Week 2 - H - Stuffy nose lecture

Question 1

Type 1 hypersensitivity reaction causing a runny nose What is this known as? (common name and medical name)

Answer 1

Hayfever - known as allergic rhinitis

Question 2

What are the symptoms of allergic rhinitis? (rhinoconjunctivitis)

Answer 2

Runny nose Itchy eyes Sneezing Lacrimation

Question 3

• Allergic rhinits can be split into intermittent and persistent When does intermittent and persistent occur?

Answer 3

Intermittent is usally seasonal Persistent is due to eg cats dogs

Question 4

How many weeks of the year does intermittent rhinitis occur?

Answer 4

Intermittent rhinitis occurs less than 4 weeks of the year Persistent rhinitis occurs more than 4 weeks

Question 5

Allergical rhinitis causes inflammation of the nasal mucosa What is the first and second line treatments for allergic rhinitis?

Answer 5

First line - anti-histamines (H1 receptor antagonist) Second line - topical intranasal steroids Can combine both if symptoms worsen

Question 6

What can be given to the patient with rhinitis who also has asthma? prevents a substance of the arachdonic pathway

Answer 6

Anti-leukotrienes

Question 7

In allergic rhinitis where the allergen is unavoidabe or medical therapy is inadequate, what can be given as treatment?

Answer 7

Topical intranasal immunosuppresants - suppresses the IgE causing degranulation of mast cells

Question 8

On CT scan of nose the nasal passageway should be black as air is black on CT however on blocked nose it shows up what colour?

Answer 8

Shows up white

Question 9

What is an example of non-allergic non-infective rhinitis (just inflammation of nasal mucosa) causing a blocked nose? associated with samter’s triad - explain?

Answer 9

Nasal polyps

• Samter’s triad - Nasal polyps, salicytate sensitivity and asthma

Question 10

Nasal polyps are a chronic inflammatory condition of the nose and paranasal sinuses.

• What are the symptoms of nasal polyps?
• Are they usually unilateral or bilateral?
• How are nasal polyps treated?

Answer 10

They are characterised by slow, progressive nasal obstruction, with accompanied reduction in sense of smell. Polyps will appear generally pale (yellow-grey colour), and insensate, while the turbinates are pink/reddish and will feel light to touch. At least a third of patients with nasal polyps will also have asthma. Polyps are usually bilateral

Treated with topical corticosteroids (intranasal steroid spray - for example, mometasone or fluticasone)

Question 11

When would you refer nasal polyps?

Answer 11

Refer nasal polyps -

• For confirmation of diagnosis or if “red flags” (be wary of patients presenting with unilateral symptoms or a unilateral polyp, as this may herald the presence of an underlying neoplasm.)
• Nasal polyps causing significant nasal obstruction.
• Poor response to nasal steroid spray e.g. mometasone furoate after 3 month trial (after assessing compliance and technique).
• Poor response to course of Flixonase® nasules or course of oral steroids with Flixonase® nasules.
• Patients with persistent symptoms despite maximum medical treatment may be referred for consideration of nasal polypectomy endoscopic sinus surgery.

Question 12

can cause necrosis of septal cartilage as the ‘blood bubble’ will stop the blood supply to the nose and requires urgent drainage?

Answer 12

this is a septal haemotoma

Question 13

What deformity to the nose can a septal haemotoma cause? Also present in wegners granulomatosis

Answer 13

Can cause saddle-nose deformity