriate for nasal disorders?

A
  • FBC
  • ESR
  • Radioallergosorbent blood Test (RAST)
  • ANCA (Anti-neutrophil cytoplasmic antibody) for vasculitis
  • ACE (angiotensin Converting Enzyme)
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4
Q

Why would you use an ACE test for nasal disorders?

A

Rhinosinusitis could be related to TB or Sarcoid which would show up on an Angiotensin Converting Enzyme test.

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5
Q

What does a RAST test show?

A

Radioallergosorbent Test

It tests the blood for specific IgE levels.

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6
Q

Define Choanal Atresia?

A

Congenital Blockage of the posterior nasal aperture by either a membrane or bone.

Bilateral tends to show up in babies with trouble feeding.
If unilateral may not show up till later

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7
Q

Whats the relevance of aspirin sensitivity?

A

Related to lots of atopic disease such as aspirin sensitive asthma or rhinitis

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8
Q

An URTI infection can causes periorbital swelling, how would we handle this situation?

A
  • Emergency ENT referral
  • Ophthalmology Opinion to assess colour vision, its the first to go when the optic nerve is damaged
  • Urgent CT to show up abscess
  • IV antibiotics and Steroids
  • Emergency Surgery
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9
Q

What is Pott’s puffy tumour?

A

Its a complication of sinusitis, basically a subperiosteal abscess.
So the patient appears with sinusitis symptoms + fever, frontal headache and central forehead swelling.

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10
Q

How do we treat Pott’s Puffy Tumor?

A

Frontal Sinus Surgery or Endoscopic Sinus Surgery (ESS) followed by Abx

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11
Q

What is mucocele?

A

A benign cyst lesion of a minor salivary gland containing mucous. Needs to be removed with endocopic sinus surgery

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12
Q

What would you see on sinusitis CT or MRI

A
  • Sinus opacification
  • Or a visible air/fluid level
  • and/or mucosal thickening
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13
Q

How do we classifiy rhinosinusitis?

A

Into Acute, Recurrent Acute, Chronic and Acute exacerbation of chronic.

Acute = <12 wks & Symptoms resolve completely

Recurrent Acute = 1-4 episodes a yr with completely recovery and 8wks symptom free between episodes.

Chronic = >12wks with persistant inflammatory changes on imaging for >4wks

Acute Exacerbations of Chronic: = Worsening or new symptoms with the acute ones resolving completely but not the chronic ones

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14
Q

What microorganisms cause rhinosinusitis?

A

Strep Pneumonia -31%
Haemophilus Influenzae - 21%
Both - 5%

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15
Q

What symptoms come with rhinosinusitis?

A
  • Facial pain/pressure
  • Hyposmia/Anosmia
  • Congestion/Obstruction
  • Purulent postnasal drain
  • Olfactory Disturbance
  • Cough

Also possible to get:

  • Headache
  • Fever
  • Fatigue
  • Halitosis
  • Dental Pain
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16
Q

How would you treat rhinosinusitis?

A
  • B-lactams (e.g. penicillins or cephalosporins)
  • Macrolides (E.g. Erythromycin/Clarithromicin)

Or sinus surgery

17
Q

Explain the aetiology of nasal polyps?

A

-Unknown
-Chronic inflammation
-Autonomic nervous system dysfunction
-Genetic predisposition
CF
AFS- allergic fungal sinusitis
Chrug-strauss syndrome (vasculitis of people with a history of airway allergic hypersensitivity)
-Associated with Allergic conditions
20-50% have asthma
Allergic rhinitis
Aspirin intolerance
Alcohol intolerance

18
Q

What is churg-strauss

A

An allergic (i.e. autoimmune) granulomatosis causing vasculitis of people with a history of airway allergic hypersensitivity.

19
Q

How would we investigate a case of nasal polyps?

A
  • Sweat test in case of CF
  • RAST/allergic skin tests for atopic disease
  • Coronal CT/MRI
  • Flexible or Rigid Nasoendoscopy

Can also do a nasal smear for eosinophils (allergic component) or neutrophils (chronic sinusitis)

20
Q

How do we treat nasal polyps?

A
  • Oral or nasal Steroids
  • Immunotherapy for allergic rhinitis or aspirin hypersensitive patients
  • Surgery (either a nasal polypectomy or Functional Endoscopic Sinus Surgery - FEST)
21
Q

What causes Epistaxis?

A
  • Infection
  • Idiopathic
  • Trauma/Iatrogenic
  • Allergy
  • Vascular (Atherosclerosis/hypertension)
  • Blood Dyscrasias
  • Atrophic Rhinitis
  • Tumor
  • Nasal Defect
  • Hereditary Hemorrhagic Telangiectasia
22
Q

What could cause blood dyscrasias?

A
  • Drugs
  • Disease
  • Alcoholism
23
Q

What is hereditary Hemorrhagic Telengiectasia?

A

Autosomal Dominant condition leading to abnormal blood vessel formation.
One manifestation is Epistaxis

24
Q

How would we manage Epistaxis?

A
  • Vital signs i.e. do they need IV transfusions etc
  • Physical exam incl. rhinoscopy
  • Labs
  • current medications
  • Nasal Packs
  • Surgery
25
Q

What types of nasal packs are there?

A
  • Ant Nasal Packs
  • Post Nasal Pack
  • Ant/Post Pack, uses balloons
26
Q

What kind of surgery is there for epistaxis?

A

Arterial Ligation

  • Sphenopalatine
  • Internal Maxillary
  • Ant/post ethmoids
  • ECA

Laser Ablation + Septodermoplasty

Embolisation (blocking abnormal vessels)

27
Q

How do we treat Hereditary Haemorrhagic Telangectasia?

A
  • Laser Coagulation
  • Septodermoplasty
  • Young’s Procedure
28
Q

What is youngs procedure?

A

Involves closing the nasal cavity with mucocutaneous flaps.

29
Q

How would a patient present with an angiofibroma?

A

Profuse one sided epistaxis.
Exclusively male and mainly in teens or twenties.
Don’t Biopsy as its a vascular tumor and theyll bleed.

30
Q

How would you treat an angiofibroma?

A

Pre-op Embolisation

Surgery

31
Q

Why would you be worried about a hearing loss and epistaxis together?

A

Together they’re a red flag symptom

Head and neck pathologies (11 decks)

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