The Nose

Question 1

Describe the functions of the nose. (6)

Answer 1

Smell
Route of air 
Filters air 
Humidifies air
Warms air
Resonating chamber for speech.

Question 2

Describe the lateral wall of the nasal cavity. (6)

Answer 2

3 bony projections called the superior (smallest), middle and inferior conchae.
3 meatuses (dents below conchae) called superior middle and inferior.
The Ostia connect the paranasal air sinuses and the nasolacrimal duct to the nasal cavity.

Question 3

Describe the purpose of the organisation of the lateral wall of the nasal cavity. (2)

Answer 3

Slows airflow by causing turbulence and by creating a large open space.

Question 4

Describe the medial wall of the nasal cavity. (3)

Answer 4

Bony (ethmoid and vomer) and cartilaginous parts.

Question 5

Explain the formation of saddle nose deformity. (4)

Answer 5

The nasal septum recieves it’s blood supply from perichondrium, meaning any impact can shear the blood vessels and cause blood to accumulate sub-perichondrially, a septal haematoma. This causes cartilaginous necrosis, and can lead to a saddle-nose deformity.

Question 6

Which nerves innervate the nose? (2)

Answer 6

Va and Vb of Trigeminal.

Question 7

Explain the purpose of having mixed types of mucous membrane. (4)

Answer 7

Olfactory mucous membranes house olfactory receptor neurones.
Respiratory mucous membranes have pseudostratified columnar ciliated epithelium which acts to filter (cilia), humidify (secretions from goblet cells) and warm air (vascular).

Question 8

Describe nasal polyps. (5)

Answer 8

Fleshy, benign, bilateral swellings of mucosa that are yellowish, non-tender and found often in the elderly.
Symptoms include watery rhinorrhoea, decreased smell, blocked nose.
A unilateral mass with blood suggests cancer.

Question 9

Describe rhinitis. (3)

Answer 9

Rhinitis is an inflammation of the nasal mucosal lining
Symptoms: congestion’s, rhinorrhoea, sneezing, post-nasal drip.
Cause is often infective (cold) or allergic.

Question 10

What are the signs that indicate foreign body? (2)

Answer 10

A child that presents with unilateral unusual discharge.

Question 11

Define epistaxis and it’s common pathology. (5)

Answer 11

A nosebleed.
Most common cause is anterior bleeding from Kiesselbach’s (Little’s) area (a plexus of ICA and ECA branches).
Less common and more serious is a posterior bleed from the sphenopalatine artery.

Question 12

Describe the treatment path for epistaxis. (4)

Answer 12

1 - hard pressure on the cartilaginous portion for 15 mins leaning forwards
2 - cautery with silver nitrate
3 - anterior packing with nasal tampons
4 - refer to ENT for posterior packing, ligation, surgery.

Question 13

Describe the paranasal sinuses. (4)

Answer 13

Air spaces found within bones (named according to the bone) which are extensions of the nasal cavity so lines with ciliated respiratory mucosa.
They help humidify and warm air, and reduce skull weight.
Drain into the nasal cavity via ostea into the nasal meatus.

Question 14

Describe sinusitis. (1)
Causes (4)
Presents (2)

Answer 14

Infection of the sinuses, often maxillary.
Can be caused by: dental abscess (Maxillary has roots of teeth in), and nasal cavity infections. This causes reduced ciliary function, oedema, increased secretions, impeded draining - creates a breeding ground for strep pneumonia and haemophilius influenzae.
Presents with recent URTI, pyrexia, blocked nose, rhinorrhoea, headache worse on leaning forwards.
Fluid levels can sometimes be seen on X Ray.