Rhinology Flashcards
Symptoms in rhinology
Nasal obstruction Nasal discharge Epistaxis Nasal deformity Facial pain Anosmia Sneezing
Definition of epistaxis
Nose bleed
Definition of anosmia
Loss of sense of smell
Possible relevant PMH in rhinology
Medical treatment Nasal surgery Nasal trauma Atopy Samters triad
What is samters triad?
Asthma
Aspiring sensitivity
Polyps
Possible social factors in rhinology
Woodworkers
Alcohol
Smoking
Cocaine abuse
Investigations in rhinology
Allergy tests - skin prick, RAST FBC ANCA, ESR, ACE (for wegeners, sarcoidosis) CT MRI
What is a positive result in skin prick testing?
Over 3mm wheal with associated flare and pruiritis
Examples of nasal disorders
Nasal trauma
Epistaxis
Rhinosinusitis with or without nasal polyps
Investigations for chronic rhinosinusitis with nasal polyps
Flexible or rigid nasendoscopy
Coronal CT scan
Treatment of chronic rhinosinusitis with nasal polyps
Steriods - prednisolone 30mg od 10 days - nasal drops - nasal spray Saline nasal douche Surgery
Definition of acute rhinosinusitis
< 12 weeks
Definition of chronic rhinosinusitis
> 12 weeks
What is a complication of nasal trauma?
Septal haematoma
What is the commonest cause of epistaxis?
Idiopathic
Causes of epistaxis
Idiopathic Infection (rhinitis/sinusitis) Trauma Drug induced blood dyscaria Disease mediated blood dyscaria Alcoholism
Initial management of epistaxis
Digital pressure 20 minutes (resolves 90%)
Management of epistaxis
Digital pressure 20 mins Nasal packs Surgery - artery ligation - embolization
What is the most suitable management for epistaxis where the bleeding site is difficult to localise?
Anterior pack insertion
What would facial pain when leaning forwards indicate?
Sinusitis
Prophylaxis of sinusitis
Intranasal corticosteroids
When should intranasal corticosteroids be given for acute sinusitis?
If symptoms have persisted for 10 days or more
What is “double-sickening” and what is this usually seen in?
An initial period of recovery followed by a sudden worsening of symptoms
Seen in bacterial sinusitis following viral sinusitis
Management of bilateral nasal polyps and what is generally the cause?
Rhinosinusitis
If small - saline nasal douche and intranasal steroids in primary care
If significant obstruction - Refer to ENT
Management of unilateral nasal polyp and what can be the cause?
Refer to ENT
To exclude malignancy
What are two red flag symptoms in rhinology?
Unilateral nasal polyps
Unilateral recurrent epistaxis
Recurrent epistaxis WITHOUT red flags can be treated with what?
Naseptin (chlorhexidine/neomycin) cream
