DISORDERS OF THE NOSE & SINUS Flashcards
(23 cards)
What are the seasonal allergic triggers ?
– Spring - flowering shrubs and
tree pollens
– Summer - flowering plants and
grasses
– Fall - ragweed and molds
– Perennial - dust mites, air
pollution, pet dander
What is the pathophysiology of allergic rhinitis?
It is an IgE mediated type 01 hypersensitivity reaction leading to immune sensitisation, mast cell degranulation increased vascular permeability and leukocyte chemotaxis.
What are the signs and symptoms of allergic rhinitis ?
It looks like viral cold and the PE findings are:
– Allergic shiners
– Allergic salute
– Nasal crease
– Boggy turbinates
– Cobblestoning
What are the Differential diagnosis of allergic rhinits ?
- Acute Viral Rhinosinusitis
- Vasomotor Rhinitis
- Rhinitis Medicamentosa
What is the first line management of allergic rehinits ?
– Intranasal corticosteroid
– Intranasal antihistamine
– Oral non-sedating antihistamine
What are the second line management of allergic rehinits ?
– Intranasal corticosteroid + intranasal antihistamine
– Intranasal corticosteroid + oral nonsedating antihistamine
– Intranasal antihistamine + oral nonsedating antihistamine
What are the tertiary management of allergic rhinitis ?
– Leukotriene receptor antagonists
– Mast Cell Stabilizer
– Intranasal Decongestant
– Oral Decongestant
What is subcutaneous immunotherapy in allergic rhinitis ?
It consist of “High dose allergy shots” every four week and it takes 1 year for symptom reduction and 5 year for Tx success. If allergen is known 80 to 90% success rate. It has a severe allergic reaction as side effect.
What is Sublingual Immunotherapy in allergic rhinitis ?
It consist of Sublingual drops or tablets, increasing dose over 4 months, then maintenance exposure.
What are the steps to avoid outdoor allergen ?
– Pollen counts
– Close windows
– Use AC and air filters
– Shower after outdoor exposures
– Shower before bed
What are the measures to avoid indoor allergens ?
– Wash bed linens frequently in hot water
– Replace carpeting with solid surface flooring
– Frequent vacuuming of carpet, rugs
– Dehumidifiers
– Confine pets to non-carpeted rooms
* Keep out of bedrooms
– HEPA filters for cat hair or bathe cat weekly
What is the most common etiology of rhino sinusitis ?
- Viral
– Rhinovirus
– Influenza virus
– Parainfluenza virus
What are the bacterial etiologies of rhino sinusitis ?
– S pneumoniae
– H influenzae
– Moraxella catarrhalis
What are the risk factors for rhino sinusitis ?
– Older age and Smoking
– Air travel and Swimming
– Change in air pressure (diving)
– Asthma / seasonal allergies
– Dental disease
– Immuodeficiency
What is the presentation of rhinosinusitis ?
- Nasal congestion & obstruction
- Purulent nasal discharge
- Maxillary tooth discomfort
- Facial pain or pressure that is worse or localized to the sinuses when
bending forward
What is the presentation difference between viral and bacterial rhino- sinusitis ?
In viral rhino-sinusitis the symptoms peaks in 3 to 6 days and resolves by 10 days with early fever. Whereas in bacterial disease much worse symptoms that lasts > 10 days.
What are the PE findings in rhino-sinusitis ?
- Erythema over sinus regions
- Tenderness to percussion over
upper teeth and sinus cavities - Boggy, swollen nasal mucosa
- Purulent nasal secretions
- +/- Polyps
- Transillumination discrepancy ??
What is the symptomatic management of rhino-sinusitis ?
- Reduce Swelling using intranasal corticosteroids or mast cell stabilizaers or decongestants.
- use mucolytics to thin secretions.
- Anti-histamines to dry the sinuses.
- pain control.
- If bacterial infections that last > 10 days start 5 ot 7 days of high dose augmentin.
What are the four cardinal signs of rhino-sinusitis ?
– Anterior and/or posterior nasal
mucopurulent drainage
– Nasal obstruction / congestion.
– Facial pain, pressure, and/or fullness
– hyosmia or anosmia.
What are the types of chronic rhinosinusitis ?
- CRS with Nasal Polyps
- Allergic Fungal Rhinosinusitis
- CRS without Nasal Polyps
What is the time frame to diagnose chronic rhinosinusitis ?
12 weeks or more
What is anterior epitaxis ?
It accounts for 90% of epitaxis from the keisalbach plexus. It is more common in children
What is posterior epitaxis ?
It is bleeding from the Woodruff’s plexus and is more profuse and common in adults.
