Upper Respiratory Tract Conditions Flashcards
What is Sinusitis?
Sinusitis is a reasonably common, painful condition affecting the paranasal sinuses.
It may present as a self-limiting acute condition or in predisposed individuals it may become chronic and recurring.
What causes sinusitis? What and the impacts on wellbeing?
- Acute viral upper respiratory tract infection (predominantly rhinovirus) is the leading aetiological cause of acute sinusitis
- Children and women are more likely to develop the condition - children as they are in crowded, mixed settings
- Autumn and winter are the main periods in which sinusitis develops
Usually with prompt treatment impacts on wellbeing are minimal. Chronic sinusitis may point to a more significant underlying cause which should indicate referral to reduce prolonged patient discomfort.
What are the signs and symptoms of sinusitis?
- Pain and tenderness, with possible swelling and pressure around your eyes, forehead, nose and/or cheeks, aggravated by bending forward
- Thick yellow or green nasal discharge which may also drain down the back of the throat (postnasal drip)
- Nasal congestion, interfering with breathing
What is the pathophysiology of Sinusitis?
- Normally, sinus cavities are sterile under healthy physiological conditions - things don’t easily get in there
- However infection or allergy causes swelling of mucous membranes surrounding the outlet of the sinuses, causing an outflow obstruction to sinus mucous - things can’t drain out as well which pools and stagnates
- Retained mucous is then vulnerable to becoming infected itself, leading to the
inflammation, pain and discharge characteristic of sinusitis
What is usual diagnosis and treatment of Sinusitis?
Diagnosis won’t usually require all of the below but:
* Physical examination
* Imaging (CT/MRI)
* Mucous cultures
* Allergy test
* Fibre optic examination of inside of sinus
Treatment
* Nasal sprays containing steroids
* Allergy medication
* Nasal irrigation with saline
How can herbs help with Sinusitis?
What herbal actions could you consider relevant for treating sinusitis? Anti inflammatory herbs would help as well as ones that support mucus membranes.
What are Nasal Polyps?
Non-painful abnormal, though not cancerous, lesions arising in either the paranasal sinuses or the mucosa of nasal passages so quite high up.
What are the signs and symptoms of Nasal Polyps?
Smaller polyps ted to be asymptomatic. Larger ones, you might get:
* Nasal congestion
* Postnasal drip
* Headache (if associated with sinusitis)
* Snoring - partner may complain!
* Runny nose
* Potential anosmia - loss of sense of smell
What is the pathophysiology of Nasal Polyps?
Tending to be associated more with non-allergic than allergic chronic
inflammation, with a possible genetic component, recurrent infections,
immune dysfunction and drug sensitivity (e.g. aspirin) may be implicated.
Asthma is an associated condition in a proportion of cases.
What is Allergic Rhinitis?
Most commonly recognised as seasonal hay-fever, this uncomfortable condition affecting the nose and eyes may - also manifest non-seasonally in response to exposure to allergens eg animal dander or mould spores.
What causes Allergic Rhinitis? What and the impacts on wellbeing?
Exposure to allergens. Although considered harmless, this condition can cause great discomfort and impact on work or school life
significantly.
What are the signs and symptoms of Allergic Rhinitis?
- Main one is sneezing with rhinorrhoea (runny nose)
- Nasal congestion and post-nasal drip
- Itching of the nose and eyes, ears, soft palate
- Anosmia - loss of sense of smell
- Earache and/or headache if congestion severe
- Watering red eyes and possible eye swelling
- Malaise with potential drowsiness and fatigue
What is the pathophysiology of Allergic Rhinitis?
Pathophysiology
* Interplay of inflammatory mediators; key player is IgE reacting to an extrinsic allergen protein – this **specific IgE excess **arises from allergic sensitisation (by prior exposure to the protein) in genetically susceptible individuals
* Main inflammatory mediators in allergic rhinitis are histamine, heparin and leukotrienes and prostaglandin D2 from pre-sensitised mast cells - herbs chamomile and ginko can help here
* Vascular permeability increases, vasodilation occurs, mucous cells and sensory
nerve endings are stimulated – leading to increased secretion, sensation of
congestion and the sneezing and coughing response of allergic rhinitis
What is usual diagnosis and treatment for Allergic Rhinitis?
Diagnosis
* Case history and physical examination
* Allergen skin prick tests
* Blood tests for IgE markers
* CT or MRI imaging if complications present suggesting anatomical abnormality (eg things might be draining as they should) or more severe underlying disorder
Treatment
* Antihistamine tablet, drop or spray
* Nasal corticosteroids
* Immunotherapy in treatment resistant cases
Local honey can help - a teaspoon a day ahead of hayfever season
What is Tonsilitis?
- Inflammation of palatine tonsils
- Tends to include lingual tonsils and also adenoids, presenting as pharyngitis
- Complications may include suppuration (pus), progression to chronic or recurrent tonsillitis and peritonsillar abscess
