Rhinology Flashcards
1
Q
What is typically seen in the history for rhinology diseases?
A
- Symptoms
- Nasal obstruction
- Nasal discharge
- Epistaxis
- Facial pain
- Nasal deformity
- Anosmia
- Sneezing
- PMH
- Medical treatment
- Nasal surgery
- Nasal trauma
- Asthma/aspirin sensitivity
- Social history
- Alcohol
- Smoking
- Cocaine abuse
- Woodworkers
2
Q
What investigations are often done in rhinology?
A
- Nasal endoscopy
- Blood tests
- FBC, ANCA, ESR, ACE, RAST
- CT scan
- MRI scan
- Skin tests
- Rhinomanometry
3
Q
What are some examples of nasal disorders?
A
- Nasal trauma
- Epistaxis
- Rhinosinusitis
- Nasal polyps
- Nasal deformity
- Nasal tumours
- Choanal atresia
4
Q
Nasal trauma - aetiology
A
Fight
5
Q
Nasal trauma - treatment
A
- Wait until swelling down and usually not much change in nose shape
- If there is, manipulation under anaesthetic
6
Q
Nasal trauma - complications
A
- Septal haematoma
7
Q
Nasal polyps - aetiology
A
- May be associated with asthma or aspirin sensitivity
- If in children consider CF
8
Q
Nasal polyps - presentation
A
- Symptoms
- Asymptomatic
- Nasal obstruction
- Rhinorrhoea
- Post-nasal drip
- Hyposmia
- Signs
- Pale fleshy polyps seen usually arising from the middle meatus
9
Q
Nasal polyps - investigations
A
- Sweat test
- RAST/skin testing
- Nasal smear
- Microbiology
- Eosinophils (allergic component)
- Neutrophils (chronic sinusitis)
- Coronal CT scan
- MRI scan
- Flexible nasendoscopy
- Rigid nasendoscopy
10
Q
Nasal polyps - treatment
A
- Medical
- Topical and nasal steroids
- Surgical
- Endoscopic sinus surgery and polypectomy
11
Q
Sinusitis - pathology
A
- Inflammation and infection of the sinuses, maybe acute or chronic
- Any one or all four pairs may be affected
12
Q
Sinusitis - classification
A
- Acute
- Acute onset of symptoms
- Duration < 12 weeks
- Symptoms resolve completely
- Recurrent acute
- More than 1 to 4 episodes of acute per year
- Complete recovery between episodes
- Symptom free for >8 weeks between acute attacks in absence of medical treatment
- Chronic
- Duration of symptoms > 12 weeks
- Persistent inflammatory changes on imaging > 4 weeks
- After starting appropriate therapy
- Acute exacerbations of chronic
- Worsening of existing symptoms or appearance of new symptoms
- Complete resolution of acute (but not chronic) symptoms between episodes
13
Q
Sinusitis - aetiology
A
- Usually secondary to viral upper respiratory infection
- Maxillary sinusitis may be dental in origin such as dental root abscess
14
Q
What organisms are usually responsible for sinusitis?
A
- S. Pneumoniae 31%
- H. Influenzae 21%
15
Q
Sinusitis - presentation
A
- Symptoms
- Facial pain over sinuses
- Nasal obstruction
- Preceding URTI
- Signs
- Fever
- Tenderness over sinuses
- Mucopus in middle meatus
- Swelling over cheek rare in maxillary sinusitis
- Swelling over frontal sinus may be secondary to frontal osteomyelitis
16
Q
Sinusitis - invesitgations
A
- CT scan if planning surgery or atypical presentation
17
Q
Sinusitis - treatment
A
- Antibiotics
- B-lactams
- Macrolides
- Nasal vasoconstrictors
- In chronic disease, surgery
- Enlargement of sinus drainage opening when medical therapy failed
18
Q
Sinusitis - complications
A
- Orbital cellulitis or abscess
- Meningitis
- Intracranial abscess
- Osteomyelitis of the frontal bone
19
Q
Epistaxis - pathology
A
- Haemorrhage from the nose
- Most recurrent epistaxis is from the anterior part of septum
20
Q
Epistaxis - aetiology
A
- Local
- Idiopathic
- Trauma
- Tumours
- Infection
- Allergy
- Systemic
- Anticoagulants
- Bleeding disorders
- Hypertension
- Olser-Weber-Rendu disease
- Hereditary haemorrhagic telangiectasia (rare)
21
Q
Epistaxis - presentation
A
- Nose bleed
- Occasionally shock or haematemesis
22
Q
Epistaxis - investigations
A
- Direct inspection of nose +/- blood tests
- Haemoglobin, clotting screen, group and save
23
Q
Epistaxis - treatment
A
- ABCs
- Cautery (with silver nitrate)
- Nasal packing
- For refractory bleeding surgery with artery ligation or radiological embolization may be required
24
Q
Epistaxis - complications
A
- Hypotension
- Shock
