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Flashcards in Disorder of Nose and Sinus Deck (25)
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1

Consequences of impaired olfaction (ability to perceive smell)

-impaired sense of taste

-leads to nutritional deficiencies

-impairs social interactions

-depression

-may be dangerous (tumors, alzheimer's, parkinson's, neuro disorders)

2

Define:
-anosmia
-hyposomia
-dysosmia
--parosmia
--phantosmia
--agnosia

-anosmia: inability to detect odors

-hyposomia:decreased ability to detect odors

-dysosmia:distorted identification of smell

--parosmia:altered perception of smell in the presence of
an odor, usually unpleasant

--phantosmia:perception of smell without an odor present

--agnosia:inability to classify or contrast odors, although able to detect odors

3

What are the three most common causes of primary olfactory deficits?

nasal and/or sinus disease

prior viral upper resp infection

head trauma

4

Congenital causes of anosmia

Causes of dysosmia

Causes of parosmia and hyposmia

Anosmia
-midline facial abnormalities (cleft palate)
-neurosensory hearing loss

Dysosmia
-nasal and paranasal sinus disease (most common)
-head trauma
-URI
-medications
-exposure to toxins

Parosmia and Hyposmia
-AGING and neurodegenerative processes
-nasal obstruction
-URI
-head/facial trauma
-central olfactory damage

5

The nose contains cilia that are less than a cm in length and beat at a frequency of 1000 cycle/min. True or false?

Truuuuue

-there is also a mucous blanket that is important in preventing infection and subsequent problems

6

Rhitinis
-defined as
-caused by

Defined as
-inflammation of the nasal mucosa

Cuased by
-infection (viral, bacterial, fungal)
-allergy
-environmental irritants
-medications (rhinitis medicamentosa-afrin abuse)
-hormonal changes
-chronic inflammatory disease
-other undefined mechanisms (vasomotor rhinitis)

7

Rhinitis
-presentation

Presentation
-nasal congestion
-rhinorrhea/discharge
-epistaxis
-pain (nasal, sinus, pharyngeal, dental)

8

What is an upper respiratory infection?

How many URIs do the following age groups typically get per year?
-preschool children
-kindergarten
-school age
-adolescents/adults

URI/infectious rhinitis/the common cold

-inflammation of the nasal passages commonly due to any number of respiratory viruses
-vast majority are self treatable

-preschool children: 6-10/year
-kindergarten: 12/year
-school age: 7/year
-adolescents/adults: 2-4/year

9

Infectious rhinitis/the cold/URI
-presentation

Presentation
-pharyngitis (usually first sx)
-nasal congestion, rhinorrhea, obstruction
-sneezing
-facial and/or ear pressure
-loss of smell/taste
-cough (mucous drainage)
-hoarseness (mucous coating larynx)
-HA
-Malaise
-fever greater than 100F/37.7C

10

Infectious rhinitis/the common cold/URI
Cause

Cause
-weather
-exercise, diet, enlarged tonsils/adenoids
-psychological stressors
-allergic disorders
-VIRAL *** (more than 200 strains of viruses can cause URI)
--rhinoviruses (80%)
--coronaviruses
--adenoviruses

-40% of cases have an unknow etiology

11

What are the viruses that can causes a more severe Infectious rhinitis/the cold/URI?

orthomyxovirus (influenza A and B)

Paramyxovirus (parainfluenza)

Echoviruses

Respiratory syncytial virus

Enteroviruses (polio)

Coxsackieviruses (heart muscle)

12

Infectious rhinitis/the cold/URI
Treatment

-rest
-drink plenty of fluids (think mucous)
-gargle with warm salt water
-Use throat sprays, lozenges
-petroleum jelly for sore nose
-aspirin, ibuprofen, or acetaminophen for HA and fever
-reassurance (usual course is 6-10 day)
-discontinue tobacco and alcohol use

*Never use aspirin for Ha or fever in children..Reyes Syndrome (N/v/liver inflammation/progressive mental changes)

-Antihistamines (benadryl, zyrtec)
-NSAIDs
--relieve fever, myalgias, HA
--"the way to go with the common cold"
-Decongestants (sudafed/pseudoephedrine, afrin is a decongestant but you don't use it for the common cold)
--SE: narrow angle closure glaucoma, HTN, CAD

13

Infectious rhinitis/the cold/URI
-Possible complications

Complications
-Lower resp tract infection (bronchitis, pneumonia)
-bronchial hyperreactivity (reactive airway)
-exacerbation of chronic lung diseases (asthma, COPD)
-otitis media (bacterial)
-acute sinusitis (bacterial)
-rhinitis medicamentosa

14

Sinusitis
-Definition
-Causes
-classifications
--acute rhinosinusitis
--subacute rhinosinusitis
--chronic rhinosinusitis
--recurrent acute rhinosinusitis

Definition
-inflammatory or infectious processes in the paranasal sinuses (air pockets on either side of and behind the nose

Causes
-bacteria
-Viruses (most common)
-Fungi
-possibly allergies

Classifications
--acute rhinosinusitis:sx last less than 4 weeks
--subacute rhinosinusitis: sx for 4-12 weeks
--chronic rhinosinusitis:sx persist greater than 12 weeks
--recurrent acute rhinosinusitis:4 or more episodes per year, with interim sx resolution

15

Sinusitis
-Patho
-3 factors crucial for the normal physiologic functioning of the sinuses
-predisposing factors for reccurent sinus infections

Patho
-the most important element in the development of sinusitis is the osteomeatal complex of the outflow tracts of all the sinuses into the nose, but most importantly the maxillary and ethmoid sinuses
-obstruction may occur causing sinusitis of the sinuses

3 factors crucial for the normal physiologic functioning of the sinuses
-Patency of the osteomeatal unit (OMU)
-normal mucociliary transport
-normal quantity and quality of secretions

Predisposing Factors
-anatomical irregularities
-infections
-allergies
-polyps
-hormones
-environment
-foreign bodies
-cystic fibrosis

16

What bacteria is acute sinusitis associated with? Chronic sinusitis?

Acute
-associated with The same bacteria as otitis media!

-Strep pneumo
-H. Flu
-M. Cat

Chronic
-Staph aureus and anaerobes

17

Sinusitis
-sx
-presentation of viral vs bacterial

Sx
-Facial pain/tenderness*
-nasal congestion
-purulent nasal and post nasal discharge
-HA* (frontal or under cheek bones)
-maxillary tooth pain
-malodorous breath
-fever*
-eye swelling
-pain/pressure in the cheeks and deep nasal recesses is common

Presentation
-if sx last for less than 7-10 days and pt is recovering, a self limited viral URI is the most likely cause
-worsening sx or sx for more than 7-10 days are more likely to be bacterial sinusitis

18

Sinusitis
Physical Exam findings

-Pain localized to sinuses when the pt is asked to end forward
-diffuse mucosal edema
-narrowing of the middle meatus
-inferior turbinate hypertrophy
-copious or purulent discharge...polyps, septal deviation

Pain in the forehead...frontal Sinusitis
Pain behind/between eyes... ethmoid Sinusitis
Pain behind eyes...sphenoid sinusitis
Pain in upper jaw, teeth, cheeks...maxillary sinusitis

19

Sinusitis
Dx
Tx

Dx
-Initial presentation: clinical
-Plain films are usually unnecessary
-CT scan... only used if the dx remains uncertain
-MRI...useful when fungal infections or tumors are seriously considered
-Sinus aspiration...only indicated for complicated sinusitis, immunocompromised pts, chronic recurrent infections that fail to respond to tx...ENT referral at this point!!

Tx
-mild recent onset sinusitis: treat as you would viral rhinitis
-Bacterial sinusitis:
--Amoxicillin (first line)
--Augmentin
--Doxy (not for kids)
--Zithromax
-Chronic sinusitis: 3-4 weeks of therapy or longer is required

Home care
-hydrations
-steamy shower
-warm pack packs
-analgesics
-decongestants
-saline irrigation lavaage
-saline spray
-sleep with HOB elevated, avoid smoke

20

Complications of bacterial sinusitis

Meningitis, epidural abscess, subdural empyema, brain abscess, orbital cellulitis, cavernous sinus thrombosis

21

Allergic Rhinitis
-sx
-PE findings
-Tc

Sx
-CLEAR rhinorrhea, sneezing, tearing, eye irritation, pruritus, cough, bronchospasm, eczematous dermatitis

PE
-mucosa of turbinates is pale
-nasal polyps

Tx
-antihistamines, intranasal corticosteroids, antileukotriene medications, immunotherapy

22

Nasal Airway Obstruction
-define
-causes

Define:
inability to inspire or expire through the nasal passage
-could be life threatening in infants who are obligate nose breathers

Causes
-polyps
-tumors
-foreign bodies (usually one sided)
-septal deviations
-trauma

23

Nasal Polyps
-Pathophys
-PE
-Dx
-Tx

Pathophsy
-intense inflammatory reaction of the sinonasal mucosa of unknown etiology
-may block osteomeatal unit leading to chronic sinusitis
-could decrease flow of mucous, further contributing to sinusitis

PE
-Polyps are not innervated, do on PE they can be distinguished by lack of pain on manipulation

Dx
-Coronal sinus CT*** (study of choice)
-waters view xray may show opacification of the sinuses

Tx
-Refer to ENT
-Topical steroids** (first line)
-antihistamines
-oral steroids
-surgery involves removal of polyp

24

Septal Deviation
-Sx
-Tx

Sx
-infections of the sinus, sleep apnea, snoring, change in smell, frequent sneezing, difficulty breathing

Tx
-decongestants, antihistamines, nasal spray
-surgery (septoplasty)

25

Septal perforation
causes
sx
tx

causes
-can be caused by cocaine, nasal sprays, piercing

sx
-whistling when breathing, bloody discharge, nasal pressure and discomfort

Tx
-usually heal without surgery