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ENT (nose) > Rhinosinusitis > Flashcards

Rhinosinusitis Flashcards

1
Q

Define rhinosinusitis

A

Inflammation of the nose and paranasal sinuses

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2
Q

What is it characterised by?

A

2 or more symptoms, one of which should be:
Either nasal blockage/obstruction/congestion or nasal discharge (anterior or posterior nasal drip)

+/- Facial pain/pressure
+/- Reduction or loss of smell

And either:
Endoscopic signs of polyps, mucopurulent discharge or oedema in middle meatus

And/or
CT changes - mucosal changes within the osteomeatal complex or sinuses

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3
Q

How is it classified?

A

Acute (ARS)

Chronic (CRS)

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4
Q

How long does ARS last?

A

Less than 12 weeks, complete resolution of symptoms

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5
Q

What can ARS be divided into?

A

Viral and non viral

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6
Q

How long does CRS last?

A

More than 12 weeks without complete resolution of symptoms

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7
Q

What can CRS be divided into?

A

With nasal polyps

Without nasal polyps

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8
Q

What is another term for viral ARS?

A

Common cold

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9
Q

What is viral ARS caused mainly by?

A

Rhinovirus

Influenza virus

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10
Q

Viral ARS normally has resolution of symptoms with how many days?

A

5 days

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11
Q

How long does non viral ARS last and what causes it?

A

Persistence of symptoms after 5 days
Streptococcus pneumoniae
Haemophilius influenzae
Moraxella catarrhalis

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12
Q

What can predispose ARS?

A

Allergy

Ciliary impairment

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13
Q

How is ARS managed?

A

Analgaesia if required
Nasal decongestants
If persists longer than 5 days consider - topical nasal steroids and oral antibiotics

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14
Q

What can predispose chronic rhinosinusitis with or without nasal polyps?

A 
Allergy 
Infections 
Ciliary impairment - CF 
Anatomical abnormalities- septal deviation, abnormal uncinate process
Immunocompromised 
Aspirin hypersensitivity 
Atmosphere irritants - smoking, dust, fumes 
Hormonal - pregnancy, hypothyroidism 
Trauma 
Foreign body 
Swimming and diving
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15
Q

Why is nasal congestion common during pregnancy?

A

Due to oestrogen and progesterone effect on nasal mucosal vascularity

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16
Q

What do nasal polyps represent?

A

The extreme end of the spectrum of inflammation seen in chronic rhinosinusitis

17
Q

Are polyps normally bilateral ?

A

Yes - as long as no worrying signs from history and examination, they do not require biopsy for histiological diagnosis

18
Q

Do all unilateral polyps require biopsy?

A

Yes

19
Q

What investigations can be done for CRS?

A

Skin prick rest if allergy suspected

Radiology: CT sinuses - if surgery planned, atypical features to history or examination

20
Q

How is CRS managed?

A

For majority there is no cure, treatment aimed at improving symptoms
Conservative- nasal douching, avoid allergens
Medical:
Antihistamines
Topical nasal steroids
Oral steroids - 1 week course in severe cases
Oral antibiotics

Surgical:
Nasal polypectomy
Functional endoscopic sinus surgery - improve ventilation /drainage
Septoplasty

21
Q

Does nasal polypectomy have high reoccurrence rates?

A

Yes

22
Q

What type of hypersensitivity reaction is allergic rhinitis?

A

Type 1 IgE mediated reaction in the mucous membranes of the nasal airways

23
Q

What does allergic rhinitis have a strong association with?

A

Asthma

24
Q

Allergic rhinitis can be seasonal ie summer hay fever or ..

A

Perennial

25
Q

What are the commonest allergens I’m allergic rhinitis?

A

Pollens
Moulds
House mites
Animal epithelia

26
Q

What are the duration of symptoms classified as in allergic rhinitis?

A

Intermittent : symptoms < 4 days per week and less than 4 weeks

Persistent: symptoms > 4 days per week and more than 4 weeks

27
Q

Define mild allergic rhinitis

A

Normal daily activities and sleep

28
Q

What investigations can be done (allergic rhinitis)?

A

Skin prick tests for specific allergens

Or RAST blood tests if SPT not possible

29
Q

How is allergic rhinitis managed?

A 
Allergen avoidance
Nasal douching
Antihistamines 
Topical nasal steroids
Immunotherapy

ENT (nose) (9 decks)

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