Rhinology Flashcards
- noses and sinuses - key points*
- -function nose re condition of air breathed(2)*
- -sinuses can be thought of what in relation to nasal airway(1)*
- -most sinuses drain where (1)*
- -the eustachian tubes drain opens into the postnasal space. when these are affected by disease what is a poss complication(1)*
- nose warms and humidifies air breather
- sinuses can be thought of as out pouchings of nasal airway. diseases affect one often have secondary effects on other
- most sinuses drain into middle meatus
- disease of eustachian tubes can often result in middle ear effusion and pt may notice reduced hearing
rhinitis - overview
- rhinitis defined as (1)
- most causes of rhinitis lead to broadly similar sx. common pcs/sx (5)
- how best to determine cause(2)
- rhinitis=inflammation of nasal lining. used interchangeably with rhinosinusitis
- pcs/sx - nasal congestion, rhinorrhoea, postnasal drip, sneezing, nasal irritation, oedema/swelling, congestion, itch
- hx and allergy tests
rhinitis-simple acute infective
- this is well known as the nasal effects of the common cold. most common cause of rhinitis
- usual aetilogy(1) spread how(1) usual course(1)
- complicated infective rhinusitis. aetiology(1) comps(2)
- usually viral, spread by droplet transmittion, usually mild and self limiting
- complications usually result due to secondary bacterial infection. can result in middle ear effusion , long running sinusitis
rhinitis - allergic
-aetiology(3) hypersensitivity type (1) sx (6)
-aetiology
>nasal lining become sensitive to particular allergens. can be inhaled or ingested
>allergens are absorbed by mucous membrane. causing hypersensitivity reaction (type 1 igE mediated).
>vasoactive substances eg histamine released
-local effects- oedema/swelling, congestion, rhinorrhea, irritation, sneezing, itch
rhinitis - allergic
-what is seasonal allergic rhinusitis(1)
>in summer common allergen(1) (=hayfever). typical sx(2)
> in autumn common allergen(1)
-seasonal allergic rhinusitis presenta at particular time of year
>in summer common allergen is grass pollen. hayfever typical sx watery, itchy eyes
>in autumn common allergen is fungal spores
rhinitis - allergic
-what is perennial rhinitis (1)
>common allergens(2)
>o/e of these pts (3). in long standing condition what may happen to turbinates (2)
-perennial rhinitis is rhinitis caused by allergen present all year round
>common allergens - house dust, house dust mite
>o/e - pale, damp nasal lining, oedema/swelling of turbinates. long standing condition turbinates can become permenantly hypertrophied and lose much of their erectile tissue
rhinitis - allergic
mx options (3)
-common inhaled allergens (5). common ingested allergens(4)
mx options - medication, allergen avoidance, occasionally turbinate surgery
- inhaled allergens - house dust, house dust mite, animal dander, feather, fungal spores, pollen
- inhested allergens - egg , milk, nuts, wheat
rhinits - allergic - mx
- allergen avoidance when single allergen has been identified. >obvious measures - regular vacuuming, washing sheets, avoidance of animal
- drug therapies (4)
-drug therapies
>antihistimines - topical nasal spray or oral nonsedating preparations
>steroids - topical nasal spray, oral in severe . may need long term
>sodium cromoglicate nasal spray - stabilizes mast cells. apply 4-6 times a day. good second line if pt can have/resistant to steroids
>montelukast - nasal spray. lukotriene receptor antagonist. good second line if pt can have/resistant to steroids
>allergen immunotherapy - effective. used in europe. not used in uk due to risk of anaphylaxis
non - allergic rhinits / vascular rhinitis
-diagnosis of exclusion. unclear aetiology. sx similar to allergic rhinitis however pt does not test positive to allergens. could be unidentified allergen.
-could be separate disease
>hx in some pts suggests positional and climatic factors eg temp change
>hx in some pts suggests alcholol or emotional trigger
-mx
-mx
>avoidance known precipitating factors, nasal steroids, anticholinergic ipratropium bromide if primary complaint is watery rhiniorrhoea, surgery in cases with turbinate hypertrophy
septal deviation
- aetiology (2)
- complications
- mx(1)
- trauma during descent down the birth canal, trauma later in life, differential growth rates between septum and rest of midface can lead to buckled deviation
- complication is symptomatic nasal obstruction.
- mx is septal sugery. to correct deviation. can remove deviated cartilage or bone. can mobilize and reposotion deviated cartilage.
external nasal skeleton
- this is in objectives but it is not a disease. assume it means fractured external nasal skeleton*
- -*fractured nose or query fractured nose common presentation
- image shows mx
epistaxis
- common. usual course(1)
- causes. local (4). systemic(4). causes may be in combination
-usual course is mild and self limitting. however can be life threatening. can also be v distressing for pt.
-local causes
>idiopathic common
- >trauma inc digitalcommon*
- >*infection
>tumour unilateral severe nosebleed in adolescent boy should raise suspicion of juvenile angiofibroma
-systemic causes
>coagulopathy - eg haemophilia, von willebrands disease, leukaemia, disseminated intravascular coagulatioon
>htn - alone rarely causes nosebleed but if present it can prolong and worsen nosebleed
>use of antcoagulants eg warfarin and antiplatelets eg nsaids
>hereditory haemmorhagic telangiectasia (HTT)
here multiple abnormal capilliaries occur in resp, gi, urogenital tracts and skin = telangiectasias. mx lazer cautery of the telangiectasias.
epistaxis - most common site of bleeding is ant septum due to rich blood supply and propensity for digital trauma
-mx
>first aid (4)
>action in emergency/rescus situation (8)
>o/e if nose bleed is visible/in anterior part of septum/littles area (2)
>o/e if bleeding severe or posterior/not visible or cautery failed (1)
refer to ent if failure to control, rescus, nose packed, recurrent, unable to cauterize
-mx
>first aid-lean forward, avoid swallowing blood, pinch fleshy part of nose for 10min aqpply icepack on nasal bridge
>action in emergency- a, b, c-assess blood loss, assess pulse, assess bp, gain iv access, set up iv fluid, take fbc, assess coagulation, group and save.
>o/e if nose bleed is visible/in anterior part of septum/littles area - apply local anaesthetic eg lidocaine and attemnpt nasal cautery
>o/e if bleeding severe or posterior/not visible or cautery failed - pack the nose
OSA
-pathophysiology(3). complication of long term (1)
pathophyiology
- upper airways collapse
- chest movements continue in an effort to shift air through obstructed segement
- with time blood o2 levels fall.
- at a low level a central reflex is activated. causes pt to wake and take a deep breath to overcome obstruction
comp - long term these periods of desaturation may lead to pulmonary htn > rv strain > ventricular failure > cor pulmonale
obstructive sleep apnoea - signs
- o/e - at end of bed(1).
- ent examinatin should pay attention to poss causes. nose and nasopharynx (3). mouth and oropharynx (3). trachea and laryngopharynx (1) see image
- o/e - overweight, esp on neck
- in children almost always occurs due to adenotonsillar hypertrophy
image shows surface anatomy
image shows external nasal skeleton
image shows nasal cavity - saggital section
-image shows turbinates/concha - coronal section
image shows paranasal sinuses
1 – Frontal sinuses
2 – Ethmoid sinuses
3 – Sphenoid sinuses
4 – Maxillary sinuses
