ENT - The nose Flashcards
A man presents with epistaxis which started 20 mins ago and has not stopped with bending head forwards/pinching nose. He is haemodynamically stable. What is your step-wise management?
- silver nitrate cauterisation of bleeding vessel
- anterior or posterior nasal packing (leave in for 2-3/7)
- embolisation or endoscopic ligation of anterior ethmoidal artery (anterior bleed) or sphenopalatine artery (posterior bleed)
Name a contraindication for nasal packing during epistaxis.
Hereditary haemorrhagic telangiectasia (can cause more bleeding)
Suggest possible complications of nasal packing for epistaxis.
- pack falls out… continued bleeding
- posterior migration of pack… airway obstruction
- nasal septum perforation or pressure necrosis of cartilage
- toxic shock syndrome (give co-amoxiclav prophylaxis 5/7)
Name the common sites of bleeding for anterior + posterior epistaxis.
Anterior: Kiesselbach’s plexus (anterior ethmoidal, sphenopalatine, greater palatine, superior labial arteries)
Posterior: Woodruff’s plexus (sphenopalatine and pharyngeal arteries)
A man presents to ED after being punched in the nose. On rhinoscopy, you notice a red fluctuant swelling that obstructs cavity bilaterally. How should you manage this patient and why?
Urgent ENT referral for incision + drainage of nasal septal haematoma + IV Abx to prevent ‘saddle nose deformity’ and serious infections.
What is Samter’s triad?
asthma + aspirin sensitivity + nasal polyposis
Which features of nasal polyps are red flags and require urgent NET referral?
- single unilateral polyp
- bleeding
- crusting
- cacosomia
What are the features of chronic rhinosinusitis?
- nasal congestion/obstruction
- nasal discharge (anterior or posterior drip)
- facial pain/pressure
- anosmia
What are the treatment options for chronic rhinosinusitis?
- nasal saline irrigation
- topical intranasal steroids e.g. FLUTICASONE nasal spray 3/12
- Abx e.g. ROXITHROMYCIN for 12/52
- PREDNISOLONE 7/7
If no improvement:
CT scan + FESS
