Common Conditions of the Nose

Question 1

How does the nose warm and humidify the air?

Answer 1

Turbinates direct air flow

Question 2

Which sinuses drain to the middle meatus?

Answer 2

Maxillary
Frontal
Anterior ethmoids

Question 3

Which sinuses drain to the superior meatus?

Answer 3

Sphenoid

Posterior ethmoids

Question 4

What are common nasal symptoms?

Answer 4

Blockage
Congestion
Rhinorrhoea
Sneezing
Irritation
Post-nasal drip
Loss of olfaction
Epistaxis
Facial pressure/pain

Question 5

What symptoms arise from pathology affecting the orbits and lacrimal system?

Answer 5

Blockage of nasolacrimal apparatus > epiphora
Diplopia
- Due to displacement of axis of globe
- Ophthalmoplegia due to mechanical restrction of extra-ocular muscles

Question 6

When can you get a raccoon eye?

Answer 6

Base of skull fracture

Procedures around nose

Question 7

What symptoms arise from pathology affecting the base of the skull?

Answer 7

CSF rhinorrhoea
Mechanial restriction of airflow to olfactory region/neurological deficit > change in smell
Frontal lobe lesion > change in cerebral function

Question 8

How can you detect CSF rhinorrhoea?

Answer 8

Doulbe ring sign on blotting paper
Measure
- Glucose
- Beta-2 transferrin = gold standard

Question 9

What symptoms arise from pathology affecting the oral cavity and teeth?

Answer 9

Dental pain

Discharge through oro-antral fistula

Question 10

What can cause the formation of an oro-antral fistula?

Answer 10

Traumatic tooth extraction

Chronic infections

Question 11

What symptoms arise from pathology affecting the post-nasal space and auditory tube?

Answer 11

Nasal obstruction

Middle ear effusion

Question 12

Why do persisting unilateral middle ear effusions need further investigation?

Answer 12

Rule out post-nasal tumours

Question 13

What is Horner’s syndrome?

Answer 13

Miosis
Anhydrosis
Ptosis

Question 14

What can Horner’s syndrome be a sign for?

Answer 14

Gastric tumours, and others

Question 15

What is the significance of aspirin intolerance in nasal pathology?

Answer 15

Samter’s triad

• Aspirin intolerance
• Asthma
• Nasal polyps

Question 16

What features of history are important in nasal pathology?

Answer 16

Smoking
Drug Hx
Aspirin intolerance
Asthma
Allergic Hx
Age
FHx
- ENT cancers

Question 17

In which lung condition are polyps common?

Answer 17

Cystic fibrosis

Question 18

What is rhinitis?

Answer 18

Inflammation of nasal mucosa

Question 19

What are the causative groups of rhinitis?

Answer 19

Allergic
Infectious
Occupational
Drug induced
Hormonal
Idiopathic

Question 20

What is intermittent allergic rhinitis?

Answer 20

Less than 4 days/week or <4 weeks

Question 21

What is persistent allergic rhinits?

Answer 21

More than 4 days/week for >4 weeks

Question 22

What are the symptoms of allergic rhinitis?

Answer 22

Clear rhinorrhoea
Nasal blockage
+/- itching of nose
Sneezing

Question 23

What is the management for mild intermittent allergic rhinitis?

Answer 23

Oral/local non-sedative H1 blocker
Intra-nasal/oral decongestant
Allergen and irritant avoidance

Question 24

What is the management for moderate-severe intermittent allergic rhinitis?

Answer 24

Oral/local non-sedative H1 blocker
Intra-nasal/oral decongestant
Allergen and irritant avoidance
Intra-nasal steroid
Local cromone

Question 25

What is the management for persistent allergic rhinitis?

Answer 25

``` Oral/local non-sedative H1 blocker Intra-nasal/oral decongestant Allergen and irritant avoidance Intra-nasal steroid Local cromone Consider immunotherapy ```

Question 26

What is rhinitis medicamentosa?

Answer 26

Inflammation of nasal mucosa secondary to prolonged alpha agonist topical medications

Question 27

What are the symptoms of rhinitis medicamentosa?

Answer 27

Clear rhinorrhoea | Marked nasal congestion > obstruction > progressively less well controlled by topical medication

Question 28

What is infectious rhinitis called?

Answer 28

Rhinosinusitis

Question 29

What are the symptoms of viral rhinosinusitis?

Answer 29

Less than 10 days Rhinorrhoea Blockage Itching

Question 30

What are the common causes of viral rhinosinusitis?

Answer 30

Rhinovirus

Question 31

What is the duration of symptoms for acute non-viral rhinosinusitis?

Answer 31

Symptoms increase after 5 days Last >10 days Less than 12 weeks

Question 32

What is the usual duration of rhinosinusitis?

Answer 32

Less than 2 weeks

Question 33

What are the common symptoms of rhinosinusitis?

Answer 33

``` Clear/purulent rhinorrhoea Nasal congestion/obstruction Sneezing Nasal irritation Epiphora ```

Question 34

What is the most common site of anterior epistaxis?

Answer 34

Anterior septum - confluence of multiple vessels

Question 35

How is anterior epistaxis controlled?

Answer 35

Direct pressure

Question 36

Where is posterior epistaxis most commonly felt?

Answer 36

Dripping down back of throat

Question 37

What is the common artery that bleeds in posterior epistaxis?

Answer 37

Sphenopalatine

Question 38

How is posterior epistaxis controlled?

Answer 38

Nasal packing - usually kept in for 1-2 days

Question 39

How is a nasal fracture confirmed?

Answer 39

No indication for imaging unless suspecting - Other facial fractures - Skull base disruption - Central signs

Question 40

What raises your suspicion of a skull base fracture?

Answer 40

``` Mechanism of injury CSF rhinorrhoea/othorrhoea Raccoon eyes Battles sign Haemotympanum Subconjunctival haemorrhage with no posterior margin ```

Question 41

If left untreated, what can a septal haematoma progress to?

Answer 41

Septal abscess > cartilage destruction > saddle nose deformity

Question 42

What is the management of a septal haematoma?

Answer 42

Immediate ENT referral for - Drainage of haematoma - Possible nasal bone manipulation

Question 43

What are the likely bacterial organisms that cause acute rhinosinusitis?

Answer 43

Upper respiratory tract pathogens - Streptococcus pneumoniae - Haemophilus influenzae - Moraxella catarrhalis

Question 44

What are symptoms of orbital spread of the infection from the paranasal sinuses?

Answer 44

Eye pain and swelling Double vision Ophthalmoplegia

Question 45

What is an initial sign of increased intra-orbital pressure?

Answer 45

Red-green colour vision disturbance

Question 46

What is the management for chronic rhinosinusitis?

Answer 46

Nasal steroid spray - Mainstay of therapy Saline nasal douche Abx if purulent

Question 47

What bacteria cause chronic rhinosinusitis?

Answer 47

Similar to acute rhinosinusitis Staphylococcus aureus Anaerobes

Question 48

What is FESS?

Answer 48

Functional Endoscopic Sinus Surgery

Question 49

What is the aim of FESS?

Answer 49

To open sinuses and return them to premorbid functioning state Allows medical therapy to enter