rhinology Flashcards
what could someone present with when going to the rhinology unit?
Nasal obstruction nasal discharge epistaxis facial pain nasal deformity anosmia sneezing
investigations a rhinologist would carry out?
Blood tests-FBC, ANCA, ESR, ACE,
RAST
CT SCAN
MRI SCAN
SKIN TESTS
RHINOMANOMETRY
what are the different types of nasal disorders?
Nasal trauma Epistaxis Rhinosinusitis Nasal polyps Nasal Deformity Nasal tumors Choanal atresia
what are nasal polyps?
Unknown Chronic inflammation Autonomic nervous system dysfunction Genetic predisposition Allergic verses non-allergic
pathophysiology of nasal polyps
Associated with allergic conditions
20-50% have asthma
Allergic rhinitis
8-26% have aspirin intolerance
50% have alcohol intolerance
Non allergic conditions
Cystic Fibrosis 6-48% have polyps
AFS 85% have polyps
Churg-Strauss syndrome
investigations of nasal polyps
Sweat test RAST / skin testing Nasal smear Coronal CT scan MRI scan Flexible nasendoscopy Rigid nasendoscopy
treatment of nasal polyps
Oral and nasal steroids
High dose prednisolone and nasal steroid for 20 days will eliminate 50% of polyps
Lower bioavailability in modern nasal steroids
Poor response in certain groups
Intranasal injection not effective
Immunotherapy
Diet (no effect)
surgical treatment of nasal polyps
Traditional polypectomy Microdebrider Endoscopic sinus surgery Recurrence Multiple small polyps common Large and antro-coanal less so
definition of an acute sinusitis ?
acute onset symptoms
duration of symptoms <12 weeks
symptoms resoolve completely
definition of recurrent acute sinusitis?
> 1 to <4 episodes of acute rhinosinutitis per year.
– Complete recovery between episodes.
– Symptom-free period of >8 weeks between acute attacks in
absence of medical treatment.
definition of chronic rhinosinusitis
– Duration of sysmptoms >12 weeks
– Persistent inflammatory changes on imaging >4 weeks
after starting appropriate therapy
definition of acute exacerbations of chronic rhinosinusitis
Worsening of existing symptoms or appearance of new
symptoms
– Complete resolution of acute (but not chronic)
symptoms between episodes
microbial etiology of acute rhinosinusitis
S. pneumoniae 31%
H. influenzae 21%
S. pneumoniae +H. influenzae 5%
Anaerobes 6%
rhinosinusitis symptoms
facial pain and pressure hyposmia nasal congestion purulent postnatal drain olfactory disturbance cough not due to asthma
antimicrobial choices for rhinosinusitis
β-lactams – penicillins, cephalosporins
Macrolides - e.g erythromycin,clarithromycin
