sinonasal disease (see DM) Flashcards
what is anosmia
no sense of smell
what is hyposmia
diminished sense of smell
what is rhinits
an inflammatory disorder of the nasal mucosa characterised by 2 or more of:
1. rhinorrhoea
2. blockage
3. itching sneezing
what is rhinorrhoea
runny nose
3 types of allergic rhinits
- persistent
- intermittent
- oral allergy syndrome
5 types of non-allergic rhinits
- non-allergic rhinits with eosinophilia syndrome (NARES)
- non-eosinophilis non-allergic rhinits (NENAR) -> aka idiopathic/vasomotor
- pregnancy rhinitis
- atrophic rhinitis -> primary or secondary
- rhinitis medicamentosa
what other conditions are allergic rhinitis associated with
asthma + atopic dermatitis -> atopic triad
intermittent acute rhinits classification
≤4 days per week or ≤4 weeks
persistent acute rhinitis classification
≥ 4 days per week AND ≤4 weeks
mild acute rhinitis classification (4)
- normal sleep
- no impariment of daily activities, sport etc.
- normal work and school
- no troublesome symptoms
peristent acute rihinits classification (4)
one or more of:
1. abnormal sleep
2. impairment of dialy activities
3. impairment of school
4. troublesome symptoms
what is acute rhinosinitis
10 days - 12 weeks of:
1. nasal blockage
2. hyposmia
3. mucopus dishcarge
4. facial pain or pressure
signs of acute bacterial rhinosinusitis (5)
at least 3 of:
1. fever > 38
2. double sickening
3. unilateral disease
4. severe pain
5. raised ESR/CRP
4 key organism involved in bacterial rhinosinusitis
- streptococcus pneumoniae
- haemophilus influenzae
- moraxella catarrhalis
- staphylococcus aureus
6 complications of sinusitis
- mucucole/ pyomucocoele formation
- osteomyelitis (pott’s puffy tumour)
- periorbital cellulitis
- silent sinus syndrome
- meningitis
- cranial nerve palsies
what is silent sinus syndrome
spontaneous, asymptomatic collapse of an air sinus associated with negative sinus pressures
silent sinus syndrome presentation (3)
- painless facial asymmetry (ptosis, eye retraction etc.)
- diplopia
- enophthalmos (secondary to collapse of orbital floor)
what are mucocoeles
benign, cystic and slow growing lesions located in the paranasal sinuses, which are believed to form due to obstruction of the sinus ostia
what is pott’s puffy tumour
a forehead swelling due to frontal bone osteomyelitis with associated subperiosteal abscess
what is periorbital cellulitis
an acute infection of the tissues surrounding the eye, which may progress to orbital cellulitis with protrusion of the eyeball -> meningitis is a complication
what is chronic rhinosinusitis
> 12 weeks of:
1. nasal obstruction/congestion
2. rhinorrhoea (mucopurulent)
3. hyposmia and/or facial pressure
+
evidence of mucopus/polyps/middle meatal oedema on endoscopy
secondary CRS classification (4)
- anatomically discrete, local pathology -> odontogenic, fungal ball or tumour
- diffuse distribution + mechanical -> Primary ciliary dyskinesia, CF
- diffuse distribution + inflammatory -> eosinophilia angiitis, Granulomatosis with polyangiitis (GPA)
- diffuse distribution + immunity -> selective IgA deficency
what is allergic fungal rhinosinusitis
an intense, localized allergic/eosinophilic inflammatory sinus disease that results in the accumulation of eosinophilic (allergic) mucin (a thick, tenacious eosinophilic secretion that contains fungal hyphae)
allergic fungal rhinosinusitis presentation (5)
Anesthesia, cranial nerve palsies, proptosis, headache and facial pain
2 causes of bilateral nasal obstruction
- rhinitis
- rhinosinusitis
5 causes of unilateral nasal obstruction
- neoplasia
- antro-choanal polyp
- deviated nasal septum
- foreign body
what should be avoided in those with nasal septal deviation
decongestants - may result in rhinitis medicamentosa
ddx for facial pain (5)
if there is only facial pain sinusitis is unlikely to be the cause
1. trigeminal neuralgia
2. cluster headaches
3. migraine
4. tension headache
5. atypical facial pain
red flag symptoms for facial pain (5)
- unilateral symptoms (e.g. bleeding, crusting, blockage)
- orbital symptoms
- neurological signs incl CN palsies
- severe frontal headaches
- clear, watery, unilateral rhinorrhoea
causes of olfactory disturbance (13)
- conductive (sino-nasal pathology, nasal obstruction)
- sensorineural (URTIs, trauma)
- iatrogenic
- cerebrovascular disease
- temporal lobe epilepsy
- intracranial neoplasia
- toxic exposure
- medical co-morbidity
- chronic alcoholism
- recreational drug use
- psyhogenic (schizophrenia0
- idiopathic
- Parkinsons
7 smell/taste disorders
- anosmia
- parosmia (smell doesnt correspond to stimulus)
- phantosmia (hallucination)
- troposmia (unpleasant parosmia)
- cacosmia (unpleasant phantosmia)
- ageusia (absent taste)
- dysgeusia (taste distortion)
4 iatrogenic causes for gustatory disorders
- tonsillectomy
- middle ear surgery
- microlaryngoscopy
- salivary gland surgery
mgx for post viral smell loss (4)
- steroids (+ ginko biloba?)
- theophylline
- pentoxifylline
- smell training
mgx for post traumatic smell loss
- early steroids
- same as post viral
