Rhinology Flashcards
Common presenting symptoms in rhinology cases (9)
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
Name some nasal examination techniques (2)
Auriscope
Nasal speculum - tool used to widen nostril to see into it more clearly
Investigations of rhinology cases
- blood tests (4)
- imaging (3)
- other (2)
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
What does rhinomanometry measure
Nasal airway resistance and airflow, so measuring degree of nasal obstruction
Name some disorders of the nose (7)
Nasal trauma, e.g. septal haematoma Epistaxis Rhinitis Rhinosinusitis Nasal polyps Nasal tumour Choanal atresia
Rhinosinusitis is just referred to as
Sinusitis
What is samter’s triad (consists of 3 things)
Chronic condition that consists of asthma, sinus inflammation with recurrent nasal polyps, and a sensitivity to aspirin and other NSAIDs
What is samter’s triad also referred to as
Aspirin exacerbated resp disease or aspirin sensitive asthma
Symptoms/signs of samter’s triad (7)
Increased nasal congestion/stuffiness Eye watering/redness Cough, wheezing chest tightness Frontal headache Sinus pain
Rhinosinusitis =
inflammation of the nasal cavity and the paranasal air sinuses
How long do symptoms last in acute rhinosinusitis
<12 weeks
Rhinosinusitis usually caused by bacteria or viruses + name some causative bacterial/viral organisms
Viruses - usually
- rhinoviruses
Bacteria
- strep pneumoniae
- H. influenza
- staph. aureus
- M. catarrhalis
Symptoms of rhinosinusitis (6)
Rhinorrhoea Nasal congestion/obstruction Facial pain/pressure Hyposmia/ anosmia Post nasal drip Cough
Define recurrent acute rhinosinusitis
> 1 but <4 episodes of acute rhinosinusitis per year
How long do symptoms last in chronic rhinosinusitis
> 12 weeks
Main radiological investigation of rhinosinusitis
CT sinuses
Treatment of rhinosinusitis
If bacterial
- b lactase (penicillins, cephalosporins)
- macrolides (Erythromycin, clarithromycin) - better penetration of sinuses
What antibiotics have better penetration of sinuses
MacROlides, e.g. erythromycin
Complications of rhinosinusitis
Periorbital cellulitis
-needs oral or IV antibiotics
Pott’s puffy tumour (RARE)
What is a pott’s puffy tumour + treatment (2)
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
Treatment of a nasal fracture (2)
Digital manipulation - moving the bones back into placebo hand ASAP
Rhinoplasty - plastic surgery to reshape nose if left uncorrected for months
Causes of nasal polyps (4)
Idiopathic
Chronic inflammation - asthma, recurring infection, allergies etc
Genetic predisposition
Autonomic nervous system dysfunction
What are nasal polyps
prolapsed swellings of the mucosal lining of the paranasal air sinuses
Name some allergic conditions associated with nasal polyps
Asthma
Allergic rhinitis
Name some non- allergic conditions associated with nasal polyps
CF
Allergic fungal sinusitis
Nasal polyps can be associated with sensitivity to what drug
Aspirin
Investigations of nasal polyps (6)
RAST (Radioallergosorbent test)
Skin test
Nasal smear
CT of sinuses
Nasendoscopy
If CF suspected in someone with nasal polyps, what test can you do
Sweat test
Treatment of nasal polyps (4)
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
What enhances the surgical effect of polypectomy (for nasal polyps)
Steroids
What is a mucocele
Benign, mucous-containing lesion
Mucoceles (benign, mucous-containing lesion ) can occur in the paranasal sinuses due to what things (3)
Obstruction of the ostium (opening) of a sinus due to inflammation, trauma, mass lesion
Mucoceles commonly occur in what sinus
Frontal
When sinus mucoceles cannot naturally drain through the nose. Instead, they grow and slowly invade adjacent tissues leading to what…
Orbital mucocele which can displace the eye
Treatment of sinus mucoceles
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
Causes of epistaxis (5)
Idiopathic - commonest Infection Trauma Allergy Hereditary haemorrhage telangiectasia (HHT) - malformation of blood vessels
Initial management of epistaxis (1) + further management (3)
Pinch soft part of nose
Cauterise artery - with silver nitrate
Nasal packing
Endoscopic sphenopalatine artery ligation/ ligation in general
Treatment of hereditary haemorrhagic telangiectasia (HHT) (3)
Laser coagulation
Septodermoplasty - graft stratified squamous epithelium and dermis to replace the mucous membrane of the nasal septum
Young’s procedure (closure of nostrils)
What is the young’s procedure
Closure of nostrils - used in HEREDITARY HAEMORRHAGIC TELANGIECTASIA
