The Stuffy Nose Flashcards
4S symptoms that are core nasal?
Stuffy (blockage)
Smell (loss of smell)
Snot (discharge)
Sore (facial pain)
Other nasal symptoms?
Sneezing
Itch
Crusting
Epistaxis
Secondary nasal symptoms?
Dry mouth (when unable to breathe through nose)
Sore throat
Snoring
Halitosis
Loss of taste
3 main points to cover in a nasal examination?
Airway patency:
• Adults - cover one nostril and ask them to breathe out through the other
• Children - place a mirror under the nose for nasal vapour
When do nasal symptoms warrant further Ix?
Esp. if they are UNILATERAL
Potential causes of stuffy nose?
Rhinitis (+ sinusitis)
Nasal trauma
2 categories of causes of rhinitis?
- Infective:
• Viral URTI - Non-infective:
• Allergic
• Non-allergic
Timing of stuffy nose?
Intermittent (seasonal)
Persistent (perennial)
Potential allergic causes of intermittent rhinitis?
Tree pollen (spring)
Grass pollen (summer)
Fungal spores (autumn)
Potential allergic causes of persistent rhinitis?
House dust mite
Cat
Dog
Classification criteria for intermittent rhinitis?
Symptoms for <4 days per week
OR
Symptoms for <4 weeks
Classification criteria for persistent rhinitis?
Symptoms >4 days per week
AND
> 4 weeks duration
Classification criteria for mild rhinitis?
All of the following: • Normal sleep • No impairment of daily activities, sport, leisure • Normal work/school • No troublesome symptoms
Classification criteria for moderate-severe rhinitis?
One or more of: • Abnormal sleep • Impairment of daily activities, sport, leisure • Missing work/school • Troublesome symptoms
Stepwise management of allergic rhinitis?
Allergic avoidance is key along with:
- Anti-histamines
- Topical steroids
- Topical steroids + anti-histamines
Immunotherapy is for selected patients with IgE-mediated disease
Surgery has specific indications and is for relief of obstruction
Consqeuences of allergic disease?
Mucosal (turbinate) hypertrophy
Occurrence of nasal polyps assoc. with?
Often with non-allergic asthma and Samter’s triad
Treatment of nasal polyps?
Oral then topical steroids
If no relief, surgery
Symptoms of acute infective rhinosinusitis?
Facial pain
Nasal blockage and discharge
Cause of acute infective rhinosinusitis?
Majority are viral
Treatment of acute infective rhinosinusitis?
Analgesics and decongestants
If persistent/worsening, add an antibiotics
Complications of rhinosinusitis?
Orbital cellulitis and abscess - pus in the orbit due to proximity to ethmoid sinus; can lead to blindness, meningitis and death and so requires urgent referral
Presentation of orbital abscess?
Unilateral periorbital puffiness
In summary, what are the causes of rhinitis?
ADD PICTURE
Ix in rhinitis?
Skin prick tests
RAST (specific IgE levels)
NOTE: nasal and sinus X-rays are not useful in rhinitis
Management of non-infective rhinitis?
Behavioural changes: • Allergen/irritant avoidance • House dust mite exposure reduction • Change drug therapy • Alcohol reduction
Pharmacological therapy:
• Topical nasal steroid
• +/- anti-histamine
• Topical anticholinergic
Management of infective rhinosinusitis?
Nasal decongestant
Analgesia
Potential broad-spectrum antibiotic
Potential cause of congestion in children if they are not allergic and auroscope shows normal nose?
Plug of adenoid tissue
Difference in potential cause of unilateral discharge in children and adults?
Young children - foreign body in the nose
Adult - nasal/paranasal tumour
BOTH REQUIRE URGENT REFERRAL
Pharmacological therapies for stuffy nose?
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