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Rhinitis Flashcards

1
Q

what is the definition of rhinititis?

A

Inflammation in the nose and paranasal sinuses with >2 symptoms, one of which must be nasal blockage/obstruction/congestion or nasal discharge +/ facial pain or pressure, reduction or loss of smell and either endoscopic or CT signs.

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2
Q

what are the different types of Rhinitits?

A

Allergic - intermittent, persistent
Non Allergic - vasomotor, polyps
Rhinosinusitis

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3
Q

what are the causes of allergic rhinitis?

A

o Intermittent – grass pollen, tree pollen, fungal

o Persistent – house dust mite, cat, dog

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4
Q

what is the pathophysiology of allergic rhinitits?

A

o Type I Hypersensitivity

o IgE mediated inflammation from allergen exposure to nasal mucosa causing inflammatory mediator release from mast cells

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5
Q

what are the clinical features

A

o Sneezing
o Pruritis
o Nasal discharge (bilateral & variable) and congestion
o Bilateral itchy red eyes
o Asthma
o Signs: turbinate may be swollen and mucosae pale or mauve, nasal polyps

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6
Q

what is the definition of intermittent allergic rhinitis?

A

symptoms < 4 days per week or < 4 weeks

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7
Q

what is the definition of persistent allergic rhinitis?

A

symptoms >4 days per week or >4 weeks duration

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8
Q

what is the definition of mild allergic rhinitis?

A

normal sleep, no impairment of daily activities, sport or leisure, normal work and school, no troublesome symptoms

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9
Q

what is the definition of moderate/severe allergic rhinitis?

A

abnormal sleep, impairment of daily activities, sport or leisure, missing work or school, troublesome symptoms

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10
Q

what investigations are done for allergic rhinitis?

A

Allergy testing, nasal endoscope

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11
Q

What is the management of allergic rhinitis?

A 
o	Allergy avoidance
o	Nasal irrigation 
o	1. Antihistamine 
o	2. Topical Steroids (steroids)
o	3. Topical steroids and antihistamines 
o	Occasionally surgery or immunotherapy
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12
Q

what is the pathophysiology of vasomotor rhinitis?

A

swelling of blood vessels + build up of fluid in tissues of the nose – non allergic

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13
Q

what are the causes of vasomotor rhinitis?

A 
o	Infection
o	Environmental 
o	Medications 
o	Hormonal Imbalance 
o	Tissue damage
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14
Q

what are the environmental causes of vasomotor rhinitis?

A

smoke, perfume, paint fumes, change in weather, alcohol, spicy food, stress

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15
Q

what are the medication causes of vasomotor rhinitis?

A

ACE inhibitors, beta blockers, NSAIDs, nasal decongestants

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16
Q

what are the clinical features of vasomotor rhinitis?

A

o Blocked nose
o Running nose
o Sneezes
o Irritation around nose, reduced smell, cast formation

17
Q

how is vasomotor rhinitis diagnosed?

A

exclude allergens

18
Q

how is vasomotor rhinitis diagnosed?

A

avoidance, corticosteroids

19
Q

what the management of acute rhinosinusitis?

A
  • If symptoms persist >5 days, consider non-systemically bioavailable intranasal corticosteroids (e.g. momentasone, fluticasone)
  • Avoid antibiotics unless severe or worsening (most resolve in 14days)
20
Q

what is the pathophysiology of chronic rhinosinusitis with polyps?

A

simple nasal polyps are swellings of the nasal or sinus mucosa prolapsing into the nasal cavity

21
Q

what is the cause of chronic rhinosinusitis with polyps?

A

unknown
o Associations: allergic rhinitis, non-allergic rhinitis, chronic ethmoid sinusitis, cystic fibrosis, aspirin hypersensitivity, asthma

22
Q

what are the clinical features of chronic rhinosinusitis with polyps?

A 
o	Watery anterior rhinorrhoea
o	Sneezing
o	Purulent post nasal drip
o	Nasal obstruction
o	Sinusitis
o	Mouth breathing
o	Snoring 
o	Headaches
23
Q

how is chronic rhinosinusitis with polyps diagnosed?

A

anterior rhinoscopy or nasal endoscopy

o Consider allergy testing

24
Q

what is the medical management of chronic rhinosinusitis with polyps?

A

topical steroids (betamethasone, fluticasone), consider long term antibiotic (doxycycline)

25
Q

what is the surgical management of chronic rhinosinusitis with polyps?

A

endoscopic sinus surgery

26
Q

what is the management of Chronic Rhinosinusitis without Nasal Polyps?

A
  • Intranasal corticosteroids and nasal saline irrigation are central
  • If no improvement >4 weeks and mucosa disease at subsequent endoscopy is moderate or severe consider microbiological cultures + add long term (>12 weeks) antibiotics (if IgE is not elevated)
  • Perform CT scan and if poor response to treatment consider surgery
27
Q

what are the acute causes of sinusitis?

A

o Viral – rhinovirus + influenza virus
o Bacterial – streptococcus pneumoniae, H influenza, M catarrhalis, Staph Aureus
o Fungal
o Chemical irritation – cigarettes + chlorine

28
Q

what are the chronic causes of sinusitis?

A

multifactorial inflame disorder

29
Q

what are the risk factors to developing bacterial sinusitis?

A

 Follow viral
 Direct spread: dental root infection or diving/swimming in infected water
 Odd anatomy – septal deviation, large ethmoidal bulla, polyps, large uncinate processes
 ITU causes – mechanical ventilation, recumbency, use of nasogastric tubes

30
Q

what is the pathophysiology of sinusitis?

A
  • Swelling of the sinuses
  • Sinuses normally sterile and secretions unilateral
  • Obstruction of the outflow tract stasis of secretions with negative pressure, leading to infection by bacterial
31
Q

what are the clinical features of sinusitis?

A
  • Dull constant ache over frontal or maxillary sinuses with tenderness +/- post nasal drip
  • Pain worse bending over
  • Ethmoid or sphenoid pain is felt deep in midline root of nose
  • Blocked nose
  • Reduced smell
  • Temperature
  • Bad breath and toothache
32
Q

what is the time periods for acute and chronic sinusitis

A

Acute < 4 weeks, chronic > 4 weeks

33
Q

how is sinusitis diagnosed?

A

clinical, CT of paranasal sinusitis and nasal endoscopy

34
Q

what is the management of sinusitis?

A
  • Self resolving – analgesia, nasal saline irrigation, intranasal decongestants
  • Antibiotics if bacterial – 1st amoxicillin, 2nd doxycycline
  • Recurrent – if medical fails ESS

ent (13 decks)

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