Rhinology Flashcards
1
Q
What is the function of the nose
A
smell
respiration
warms/humidifiesthe air we breathe
olfaction = 85% of taste
2
Q
What are the regions of the nose
A
External Nasal Vestibule septum lateral nasal walls nasopharynx
3
Q
What is the upper 1/3 of the external nose made of
A
bone, the rest is cartilage
4
Q
what is the nasal vestibule
A
nasal entrance
5
Q
whats nasal hair called
A
vibrissae
6
Q
what is the narrowest part of the nasal cavity
A
the nasal valve
7
Q
what is the most common area for nose bleeds
A
littles area - anterior part of the nasal septum
8
Q
what is choanal atresia
A
a thin membrane blocks the choanae (opening of nostrils)
9
Q
why is choanal atresia an issue in children
A
children are obligate nasal breathers meaning death may quickly follow if an oral airway is not given
10
Q
what is rhinosinusistis
A
inflammation of nasal mucosa and sinuses
11
Q
what is acute vs subacute vs chronic
A
acute = <4 weeks sub-acute = 4-12 weeks chronic = >12 weeks
12
Q
what are the types of rhinosinusitis
A
allergic infective non-allergic occupational hormonal (pregnancy)
13
Q
what sinuses are most affected in acute rhinosinusitis
A
most to least
maxilary
ethmoid
frontal
sphenoid
14
Q
what usually precipitates rhinosinusitis and why
A
post-URTI infection, because the increase in blood flow and fluid in the mucosa leads toa blockage of sinus drainage
15
Q
what percentage of viral URTIs are complicated by a bacterial infection and why
A
2%, due to secretory stasis
16
Q
what are common organisms that cause a secondary bacterial infection on a viral URTI
A
S.pneumoniae
H.influenzae
17
Q
what are clinical features of a secondary bacterial infection on top of a viral URTI
A
severe unilateral sinus pain pyrexia malaise nasal obstruction mucopurulent rhinorrhoea decreased smell
18
Q
where is pain usually felt for each sinus
A
maxillary = cheek/upper teeth frontal = above eye/supraorbital margin sphenoid = retroorbital pain/vertex of head dental = molar
19
Q
what is shown on anterior rhinoscopy for acute bacterial sinusitis
A
inflamed nasal mucosa with mucopurulent secretions
20
Q
what is the treatment for acute sinusitis
A
analgesia
decongestant - topical FOR 5 DAYS ONLY
steam inhalation
21
Q
what is the treatment for acute maxillary aterial sinusitis
A
7-14 days penicillin/amoxicillin
cefuroxime/co-amoxiclav/doxycycline if there isresistance after 3-5 days
22
Q
what is the next step for treatment of acute sinusitis if the initial treatment isnt working
A
sinus drain
23
Q
what are signs and symptoms of acute sinusitis complications
A
periorbital cellulitis
severe headaches
focal neurology
S+S meningitis
24
Q
what is the most common type of acute sinusitis
A
infective
25
what is the difference between acute sinusitis and chronic sinusitis in presentation
acute = pyrexia, rhinorrhea, malaise
chronic = post-nasal drip, decreased concetration 'muzzy head'
26
what are common features of acute and chronic sinusitis
```
hallitosis
facial pain
headache
anosmia
obstruction in nose
```
27
what is the 2nd most common type of rhinosinusitis
allergic
28
what kind of reaction is rhinosinusitis
IgE hypersensitivity
29
what are signs and symptoms of allergic rhinosinusitis
vascular congestion
odema
rhinorrhoea
irritation
30
what would you see on examination of allergic rhinosinusitis
damp/pale mucosa with swollen tubinates
31
whats the treatment of allergic rhinosinusitis
avoid allergens
antihistamine (PO/topical)
steroids (topically, not long term)
sodium cromogylcate spray
32
what is the function of sodium cromoglycate spray
stabilises mast cells
33
what are some non-allergic, non-infective causes of rhinosinusitis
vasomotor rhinitis
rhinititis medica mentosa
atrophic rhinitis
34
how do you diagnose and treat vasomotor rhinitis
diagnosis of exclusion after testing negative for infection/allergens
treatment is same as allergic rhinitis:
avoid allergens
antihistamine (PO/topical)
steroids (topically, not long term)
sodium cromogylcate spray
35
what is rhinitis medica mentosa
acquired sensitivity of the nasal lining due to the increased use of topical nasal decongestants, causing tubinate hypertrophy and rebound vasodilation
36
what is the treatment for rhinitis medica mentosa
cessation of decongestant
topical steroid
tubinate surgery is necessary
37
what is atrophic rhinitis
abnormal nostril patency due to surgery (usually) loss of ciliary epithelium causing thick secretions which dry and form an unpleasant crust + odour
causes frequent bleeding
more common in developing countries
38
what is the best treatment for atrophic rhinitis
close off affected nostril which is poorly tolerated by patients
39
apart from surgery, what is another cause for atrophic rhinitis
pregnancy
40
what are common causative organisms for chronic rhinosinusitis
S.aureus
coagulase negative staph aureus
anaerobic gram -ve bacteria
41
what are the characteristics of a nasal polyp
pale
pendulous
opalescent (many points of shifting colour)
painless
42
whats the treatment of chronic rhinosinusitis
3 weeks Antibiotics - PO + broad (co-amox, clindamycin, metronidazole, penicillin
2 months topical steroids - betamethosone 2 drops tds (can be extended)
nasal toileting
treat any co-existing pathology
43
what is the threshold for referral to ENT with chronic rhinosinusitis
>8 weeks of requiring treatment
44
what is the last resort treatment for chronic rhinosinusitis if medical management fails
CT paranasal sinuses for surgery and perform functional endoscopic sinus surgery to clear sinus drainage
45
what is a differential for chronic rhinosinusitis presentation and what is the difference
midfacial segment pain - tension headache for midsegment of face
has the facial pain/pressure of rhinosinusitis but no nose symptoms
46
how do you treat midfacial segment pain
amitryptaline - 6 weeks to work, 6 months to treat
47
what are some complications of chronic rhinosinusitis
```
frontal sinusitis
abscesses
facial cellulitis
periorbital cellulitis
mucoceles
ccavernous sinus thrombosis
```
48
what is the most important complication of chronic sinusitis to recognise and how do you recognise it
frontal sinusitis, because it is sight and life threatening
tenderness on forehead, especially on percussion
severe frontal headache
worse on bending over
49
what is the most common abscess formed as a complication of chronic rhinosinusitis
frontal lobe abscess
50
how do you treat facial cellulitis
high dose antibiotics - penicillins tend to work as causative is usually staph
sinus drainage
51
what is a mucocele
late complication of acute sinusitis, sterile mucous occupying an obstructed sinus, over years the sinus expands due to mucous
52
how do you treat a mucocele
surgical drainage
53
what is the most common complication of chronic rhinosinusitis
orbital cellulitis
54
whats the most common intracranial complication of chronic rhinosinusitis
meningitis
55
what causes a perforated nasal septum
trauma
septoplasty complication
wegners granulomatosis
56
what are signs and symptoms of a perforated nasal septum
crusting
bleeding
whistling
57
how do you manage a perforated nasal septum
vaseline (1st line)
douching (1st line)
septal button insertion
58
what causes deviated nasal septums
trauma at birth or in later life
59
why is a deviated nasal septum a problem
disrupts the air flow
60
how do you treat a deviated nasal septum
surgical correction
61
whats an important thing to avoid when treating a deviated nasal septum
do not remove anterior/dorsal septum as it causes a cosmetic deformity
62
what are important symptoms to note in a nose break
epistaxis
CSF leakage
obstruction
septal haemoatoma
63
why are X-rays valuable for the patient in a nose break
may be needed for legal purposes
64
what is the acute management of a nose break
if epistaxis present - sit forward + pinch+ spit blood out, for 10mins then try and cauterise with silver nitrate/pack if severe/resus if very severe blood loss
septal haemoatoma = drainage under GA with antibiotic prophylaxis
65
when should a nose break be reviewed in clinic and why
5-7 days after the break, to allow the soft tissue swelling to go down
66
what does a septal haematoma look like
bilateral fluctuant swelling of septum
67
what is the ideal management for epistaxis
initially sit forward and pinch bridge of nose for 10 mins whilst spitting blood out
give ice pack for bridge
attempt to visualise bleed and if visible spray with 5% lidocaine/1:20,000 adrenaline and cauterise with silver nitrate
if bleed not visualised/is too severe for cautery pack the nose
68
what is common advice on discharge for epistaxis
```
no heavy lifting
no hot showers
no picking
gentle nose blowing
vaseline
look out for vestibulitis (s.aureus)
```
69
what is the blood supply of littles area/keissalbachs plexus
anterior ethmoid artery (opthalmic aa)
posterior ethmoidal artery (opthalmic aa)
sphenopalatine artery (terminal branch of maxillary artery)
palatine artery (maxillary aa)
palatine branch of superior labial artery (facial aa)
70
what is the technique for cauterization of epistaxis
start a few mm away from the bleeding point and work in a circle to cauterize the feeding vessels before attempting the main point
never cauterise heavily actively bleeding vessels
71
what is the difference between sleep apnoea and snoring
sleep apnoea is upper airways resistance causing cessation of breathing, sleep disruption and daytime sleepiness whereas snoring may be completely harmless
72
what is the aetiology of sleep apnoea
```
increased age
M>F (2-5:1)
obesity (70% in BMI >40)
obstructed upper airway
social habits (alcohol + smoking)
FHx
Neuromuscular disease
chronic lung disease
```
73
what is obstructive sleep apnoea
a subtype of sleep apnoea that causes desaturations leading to sleep interruptions
74
what is an apnoeic episode
30+ episodes of cessation of breathing, 10+ seconds each occuring over 7 hours sleep
75
what are signs and symptoms of obstructive sleep apnoea
```
excessive daytime sleepiness
decreased conciousness
snoring
unrefreshing sleep
choking during sleep
witnesses apnoea
restless sleep
irritability
nocturia
decreased libido
```
76
what are the main investigations for obstructive sleep apnoea
sleep studies
| endoscopy
77
what may obstructive sleep apnoea lead to long term
pulmonary hypertension
RV strain
Cor pulmonale
78
whats the treatment for obstructive sleep apnoea
lifestyle (weight loss, decreased alcohol)
drugs to decreased REM sleep
CPAP machine
adenotonsillectomy
surgery for adults focused to area of obstruction
