Nasal endoscopy / nose pathology Flashcards
(16 cards)
What is the function of turbinates in the nasal cavity?
- projections of bone covered in nasal mucosa
- warms and cleans the air before it arrives at the lungs
Spot diagnosis + management
- bilateral, painless nasal obstruction
- rhinorrhoea, anosmia, postnasal drip
Nasal polyps - smooth, pale, oedematous masses arising from the middle meatus
(Bilateral involvement (unilateral –> consider malignancy)
Management:
- Intranasal steroids (eg. mometasone) - shrink polyps and relieve symptoms
- If persistent/severe - oral steroids (short course)
- If obstructive - surgical (FESS)
What condition has:
- Nasal polyps
- Asthma
- Sensitivity to aspirin and NSAIDs
Samter’s triad (aspirin-exacerbated respiratory disease)
Spot diagnosis + management
Deviated nasal septum
Management:
- If swollen –> intranasal steroids
- If severe obstruction or recurrent infections –> septoplasty
Spot diagnosis + management
- chronic nasal congestion
- worse with allergies (allergic rhinitis)
Inferior turbinate hypertrophy - enlarged inferior turbinates (pale in allergy, red in infection)
Management:
- Intranasal steroids (1st-line)
- if allergic –> antihistamines
- if severe –> turbinate reduction surgery
Spot diagnosis + management
- triggered by trauma, dry air
Epistaxis - bleeding or visible vessels (telangiectasia) on anterior septum (Little’s area/Kiesselbach’s plexus)
Management:
- 1st-line - pinch nose for 10-15 mins + lean forward
- Further - cautery (silver nitrate) / nasal packing
- (Surgery - ligation of sphenopalatine artery)
Spot diagnosis + management
- facial pain/pressure, nasal congestion, purulent discharge
- postnasal drip, headache, anosmia
- often follows a viral URTI
Rhinosinusitis (Acute/Chronic sinus infection) - mucosal oedema + purulent discharge from sinuses
Management:
- Viral (most cases) –> nasal saline irrigation, decongestants, analgesia
- Bacterial –> oral antibiotics (eg. amoxicillin)
- (Chronic sinusitis –> intranasal steroids +/- FESS)
Spot diagnosis + management
- unilateral nasal obstruction, epistaxis, facial pain
Inverted papilloma - unilateral mass, irregular, ulcerated, wart-like
Management:
- Urgent ENT referral
- Biopsy and imaging (CT/MRI)
- If malignant –> surgical excision +/- radiotherapy/chemotherapy
Spot diagnosis + management
- trauma to the nose (eg. fall, sports injury)
- swelling, bruising, nasal deformity
- epistaxis, nasal obstruction, tenderness
Fractured nose (deviated nose + epistaxis)
Management:
- Ice + analgesia +/- splint
- Realignment - manual realignment within 14 days of the fracture OR if severe then surgery
Spot diagnosis + management
- recent nasal trauma
- progressive nasal obstruction
- pain, swelling, nasal congestion
- NO external deformity
Septal haematoma
Management:
- Urgent ENT referral
- Incision + drainage
- Nasal packing (sterile gauze or tampon) - to prevent reaccumulation
- Antibiotics (broad-spectrum) to prevent infection
Spot diagnosis + management
Squamous cell carcinoma
- Mohs surgery
Spot diagnosis + management
Basal cell carcinoma
- Mohs surgery OR cryotherapy
Spot diagnosis + management
Keratoacanthoma
- Mohs surgery OR cryotherapy
