Rhinology Flashcards
What occupations are at risk of nasal disorders?
Woodworkers
What would a nasal endoscopy see?
The middle turbinate and back of the nose
Unlikely to see the sup turbinate
What bloods are appropriate for nasal disorders?
- FBC
- ESR
- Radioallergosorbent blood Test (RAST)
- ANCA (Anti-neutrophil cytoplasmic antibody) for vasculitis
- ACE (angiotensin Converting Enzyme)
Why would you use an ACE test for nasal disorders?
Rhinosinusitis could be related to TB or Sarcoid which would show up on an Angiotensin Converting Enzyme test.
What does a RAST test show?
Radioallergosorbent Test
It tests the blood for specific IgE levels.
Define Choanal Atresia?
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
Whats the relevance of aspirin sensitivity?
Related to lots of atopic disease such as aspirin sensitive asthma or rhinitis
An URTI infection can causes periorbital swelling, how would we handle this situation?
- 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
What is Pott’s puffy tumour?
Its a complication of sinusitis, basically a subperiosteal abscess.
So the patient appears with sinusitis symptoms + fever, frontal headache and central forehead swelling.
How do we treat Pott’s Puffy Tumor?
Frontal Sinus Surgery or Endoscopic Sinus Surgery (ESS) followed by Abx
What is mucocele?
A benign cyst lesion of a minor salivary gland containing mucous. Needs to be removed with endocopic sinus surgery
What would you see on sinusitis CT or MRI
- Sinus opacification
- Or a visible air/fluid level
- and/or mucosal thickening
How do we classifiy rhinosinusitis?
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
What microorganisms cause rhinosinusitis?
Strep Pneumonia -31%
Haemophilus Influenzae - 21%
Both - 5%
What symptoms come with rhinosinusitis?
- Facial pain/pressure
- Hyposmia/Anosmia
- Congestion/Obstruction
- Purulent postnasal drain
- Olfactory Disturbance
- Cough
Also possible to get:
- Headache
- Fever
- Fatigue
- Halitosis
- Dental Pain
How would you treat rhinosinusitis?
- B-lactams (e.g. penicillins or cephalosporins)
- Macrolides (E.g. Erythromycin/Clarithromicin)
Or sinus surgery
Explain the aetiology of nasal polyps?
Its unknown although its often associated with allergic conditions such as rhinitis, asthma, aspirin sensitivity or alcohol intolerance
Also with CF and churg-strauss
What is churg-strauss
An allergic (i.e. autoimmune) granulomatosis causing vasculitis of people with a history of airway allergic hypersensitivity.
How would we investigate a case of nasal polyps?
- 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)
How do we treat nasal polyps?
- Oral or nasal Steroids
- Immunotherapy for allergic rhinitis or aspirin hypersensitive patients
- Surgery (either a nasal polypectomy or Functional Endoscopic Sinus Surgery - FEST)
What causes Epistaxis?
- Infection
- Idiopathic
- Trauma/Iatrogenic
- Allergy
- Vascular (Atherosclerosis/hypertension)
- Blood Dyscrasias
- Atrophic Rhinitis
- Tumor
- Nasal Defect
- Hereditary Hemorrhagic Telangiectasia
What could cause blood dyscrasias?
- Drugs
- Disease
- Alcoholism
What is hereditary Hemorrhagic Telengiectasia?
Autosomal Dominant condition leading to abnormal blood vessel formation.
One manifestation is Epistaxis
How would we manage Epistaxis?
- Vital signs i.e. do they need IV transfusions etc
- Physical exam incl. rhinoscopy
- Labs
- current medications
- Nasal Packs
- Surgery
What types of nasal packs are there?
- Ant Nasal Packs
- Post Nasal Pack
- Ant/Post Pack, uses balloons
What kind of surgery is there for epistaxis?
Arterial Ligation
- Sphenopalatine
- Internal Maxillary
- Ant/post ethmoids
- ECA
Laser Ablation + Septodermoplasty
Embolisation (blocking abnormal vessels)
How do we treat Hereditary Haemorrhagic Telangectasia?
- Laser Coagulation
- Septodermoplasty
- Young’s Procedure
What is youngs procedure?
Involves closing the nasal cavity with mucocutaneous flaps.
How would a patient present with an angiofibroma?
Profuse one sided epistaxis.
Exclusively male and mainly in teens or twenties.
Don’t Biopsy as its a vascular tumor and theyll bleed.
How would you treat an angiofibroma?
Pre-op Embolisation
Surgery
Why would you be worried about a hearing loss and epistaxis together?
Together they’re a red flag symptom
