ENT: Nose

Question 1

Nasal Fracture

Answer 1

• nasal bones, nasal septum, nasal turbinates

- restoring near normal anatomy for normal nasal physiology

Question 2

Nasal Septal Deviation

Answer 2

• if significant, can disrupt normal nasal airway & mucosal function
• can predispose to secondary disorders (rhinitis, sinusitis)
• Kesselbach’s plexus: nasal septal hematoma

Question 3

Epistaxis

Answer 3

-most frequently mid to anterior nares (90%)

Question 4

Anterior epistaxis

Answer 4

• anterior/posterior ethmoid artemis-nasal roof & frontal, ethmoid sinuses
• nasal arterioles: no elastic fibers to very responsive to environment
• Kiesselbach’s plexus: trauma & nasal atrophy in elderly
• if recurrent, nasal septal perforation

Question 5

RX anterior epistaxis

Answer 5

• local pressure 10 min
• look for instigators
• review meds

Question 6

Juvenile nasopharygneal angiofibroma

Answer 6

• refer to ENT immediately

- adolescent male-bleeding w/ co-existing nasal obstruction

Question 7

Posterior epistaxis

Answer 7

• 10%
• sphenopalatine artery: balance of nose
• rapid referral to ER or ENT
• oxygen sat will probably drop

Question 8

RX posterior epistaxis

Answer 8

-ENT referral

Question 9

Nasal polyps

Answer 9

• appear as boggy, masses on nasal mucosa (peeled grapes)
• patients commonly also have allergic rhinitis
• chronic congestion & decreased smell

Question 10

What is contraindicated w/ nasal polyps because of causing sever bronchospasm?

Answer 10

-aspirin

Question 11

RX of nasal polyps

Answer 11

• 3 month course of topical nasal corticosteroid
• oral steroids can help
• surgical removal may be necessary if polyps are large

Question 12

Etiologies of rhinitis

Answer 12

• allergic
• drug-caused
• pregnancy
• vasomotor
• infectious
• environmental factors
• atrophic

Question 13

Allergic rhinitis

Answer 13

• nasal mucosa edema, congestion, rhinorrhea
• allergic ‘salute’, nasal crease, allergic shiners
• may have avascular polyps

Question 14

RX allergic rhinitis

Answer 14

• antihistamines
• decongestants
• nasal corticosteroid sprays
• referral for immunotherapy

Question 15

Drug-caused rhinitis

Answer 15

-cocaine, anticholinergic meds, overuse Afrin, resperone, beta blockers, hydralazine, oral contraceptives, ACE inhibitors, Viagra

Question 16

RX drug-caused rhinitis

Answer 16

-change meds

Question 17

Pregnancy rhinitis

Answer 17

-nasal mucosal response to elevated hormone levels (estrogen receptors)

Question 18

RX pregnancy rhinitis

Answer 18

-saline NS

Question 19

Vasomotor rhinitis

Answer 19

• imbalance of ANS activity in elderly
• chronic dry nasal mucosa, clear rhinorrhea
• often confused w/ allergic rhinitis
• AR not common in elderly

Question 20

RX vasomotor rhinitis

Answer 20

• non very satisfactory
• saline NS
• corticosteroids NS
• Azelastine NS
• Ipratroprium
• avoid contributing meds

Question 21

Infectious rhinitis (viral)

Answer 21

• common cold

- mild to moderate congestion & clear rhinorrhea

Question 22

Infectious rhinitis (bacterial)

Answer 22

• more apt to be ethmoid sinusitis causing rhino sinusitis

- same bacteria that cause otitis media (S. pneumonia, H. influenza, M. catarhalis)

Question 23

RX infectious rhinitis (bacterial)

Answer 23

• amoxicillin, augmentin, doxycycline

- 2nd line: augmentin, levofloxacin, moxifloxacin

Question 24

Environmental factors to rhinitis

Answer 24

• dusty work place, toxic fumes
• wood stove
• irritants w/ hobbies/factories

Question 25

RX environmental rhinitis

Answer 25

- saline NS | - corticosteroid NS

Question 26

Atrophic rhinitis

Answer 26

- usually in elderly - anatomical deformity of nasal septum - turbinates exacerbates - dry nose, frequent minor anterior nose bleeds

Question 27

RX atrophic rhinitis

Answer 27

- premarin cream | - corticosteroid NS

Question 28

Sinusitis

Answer 28

- acute - chronic - barosinusitis

Question 29

Acute sinusitis

Answer 29

- most viral, few bacterial - purulence, dental/facial pain, unilateral sinus tenderness - initial improvement but then worsening sxs - one or both nares - usually URI proceeds - 10 days -4 weeks of sxs

Question 30

Chronic sinusitis

Answer 30

- presents as chronic obstructions, congestion (pain/pressure) - mucopurulent nasal d/c - mucosa typically damaged, thickened & cilia spotty throughout sinus mucosa - tobacco smokers

Question 31

RX chronic sinusitis

Answer 31

- empiric, CT - address underlying nasal issues, stop tobacco - abx: amox, augmentin, doxy, levo - oxymetazoline, antihistamines, fluids

Question 32

Barosinusitis

Answer 32

- negative aire pressure in one or more sinus cavity - acute forms w/ rapid change in ambient pressure - chronic forms w/ obstruction of maxillary sinus ostia (chronic pain)