The Stuffy Nose Flashcards
What immune process is a stuffy nose associated with?
IgE mediated type 1 hypersensitivity
What do mast cells release that promote a stuffy nose?
Histamine and leukotrienes
What are some drugs used to treat rhinitis?
Topical corticosteroids (beclomethasone)
Anti-histamines (cetirizine)
Anticholinergics (ipratropium)
Decongestants (pseudoephedrine)
What are the core nasal symptoms of rhinitis?
Blockage, loss of smell, discharge, facial pain (stuffy, smell, snot, sore)
What are some other nasal symptoms that may accompany rhinitis?
Sneezing, itch, crusting, epistaxis
What are some secondary symptoms to rhinitis?
Dry mouth, sore throat, snoring, halitosis, loss of taste
How may a nose be examined?
Airway patency, external nose, may use rhinoscopy
What are the types of rhinitis?
Infective (viral URTI) or non-infective
What is non-infective rhinitis divided into?
Allergic and non-allergic
What are some triggers that may cause intermittent allergic rhinitis?
Grass or tree pollen, fungal spores
What are some allergens that may cause persistent allergic rhinitis?
House dust mite, cat or dog
What is the ARIA classification for intermittent allergic rhinitis?
Symptoms <4 days per week of symptoms for <4 weeks
What is the ARIA classification for persistent allergic rhinitis?
Symptoms >4 days per week and >4 weeks duration
What is the ARIA classification for mild allergic rhinitis?
Normal sleep, no impairment of daily activities, normal work/school, no troublesome symptoms
What is the ARIA classification for moderate/severe allergic rhinitis?
One or more = abnormal sleep, troublesome symptoms, impairment of daily activities, missing work/school
What is the treatment pyramid for allergic rhinitis?
Step 1 = avoidance of allergen
Step 2 = antihistamines
Step 3 = topical steroids
Step 4 = topical steroids and antihistamines
When is immunotherapy given for allergic rhinitis?
For selected patients with IgE mediated disease
What are nasal polyps often associated with?
Non-allergic asthma
How are nasal polyps treated?
Oral then topical steroids, surgery if no improvement
How does acute infective rhinosinusitis present?
Facial pain, discharge, nasal blockage
What causes most cases of acute infective rhinosinusitis?
98% of cases are viral
How is acute infective rhinosinusitis treated?
Analgesics and decongestants, if worsening or persisting then add antibiotics
What are some causes of non-allergic rhinitis?
Nasal polyps, vasomotor rhinitis
What investigations are not recommended for rhinitis?
Nasal or sinus x-rays
What are some management options for non-infective rhinitis?
Allergen/irritant avoidance, HDM, change drug therapy, topical nasal steroid +/- antihistamine, topical anticholinergic
What are some treatment options for infective rhinitis?
Nasal decongestant, analgesia, broad spectrum antibiotic
What are some examples of nasal trauma injuries?
Septal haematoma, fracture, cartilage dislocation
How should unilateral nasal discharge be handled?
Urgent referral
What may be a cause of unilateral nasal discharge in an adult?
Nasal or paranasal tumour
What may cause unilateral nasal discharge in an infant?
Foreign body in nose
What may orbital cellulitis occur as a result of?
Complication of acute sinusitis
How does orbital cellulitis present?
Unilateral eye swelling = needs urgent referral
