Rhinology Flashcards

1
Q

What is typically seen in the history for rhinology diseases?

A
  • Symptoms
    • Nasal obstruction
    • Nasal discharge
    • Epistaxis
    • Facial pain
    • Nasal deformity
    • Anosmia
    • Sneezing
  • PMH
    • Medical treatment
    • Nasal surgery
    • Nasal trauma
    • Asthma/aspirin sensitivity
  • Social history
    • Alcohol
    • Smoking
    • Cocaine abuse
    • Woodworkers
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2
Q

What investigations are often done in rhinology?

A
  • Nasal endoscopy
  • Blood tests
    • FBC, ANCA, ESR, ACE, RAST
  • CT scan
  • MRI scan
  • Skin tests
  • Rhinomanometry
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3
Q

What are some examples of nasal disorders?

A
  • Nasal trauma
  • Epistaxis
  • Rhinosinusitis
  • Nasal polyps
  • Nasal deformity
  • Nasal tumours
  • Choanal atresia
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4
Q

Nasal trauma - aetiology

A

Fight

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5
Q

Nasal trauma - treatment

A
  • Wait until swelling down and usually not much change in nose shape
  • If there is, manipulation under anaesthetic
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6
Q

Nasal trauma - complications

A
  • Septal haematoma
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7
Q

Nasal polyps - aetiology

A
  • May be associated with asthma or aspirin sensitivity
  • If in children consider CF
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8
Q

Nasal polyps - presentation

A
  • Symptoms
    • Asymptomatic
    • Nasal obstruction
    • Rhinorrhoea
    • Post-nasal drip
    • Hyposmia
  • Signs
    • Pale fleshy polyps seen usually arising from the middle meatus
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9
Q

Nasal polyps - investigations

A
  • Sweat test
  • RAST/skin testing
  • Nasal smear
    • Microbiology
    • Eosinophils (allergic component)
    • Neutrophils (chronic sinusitis)
  • Coronal CT scan
  • MRI scan
  • Flexible nasendoscopy
  • Rigid nasendoscopy
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10
Q

Nasal polyps - treatment

A
  • Medical
    • Topical and nasal steroids
  • Surgical
    • Endoscopic sinus surgery and polypectomy
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11
Q

Sinusitis - pathology

A
  • Inflammation and infection of the sinuses, maybe acute or chronic
  • Any one or all four pairs may be affected
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12
Q

Sinusitis - classification

A
  • Acute
    • Acute onset of symptoms
    • Duration < 12 weeks
    • Symptoms resolve completely
  • Recurrent acute
    • More than 1 to 4 episodes of acute per year
    • Complete recovery between episodes
    • Symptom free for >8 weeks between acute attacks in absence of medical treatment
  • Chronic
    • Duration of symptoms > 12 weeks
    • Persistent inflammatory changes on imaging > 4 weeks
    • After starting appropriate therapy
  • Acute exacerbations of chronic
    • Worsening of existing symptoms or appearance of new symptoms
    • Complete resolution of acute (but not chronic) symptoms between episodes
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13
Q

Sinusitis - aetiology

A
  • Usually secondary to viral upper respiratory infection
  • Maxillary sinusitis may be dental in origin such as dental root abscess
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14
Q

What organisms are usually responsible for sinusitis?

A
  • S. Pneumoniae 31%
  • H. Influenzae 21%
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15
Q

Sinusitis - presentation

A
  • Symptoms
    • Facial pain over sinuses
    • Nasal obstruction
    • Preceding URTI
  • Signs
    • Fever
    • Tenderness over sinuses
    • Mucopus in middle meatus
    • Swelling over cheek rare in maxillary sinusitis
    • Swelling over frontal sinus may be secondary to frontal osteomyelitis
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16
Q

Sinusitis - invesitgations

A
  • CT scan if planning surgery or atypical presentation
17
Q

Sinusitis - treatment

A
  • Antibiotics
    • B-lactams
    • Macrolides
  • Nasal vasoconstrictors
  • In chronic disease, surgery
    • Enlargement of sinus drainage opening when medical therapy failed
18
Q

Sinusitis - complications

A
  • Orbital cellulitis or abscess
  • Meningitis
  • Intracranial abscess
  • Osteomyelitis of the frontal bone
19
Q

Epistaxis - pathology

A
  • Haemorrhage from the nose
  • Most recurrent epistaxis is from the anterior part of septum
20
Q

Epistaxis - aetiology

A
  • Local
    • Idiopathic
    • Trauma
    • Tumours
    • Infection
    • Allergy
  • Systemic
    • Anticoagulants
    • Bleeding disorders
    • Hypertension
    • Olser-Weber-Rendu disease
    • Hereditary haemorrhagic telangiectasia (rare)
21
Q

Epistaxis - presentation

A
  • Nose bleed
  • Occasionally shock or haematemesis
22
Q

Epistaxis - investigations

A
  • Direct inspection of nose +/- blood tests
    • Haemoglobin, clotting screen, group and save
23
Q

Epistaxis - treatment

A
  • ABCs
  • Cautery (with silver nitrate)
  • Nasal packing
  • For refractory bleeding surgery with artery ligation or radiological embolization may be required
24
Q

Epistaxis - complications

A
  • Hypotension
  • Shock