Rhinology Conditions Flashcards
Examples of outpatient conditions
-Allergic rhinitis
-Chronic rhinosinusitis
-Nasal polyposis
-Facial pain
-Epistaxis
-Nasal tumours
-Septal deformities
-Bony deformities
Types of rhinitis
-Allergic
=>20% population
=Significant effects on QOL (school and work)
=Seasonal (secondary to pollens= hay fever)/ perennial (throughout year)/ occupational
-Non-allergic
=Eosinophilic, multifactorial aetiology
-Infective
=Viral (mostly)
=Bacteria, fungi, protozoa (rare)
Symptoms suggestive of allergic rhinitis
2 or more of the following symptoms for >1h on most days
-Clear watery anterior rhinorrhoea, post nasal drip
-Sneezing, especially paroxysmal
-Nasal obstruction (bilateral)- painful enlarged inferior Turbinates
-Nasal pruritis
+/- Conjunctivitis
-Fatigue and irritability
Symptoms usually not associated with allergic rhinitis
-Unilateral symptoms
-Nasal obstruction without other symptoms
-Mucopurulent rhinorrhoea
-Posterior rhinorrhoea (post nasal drip)
=With thick mucous
=And/or no anterior rhinorrhoea
-Pain
-Recurrent epistaxis
-Anosmia
ARIA Classification of allergic rhinitis
-Intermittent symptoms
=<4 days/week or <4 weeks at a time
-Persistent
=4 days/week and 4 weeks at a time
-Mild
=Normal sleep, daily activities, work and school, no troublesome symptoms
-Moderate-severe
=Abnormal sleep, daily activities, work and school, troublesome symptoms
Diagnosis of AR
-History
-Skin prick testing/ Serum specific IgE
-Allergen/ irritant avoidance
-Douching
-Therapeutic trial of antihistamine or intranasal corticosteroid
Management of AR
-Avoid allergen
-Mild= oral/topical non-sedating a-H1
-Moderate/severe= topical nasal steroid (6-8 weeks regular use for result)
-Watery= + ipratropium
-Itch/sneeze= non-sedating a-H1
-Catarrh= LTRA if asthmatic
-Blockage= decongestant (rebound hypertrophy of nasal mucosa upon withdrawal), OC, long-term long acting non-sedating aH1 topical azelastine/LTRA
-Consider immunotherapy if Sx predominantly due to one allergen
Acute rhinosinusitis definition
2 or more of
-Nasal obstruction or discharge (thick and purulent)
+/- frontal pain, headache (pressure worse on bending forward)
+/- Sense of smell change for<12 weeks (can be recurrent)
Inflammation of mucous membranes of paranasal sinuses
Acute viral rhinosinusitis definition
Common cold <10 days
Acute post-viral rhinosinusitis
> Symptoms after 5 days, persisting >10 days but <12 weeks
Acute bacterial rhinosinusitis
> 10 days <4 weeks
At least 3 of:
-Discoloured discharge
-Severe local pain
->38.0
-Raised ESR/CRP
-Double sickening (viral worsened by bacterial)
Strep pneumoniae, haem infl
Chronic rhinosinusitis overview (with/without polyps)
-As ARS (>12 weeks)- inflammatory disorder of paranasal sinuses and linings of nasal passages
-Predisposing factors: atopy, obstruction, recent local infection, swimming, smoking
-Presentation: frontal facial pressure pain worse on bending forward, nasal discharge (clear= allergic, purulent= infection), mouth breathing, post-nasal drip (chronic cough), fatigue
-Investigation: anterior rhinoscopy (polyps= insensate, purulence, structural abnormalities), nasal endoscopy, sinus CT with contrast to exclude skull base fracture and tumour?
-Management= avoid allergen, intranasal corticosteroids, nasal irrigation with saline solution
-Red flags: unilateral, persistent symptoms despite compliance with 3 months treatment, epistaxis
Diagnosis of acute rhinosinusitis
-Examination of anterior rhinoscopy
-X-ray/ CT not recommended
-Clinical diagnosis
Management of common cold
-Symptoms less than 5 days or improving thereafter
-Symptomatic relief
=Analgesia
=Nasal saline irrigation
=Decongestants
=Selected herbal compounds
-No effect after 10 days treatment= topical steroids
Management of moderate post viral acute rhinosinusitis
-Topical steroids (7-14 days)
-Referral to specialist if no effect after 14 days of treatment
Management of severe ARS
-Topical steroids
-Consider antibiotics (phenoxymethylpenicillin, co-amoxiclav)
-Refer to specialist if no effect in 48hr
Treatment for trauma and deformity
-MUA
-Septoplasty
-Rhinoplasty
-Septorhinoplasty
Causes of congenital nasal obstruction
-Choanal atresia
Causes of acquired nasal obstruction
-Inflammatory
=Infective
=Non-infective
-Neoplastic
-Traumatic
-Iatrogenic
-Vascular
-Endocrine
-Metabolic
-Autoimmune
-Degenerative
-Psychogenic
Examples of traumatic/ structural rhino problems
-Narrow nose
-Alar deformity/collapse
-Dorsal deformity
-Nasal septal deformity
-Septal haematoma/abscess
-Septal perforation
-Turbinate deformity
=Hypertrophy
=Concha bullosa
=Accessory
-Foreign Body
Iatrogenic nasal deformity
-Rhinitis medicamentosa
-Drugs
=Alcohol
=Antithyroid
=OCP
-Atrophic rhinitis
Medical treatment of structural obstruction
-Treatment of associated rhinitis may be sufficient
-Alar dilators
Surgical treatment of structural obstruction
-Turbinate surgery
-Septoplasty
-Rhinoplasty
-Alaplasty
Causes of snoring
-OSA / Hypapnoea
=Sleep study
=Epworth
-Treat nasal disease
=Medical
=Surgical
-Mandibular Advancement Splints
Causes of facial pain
-Rhinosinusitis (CRS rare)
-Migraine
-Cluster headaches
-Midsegment facial pain
-Trigeminal neuralgia
-Paroxysmal hemicrania
-Hemicrania continua
-Drug-dependent headache
Examples of crusting/ granulomatous disease
-Sarcoidosis
-Wegners
-Giant cell granuloma
-Churg-Strauss
-Cholesterol Granuloma
-T cell/NK cell Lymphoma
-Syphilis, TB, Leprosy, Scleroma
-Atrophic Rhinitis
Red flags
-Unilateral
-Sero-sanguinous discharge
-Orbital signs (diplopia)
-Dental signs (wobbly teeth)
-Trigeminal symptoms (change in facial sensation)
Overview of nasopharyngeal carcinoma
-Squamous cell carcinoma of nasopharynx, EBV/ HPV
-Presentation: cervical lymphadenopathy, otalgia, unilateral serous otitis media, nasal obstruction, discharge/ epistaxis, cranial nerve palsy
-Investigation: nasal endoscopy, biopsy/ FNA, CT/MRI
-Management: radiotherapy
Overview of pharyngitis
-Presentation: sore throat, children/ adolescent, viral (spring/summer, rhinorrhoea, nasal congestion, cough), bacterial (autumn/winter, absence of cough, cervical adenopathy, pharyngeal exudate). Can have nausea, vomiting, headache, fever
-Investigation: rapid antigen detection for group A strep/ PCR
-Management: analgesic, antibiotics for GAS
Overview of laryngitis
-Presentation: recent UTRI, hoarseness, dysphagia, sore throat, odynophagia, cough
-Investigation: laryngoscopy (oedema, erythema)
-Management: supportive care, vocal hygiene
