Rhinology, Nasal obstruction and sinusitis Flashcards
Causes of rhinorrhea and post nasal drainage
allergic rhinitis, nonallergic rhinitis, vasomotor rhinitis, and acute and chronic rhinosinusitis
Causes of nasal obstruction and pain
- anatomic deformities (including septal and external nasal deviation, nasal valve compromise, turbinate hypertrophy, nasal polyps)
- inflammatory changes resulting in mucosal edema
Patients with what kinds of rhinitis present with clear rhinorrhea, no other allergic symptoms or history, and allergy tests are negative?
- Vasomotor (food, temp and sudden bright light trigger it)
2. nonallergic rhinitis
Best tx for nonallergic and vasomotor rhinitis
Intranasal steroid sprays
What virus is acute viral rhinosinusitis frequently attributed to?
Rhinovirus (common cold)
Which is false regarding the common cold?
A. pathophysiology involves infection, inflam, mucosal swelling and inc mucus
B. High grade fever, facial discomfort and purulent nasal drainage
C. Symptomatic tx w/antipyretics, hydration, analgesics, decongestion
D. Spontaneous resolution in 7-10days
E. Abx discouraged
B - low grade
Prolonged mucosal edema can cause sinus obstruction and retention of secretions. This is called what?
Acute bacterial rhinosinusitis
Which is not a major symptom of acute rhinosinusitis? A. Ear fullness/pressure B. Facial pressure/pain C. Facial congestion/fullness D. Purulent nasal discharge E. Nasal-obstruction, anosmia
A. Minor symptom. Other minor include headache, fever, cough, fatigue, toothache, halitosis
Over ___% of patients with viral URI also have an abnormal sinus CT scan?
80% - this means plain films or CTS do not differentiate acute bacterial rhinosinusitis from a viral URI
How can you differentiate between a viral vs bacterial infection?
Viral takes 7-10 days to resolve
Symptoms >7-10 days or worsens after 5 days suggests bacterial
organisms that cause acute otitis media?
S pneumonia
H influenza
Moraxella catarrhalis
How do you break down acute, subacute and chronic rhinosinusitis?
Acute: less than 1 mo
Subacute: more than 1 mo but less than 3mo
Chronic: more than 3 mo(diff underlying microbiology w/inc # anaerobes)
What is the tx of choice for acute rhinosinusitis (as well as AOM)?
What if there is resistance?
- 10 day course of amoxicillin or trimethoprim/sulfamethoxazole
- Amoxicillin/clavulanate or 2nd gen cephalosporin or macrolide or quinolone
Must cover H influenza
Oxymetazoline is what kind of adjuvant tx for acute rhinosinusitis?
Topical decongestant
Guaifenisen is what kind of adjuvant tx for acute rhinosinusitis?
Mucolytic
Which is correct about when you should call oto about acute rhinosinusitis?
A. 5-6 infections/yr
B. Infection doesn’t respond to one 3 week course of abx
C. Nasal polyps
D. Must have at least 2 complications of sinusitis
C.
A. 3-4
B. two 3 week courses
D. Any complications of sinusitis
What kind of sinusitis can result in orbital cellulitis or abscess and presents with eyelid swelling, proptosis and diplopia? Tx?
Ethmoid sinusitis
Surgical drainage ASAP if abscess present, IV abx and decongestants if no abscess.
What kind of sinusitis can cause ophthalmoplegia (eye mm paralysis), meningitis, and cavernous sinus thrombosis?
Sphenoid sinusitis
Cavernous sinus thrombosis is a complication with even more grave implications than meningitis or brain abscess, and it carries a mortality of ~__ %. Can be caused by what?
50%
Sphenoid sinusitis
Pt w/ double vision and rhinosinusitis is assumed to have what until ruled out by CT or MRI?
Cavernous sinus thrombosis
Tx of sphenoid sinusitis?
High dose IV abx
Surgical drainage of paranasal sinuses.
allergic disorder to fungi can result in severe symptoms of chronic sinusitis and significant inflammation in the sinonasal mucosa due to a preponderance of _____ ?
eosinophils
Fungal spores can also get trapped in a sinus, where they germinate and fill the sinus with debris, forming a “fungal ball” or _____
mycetoma
In what pts can certain fungal infections (e.g. mucormycosis) become invasive?
Immunocompromised or diabetic
ENT emergency!
Frequent cause of nasal obstruction?
Tx?
Septal deviation
May also snore and have obstructive sleep apnea
Rhinoplasty and septoplasty
What is this? Localized, extremely edematous nasal or sinus mucosa (microscopically full of water) Most common nasal mass
Nasal polyps
__% of patients with polyps also have allergies. What else do these patients have?
50
Asthma
Tx polyps?
Systemic steroids, intranasal steroid sprays
Surgery if polyps recur
Signs of polyps?
Grapelike swellings that protrude into lumen –> obstruction and anosmia
What is Samter’s triad?
Asthma
Allergy to aspirin
Nasal polyposis
Hard to tx
Unilateral nasal polyps may be a manifestation of what?
Neoplasm. Refer to oto
Polyps in kids is uncommon and should prompt a work up for what?
CF
Condition that develops when people repeatedly use decongestant nasal sprays over a long period and can cause nasal blockage.
Rhinitis medicamentosa
Why does rhinitis medicamentosa occur?
Tx?
Mucosa becomes inflamed due to spray. May be related to cocaine abuse
Stop spray use
Why might cocaine induce ischemic necrosis in the nasal septum?
Vasoconstricts –> nasal septal perforation
Why might a pt suffer from chronic rhinosinusitis even though they have a straight septum and no nasal polyposis or inflammation?
Blockage of sinus drainage (e.g. uncinate process is close to ethmoid bulla, forming the infundibulum where maxillary sinus drains) Swelling of the mucosa can block the sinus ostium.
How might a nasal polyp lead to sinusitis?
• Obstruction of the natural ostium of the sinus will cause a backup and may lead to sinusitis.
What are 3 intranasal masses with inflammatory etiologies?
- pyogenic granuloma
- wegner’s granulomatosis
- Sarcoidosis
What are 5 neoplasms of the nose/sinus?
- Inverting papilloma
- juvenile nasopharyneal angiofibroma
- Sinonasal undifferentiated carcinoma
- adenocarcinoma
- Esthesioneuroblastoma
