Rhinology

Question 1

Common presenting symptoms in rhinology cases (9)

Answer 1

Nasal obstruction
Rhinorrhoea (nasal discharge)
Epistaxis
Facial pain
Post nasal drip - excess mucous drips down back of nose into nasopharynx (upper throat)
Nasal deformity
Anosmia - loss of smell
Hyposmia - impaired/reduced smell
Sneezing

Question 2

Name some nasal examination techniques (2)

Answer 2

Auriscope

Nasal speculum - tool used to widen nostril to see into it more clearly

Question 3

Investigations of rhinology cases

• blood tests (4)
• imaging (3)
• other (2)

Answer 3

Rigid/flexible nasal endoscopy
Skin test - to test for allergy

Blood tests

• FBC
• RAST (radioallergosorbent test)
• antineutrophil cytoplasmic antibodies (are autoantibodies)
• ACE (angiotensin converting enzyme) test

Imaging

• CT sinuses
• MRI

Rhinomanometry

Question 4

What does rhinomanometry measure

Answer 4

Nasal airway resistance and airflow, so measuring degree of nasal obstruction

Question 5

Name some disorders of the nose (7)

Answer 5

Nasal trauma, e.g. septal haematoma
Epistaxis
Rhinitis
Rhinosinusitis
Nasal polyps
Nasal tumour
Choanal atresia

Question 6

Rhinosinusitis is just referred to as

Answer 6

Sinusitis

Question 7

What is samter’s triad (consists of 3 things)

Answer 7

Chronic condition that consists of asthma, sinus inflammation with recurrent nasal polyps, and a sensitivity to aspirin and other NSAIDs

Question 8

What is samter’s triad also referred to as

Answer 8

Aspirin exacerbated resp disease or aspirin sensitive asthma

Question 9

Symptoms/signs of samter’s triad (7)

Answer 9

Increased nasal congestion/stuffiness
Eye watering/redness
Cough, 
wheezing
chest tightness
Frontal headache
Sinus pain

Question 10

Rhinosinusitis =

Answer 10

inflammation of the nasal cavity and the paranasal air sinuses

Question 11

How long do symptoms last in acute rhinosinusitis

Answer 11

<12 weeks

Question 12

Rhinosinusitis usually caused by bacteria or viruses + name some causative bacterial/viral organisms

Answer 12

Viruses - usually
- rhinoviruses

Bacteria

• strep pneumoniae
• H. influenza
• staph. aureus
• M. catarrhalis

Question 13

Symptoms of rhinosinusitis (6)

Answer 13

Rhinorrhoea
Nasal congestion/obstruction
Facial pain/pressure
Hyposmia/ anosmia
Post nasal drip
Cough

Question 14

Define recurrent acute rhinosinusitis

Answer 14

> 1 but <4 episodes of acute rhinosinusitis per year

Question 15

How long do symptoms last in chronic rhinosinusitis

Answer 15

> 12 weeks

Question 16

Main radiological investigation of rhinosinusitis

Answer 16

CT sinuses

Question 17

Treatment of rhinosinusitis

Answer 17

If bacterial

• b lactase (penicillins, cephalosporins)
• macrolides (Erythromycin, clarithromycin) - better penetration of sinuses

Question 18

What antibiotics have better penetration of sinuses

Answer 18

MacROlides, e.g. erythromycin

Question 19

Complications of rhinosinusitis

Answer 19

Periorbital cellulitis
-needs oral or IV antibiotics

Pott’s puffy tumour (RARE)

Question 20

What is a pott’s puffy tumour + treatment (2)

Answer 20

RARE complication of frontal sinusitis
Not actually a tumour, is an abscess

Surgical drainage of abscess
Endoscopic sinus surgery - to explore and drain frontal sinus

Question 21

Treatment of a nasal fracture (2)

Answer 21

Digital manipulation - moving the bones back into placebo hand ASAP

Rhinoplasty - plastic surgery to reshape nose if left uncorrected for months

Question 22

Causes of nasal polyps (4)

Answer 22

Idiopathic
Chronic inflammation - asthma, recurring infection, allergies etc
Genetic predisposition
Autonomic nervous system dysfunction

Question 23

What are nasal polyps

Answer 23

prolapsed swellings of the mucosal lining of the paranasal air sinuses

Question 24

Name some allergic conditions associated with nasal polyps

Answer 24

Asthma

Allergic rhinitis

Question 25

Name some non- allergic conditions associated with nasal polyps

Answer 25

CF | Allergic fungal sinusitis

Question 26

Nasal polyps can be associated with sensitivity to what drug

Answer 26

Aspirin

Question 27

Investigations of nasal polyps (6)

Answer 27

RAST (Radioallergosorbent test) Skin test Nasal smear CT of sinuses Nasendoscopy

Question 28

If CF suspected in someone with nasal polyps, what test can you do

Answer 28

Sweat test

Question 29

Treatment of nasal polyps (4)

Answer 29

Oral/nasal steroids Immunotherapy - can treat aspirin sensitivity by giving a bit of aspirin; increasing every day Polypectomy Endoscopic sinus surgery - microdebrider may be used to remove any polyps to enlarge sinuses

Question 30

What enhances the surgical effect of polypectomy (for nasal polyps)

Answer 30

Steroids

Question 31

What is a mucocele

Answer 31

Benign, mucous-containing lesion

Question 32

Mucoceles (benign, mucous-containing lesion ) can occur in the paranasal sinuses due to what things (3)

Answer 32

Obstruction of the ostium (opening) of a sinus due to inflammation, trauma, mass lesion

Question 33

Mucoceles commonly occur in what sinus

Answer 33

Frontal

Question 34

When sinus mucoceles cannot naturally drain through the nose. Instead, they grow and slowly invade adjacent tissues leading to what...

Answer 34

Orbital mucocele which can displace the eye

Question 35

Treatment of sinus mucoceles

Answer 35

Drainage and marsupialisation - cutting a slit into the abscess/cyst and suturing the edges of the slit to form a continuous surface from the exterior surface to the interior surface of the cyst or abscess so it remains open drains freely

Question 36

Causes of epistaxis (5)

Answer 36

``` Idiopathic - commonest Infection Trauma Allergy Hereditary haemorrhage telangiectasia (HHT) - malformation of blood vessels ```

Question 37

Initial management of epistaxis (1) + further management (3)

Answer 37

Pinch soft part of nose Cauterise artery - with silver nitrate Nasal packing Endoscopic sphenopalatine artery ligation/ ligation in general

Question 38

Treatment of hereditary haemorrhagic telangiectasia (HHT) (3)

Answer 38

Laser coagulation Septodermoplasty - graft stratified squamous epithelium and dermis to replace the mucous membrane of the nasal septum Young's procedure (closure of nostrils)

Question 39

What is the young's procedure

Answer 39

Closure of nostrils - used in HEREDITARY HAEMORRHAGIC TELANGIECTASIA