Rhinology Flashcards
Name some local causes of epistaxis.
- Idiopathic – 85%
- Traumatic
- Iatrogenic
- Foreign Body
- Inflammatory: Rhinitis, Polyps
- Neoplastic
Name some systemic causes of epistaxis.
- Hypertension
- Coagulopathies
- Vasculopathies
- Hereditary Haemorrhagic Telangiectasia/Osler-Weber-Rendu disease
Describe the first aid management of epistaxis.
- Pinch soft part of nose
- Head forward
- Spit out (not swallow) any blood in mouth
Describe the conservative management of epistaxis.
- Cautery: silver nitrate or bipolar diathermy
- Nasal packing if cautery fails to control bleeding
NOTE: Topical adrenaline may help control bleeding before cautery
Describe the surgical management of epistaxis.
The following vessels can either
be ligated surgically or embolised radiologically:
- Sphenopalatine
- Anterior ethmoid (can not be embolised because comes from
internal carotid artery) - External carotid (last resort)
Define rhinosinusitis.
Inflammation of the nose and the paranasal sinuses characterised by two or more symptoms, one of which should be:
- Either nasal blockage/obstruction/congestion or nasal discharge
- Facial pain/pressure
- Reduction or loss of smell
AND
- Endoscopic signs of Polyps, mucopurulent discharge, or oedema in middle
meatus - CT changes- Mucosal changes within the osteomeatal complex, or sinuses.
What is acute rhinosinusitis?
Inflammation of the nose and the paranasal sinuses lasting <12 weeks.
How can acute rhinosinusitis be divided?
Viral (common cold) and non-viral
How can chronic rhinosinusitis be divided?
With or without nasal polyps
Name 2 causative organisms of viral ARS.
The common cold.
- Rhinovirus
- Influenza
Name 3 causative organisms of non-viral ARS.
Bacterial infections such as:
- Streptococcus pneumoniae
- Haemophilus influenzae
- Moraxella catarrhalis
How long does it take for viral ARS to resolve of symptoms?
5 days
How long does it take for non-viral ARS to resolve of symptoms?
Persist after 5 days
Describe how to manage patients with ARS.
- Analgesia
- Nasal decongestants
- Topical nasal steroids
- Oral antibiotics
Name some factors that predispose patients to CRS.
- Allergy
- Infections
- Ciliary impairment: cystic fibrosis (present in 40% of patients)
- Anatomical abnormalities: septal deviation and abnormal uncinate
- Immunocompromised host
- Aspirin hypersensitivity
- Atmospheric irritants: smoking, dusts, fumes.
- Hormonal: pregnancy and hypothyroidism
- Trauma
- Foreign body
- Swimming and diving
Do nasal polyps require biopsy for histological diagnosis?
Not as long as there are no worrying signs from the history and examination
Describe how you would investigate a patient with CRS.
- Skin prick tests if allergy suspected
- CT Sinuses
Describe how you would conservatively manage a patient with CRS.
- Avoidance of possible allergens
- Nasal douching
Describe how you would medically manage a patient with CRS.
- Antihistamines
- Topical nasal steroids
- Oral steroids (1 week course) in severe cases
- Oral antibiotics
Describe how you would surgically manage a patient with CRS.
- Nasal polypectomy: very high rate of recurrence
- Functional Endoscopic Sinus Surgery to improve ventilation/drainage of
sinuses
What type of hypersensitivity reaction is allergic rhinitis?
IgE-mediated, type 1
What percentage of the western population is affected by allergic rhinitis?
Approx 30%
What atopic condition is associated with allergic rhinitis?
Asthma
What is meant by perennial allergic rhinitis?
Sometimes with seasonal exacerbations
Name some commonly reported allergens from patients with allergic rhinitis.
- Pollens
- Moulds
- House dust mites
- Animal epithelia.
Describe the class-action system used by Allergic Rhinitis according to its Impact on Asthma (ARIA).
This is based on the duration, and severity of symptoms:
Duration:
- Intermittent: symptoms < 4 days per week, and less than 4 weeks
- Persistent: symptoms > 4 days per week, and more than 4 weeks
Severity:
- Mild: normal daily activities, and sleep. No troublesome symptoms
- Moderate to severe: Impairment of daily activities and sleep.
Describe the pathophysiology behind allergic rhinitis.
Allergic reaction leads to synthesis and release of arachidonic acid metabolites (prostaglandin D & leukotrienes) and mast cell degranulation to release histamine.
The effect is to increase capillary permeability which leads to congestion, oedema, rhinorrhoea, sneezing and irritation.
Describe how you would investigate a patient with allergic rhinitis.
- Skin prick tests (SPT) for specific allergens
- RAST (adioallergosorbent) blood tests if SPT not possible
Describe how you would conservatively manage a patient with allergic rhinitis.
- Allergen avoidance
- Nasal douching
Describe how you would medically manage a patient with allergic rhinitis.
- Antihistamines
- Topical nasal steroids
