Week 1.9 - Rhinology

Question 1

What history do we take for rhinology issues?

Answer 1

• obstruction
• discharge
• epistaxis
• facial pain
• nasal deformity
• anosmia
• sneezing

Question 2

What other history is relevant for rhinology issues?

Answer 2

• PMH of medical treatment or asthma/aspirin sensitivity
• smoking, alcohol, cocaine abuse

Question 3

What are some common nasal disorders?

Answer 3

• nasal trauma/deformity
• epistaxis
• rhinosinusitis
• nasal tumours/polyps
• choanal atresia

Question 4

What is the cause of nasal polyps?

Answer 4

unknown but can cause blockage. managed with nasal drops steroids long term to avoid polyp formaiton/worsening

Question 5

How do we carry out a nasal examination?

Answer 5

endoscopy - may be flexible or rigid. middle meatus is key as prone to blockage due to narrow
- look for bleeding, pus, polyp. tumour

Question 6

What investigations would you carry out in rhinology?

Answer 6

ONLY if you suspect something specific
- skin tests
- bloods
- nasal smear
- CT nose or MRI for cranial issue

Question 7

Who gets immunotherapy?

Answer 7

severe rhinitis patients - slowly build up tolerance to whatever they are reacting to

Question 8

What is significant about CF patients?

Answer 8

• thick mucus so sinuses blocked + full of polyps
• develop chronic inflamamtion with polyps.
• surgery to open up sinuses.

Question 9

What is the treatment for polyps?

Answer 9

• long term low bioavailability topical steroids - anti inflammatory so prevent worsening
• remove polyp surgically vie endoscopic sinus surgery first if drops cant reach back of nose
• treat co-existing acute rhinitis/asthma

Question 10

When may we consider a tumour?

Answer 10

if polyp is unilateral, bleeding, red, abnormal. polyps do NOT predispose cancer though

Question 11

What is acute sinusitis?

Answer 11

<4 weeks history of nasal blockage, discharge, congestion, drip, obstruction. usually self limiting and typically viral so no antibiotics
- antibiotics only if signs of complications

Question 12

What is a worrying complication of acute sinusitis?

Answer 12

abscess formation in posterior orbit or frontal sinus. neds immediate drainage and IV antibiotics as may spread to brain and cause abscess

Question 13

What is chronic sinusitis?

Answer 13

12+ weeks chronic blockage, discharge, pain, hyposmia. treat with topical steroids - works for most conditions

Question 14

For which conditions do we tend to give topical steroids?

Answer 14

acute + chronic sinusitis, rhinitis, lots of conditions

Question 15

What is ethmoidal mucocele?

Answer 15

ethmoid sinus blockage - pushes eye. leads to diplopia. drain mucocele - no nasal drops as wont reach

Question 16

What are main causes of epistaxis to consider?

Answer 16

• neoplastic
• traumatic
• infective
• inflammatory
• hereditary

Question 17

What is a hereditary cause of epistaxis?

Answer 17

HTT - weak vessels. cause nose bleeds to occur.

Question 18

What is angiofibroma?

Answer 18

tumour seen in male teenagers. severe bleeding if not embolised prior to removal. very severe and deadly

Question 19

How do we manage severe nose bleeds?

Answer 19

• arterial ligation if recurrent
• laser area of bleeding in HTT, or close up nose to reduce turbulence of air which may cause trauma
• septodermoplasty - very rarely done