Stuffy Nose Flashcards
what are the 2 main mediators of inflammation released by mast cells in type 1 sensitivity?
histamine
leukotrines
how does histamine cause blocked nose?
causes vasodilation of vessels
what types of drugs are used for stuffy nose?
topical corticosteroids
anti-histamines
decongestants
anticholinergics
what are the 4 core nasal symptoms?
blockage - stuffy
loss of smell - smell
discharge - snot
facial pain - sore
5 secondary symptoms of nasal problem?
dry mouth sore throat snoring halitosis loss of taste
name 4 other nasal symptoms
sneezing
itching
crusting
epistaxis
3 components of nasal examination?
airway patency
external nose
rhinoscopy
what are the 2 groups of rhinitis and what causes each?
infective = viral URTI non-infective = allergic/non-allergic
what might suggest an underlying allergy in rhinitis?
itching (nose, eyes, soft palate)
what can cause intermittent allergic rhinitis?
grass pollen
tree pollen
fungal spores
what can cause persistent allergic rhinitis?
house dust mite
cat
dog
what is the aria classification?
classification of severity of allergic rhinitis
intermittent allergic rhinitis?
symptoms <4 days per week
or symptoms present <4 weeks
mild allergic rhinitis?
normal sleep
no impairment of daily activities, sport and leisure
normal work and school
no troublesome symptoms
persistent allergic rhinitis?
symptoms > 4 days per week
and
>4 weeks duration
moderate-severe allergic rhinitis?
abnormal sleep
impaired daily activities, sport, leisure
missing work or school
troublesome symptoms
describe the step-wise approach to allergic rhinitis
allergen avoidance = best
antihistamines > topical steroids > topical steroids and antihistamines > immunotherapy for selected patients with IgE mediated disease > surgery for specific indications for relief of obstruction
causes of nasal obstruction?
mucosal hypertrophy
nasal polyps
what are nasal polyps associated with and how are they managed?
associated with non-allergic asthma
treatment = topical steroids, surgery if no better
how can you tell the difference between nasal poly and inferior turbinate?
polyp does not have sensation so can be touched and moved without being uncomfortable
what are 3 features of acute infective rhinosinusitis?
facial pain
discharge
nasal blockage/loss of smell
what normally causes acute infective sinusitis and how is it managed?
98% are viral
most are self limiting with analgesia and decongestants
only add antibiotic if persisting/worsening after a while
what is the danger in orbital cellulitis?
infection can spread to cavernous sinus which can cause thrombosis
how is rhinitis investigated if though to be allergic?
skin prick test
RAST (IgE)
what methods of investigations are not used in rhinitis?
nasal and sinus X rays
how is non-infective rhinitis managed non-pharmacologically?
allergen/irritant avoidance
HDM (house dust mites) specific IgE
change drug therapy
reduce alcohol etc
how is non-infective rhinitis managed pharmacologically?
topical nasal steroid +/- antihistamine
topical anticholinergic
how is infective rhinosinusitis managed?
nasal decongestant
analgesia
broad spectrum antibiotic if needed
how is nasal trauma managed?
assess breathing and any immediate problems
leave alone and reassess in 1 week
then surgery if needed (should be performed in <3 weeks)
how is nasal septal haematoma managed?
drain it out and suture perichondrium back together
how is a child with unilateral discharge managed?
refer urgently
possible foreign body in the nose
how is an adult with unilateral discharge managed?
refer urgently
possible nasal or paranasal tumour
orbital cellulitis can result as a complication of what?
acute sinusitis
what might ipratropium be used for?
to dry up a very runny nose
