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
