Nose Flashcards by Cathy Wang

What is allergic rhinitis

IgE mediated allergic reaction

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Which type of hypersensitivity is allergic rhinitis part of

Type 1 immediate hypersentivity- since it is IgE mediated

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What is considered as intermittent allergic rhinitis

Symptoms <4 days per week or symptoms <4 weeks

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What is considered as persistent allergic rhinitis

Symptoms >4 days per week AND symptoms >4 weeks

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Common triggers for intermittent allergic rhinitis

Grass pollen
Tree pollen
Fungal spores

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common triggers for persistent allergic rhinitis

House dust mite
Cats
Dogs

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Allergic rhinitis is often associated with

Allergic conjunctivitis

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An atopic patient with allergic rhinitis is likely to

Also have atopic eczema / asthma / allergic conjunctivitis

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Symptoms of allergic conjunctivitis

red eyes
puffy eyes
watery discharge

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Symptoms of allergic rhinitis

Sneeze
Nasal itching
Nasal discharge
Nasal congestion
Allergic crease

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What is allergic crease

hyper pigmented skin line on nose caused by constantly rubbing the nose in an upwards motion = indicates repeated itching of nose

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Investigations for allergic rhinitis

Clinical - symptoms may show seasonal variation
IgE level, skin prick test if in doubt

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Management for mild allergic rhinitis

Avoid allergen
Nasal irrigation
Oral / intra-nasal anti-histamines
Intranasal chromone if antihistamine is contraindicated

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Management for moderate-severe allergic rhinitis

Intranasal steroids
Intranasal steroids + oral antihistamines if symptoms persist
Short course oral steroids if severe, uncontrolled symptoms significantly affecting quality of life

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Example of intranasal antihistamine used for allergic rhinitis

Azelastine

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Example of oral anti-histamines

Loratadine
Cetirizine

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What is used for a patient with allergic rhinitis if topical antihistamine is contraindicated

Intranasal chromone - sodium cromoglicate

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Example of intranasal steroids

Mometasone furoate
Fluticasone furoate
Beclometasone

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What is non-allergic rhinitis

inflammation of the inside of the nose that is not caused by an allergy

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Causes of non-allergic rhinitis

Infections - viral
Vasomotor rhinitis
Occupational rhinitis
Hormonal rhinitis
Drug-induced

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What is vasomotor rhinitis

Non-allergic rhinitis due to parasympathetic overdrive (autonomic dysfunction)

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Triggers of vasomotor rhinitis

Chemical irritants
Changes in weather
Excess humidity
Very dry atmosphere
Stress

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What is occupational rhinitis

Non-allergic rhinitis symptoms only occur in workplace due to inhaled irritants such as latex, wood dust

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What drugs can cause drug induced rhinitis

ACEi
Beta blockers
NSAID
Cocaine

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Symptoms of non-allergic rhinitis

Runny nose, clear discharge Sneezing Itchy nose Nasal congestion

Management of non-allergic rhinitis

Supportive for viral cause Avoid triggers Consider anticholinergics for vasomotor rhinitis

Complications of non-allergic rhinitis

Sinusitis Nasal polyps

What is acute sinusitis

Inflammation of paranasal sinuses with symptoms lasting less than 12 weeks

Acute sinusitis can be preceded by

Rhinitis Viral URTI Dentition

Acute sinusitis is most commonly preceded by

Rhinitis

Causative pathogens of acute sinusitis

Strep pneumoniae H influenza Moraxella catarrhalis

Symptoms of acute sinusitis

Nasal blockage / discharge + facial pain/pressure Pain worse when bending / leaning forward Reduction of smell

Investigations for acute sinusitis

Clinical

Management for acute sinusitis

Analgesics Nasal decongestants Saline irrigation High dose intranasal steroids if symptoms > 10 days Antibiotics if severe

What antibiotics are used for severe acute sinusitis

1. Phenoxymethylpenicillin 2. Doxycyline

Contraindication of doxycycline

Children under 8 years old because it can cause discoloured teeth, photosensitivity

Complications of acute sinusitis

Orbital cellulitis Periosteal abscess - Pott's puffy tumour Thrombosis of cavernous sinus Thrombosis of superior sagittal sinus Osteomyelitis

What is chronic sinusitis

Painless sinusitis causing bilateral nasal obstruction due to mucosal hypertrophy with purulent discharge

Management of chronic sinusitis

intranasal corticosteroids nasal irrigation with saline solution

What may suggest that this condition isn't sinusitis

If nasal blockage is unilateral

What are nasal polyps

Painless, non-cancerous growths on the lining of nasal or sinus passages

Are nasal polyps common in children

Causes of nasal polyps

Non-allergic rhinitis Allergy infection Aspirin sensitivity Nickel exposure Cystic fibrosis

Symptoms of nasal polyps

Nasal obstruction Runny nose Reduced sense of taste or smell

Investigations for nasal polyps

Nasoendoscopy

Management of nasal polyps

Topical steroids Routine ENT referral

ENT symptoms of granulomatosis with polyangiitis

Sinusitis Epistaxis Mouth ulcers Sensorineural hearing loss Saddle nose deformity Otitis media

Management of GPA

If early - methotrexate + steroids If late - IV cyclophosphamide + steroids

What are the benign lesions of the nose

Squamous cell papillomas Sinonasal papillomas Recurrent respiratory papillomatosis

Which benign lesion is the most common

Squamous cell papilloma

Sinonasal papillomas tend to occur in patients who are

Over 50 Male

Subtypes of sinonasal papillomas

Inverted Exophytic Oncocytic

Where are inverted sinonasal papillomas located at

Lateral walls / paranasal sinuses

Where are exophytic sinonasal papillomas located at

Lateral walls / paranasal sinuses

Where are oncocytic sinonasal papillomas located at

Nasal septum

What is recurrent respiratory papillomatosis

Papillomas occurring at aerodigestive tract

What does the aerodigestive tract consist of

Airway (nasal cavity -> lungs) Oesophagus

Recurrent respiratory papillomatosis is associated with

HPV

Recurrent respiratory papillomatosis usually presents in

Children, causing hoarse voice and progressive SOB

What are the malignant lesions in the nose

Squamous cell carcinoma Nasopharyngeal carcinoma Primary adenocarcinoma Neuroblastoma Lymphoma

Which type of malignant lesion of the nose is the most common

Squamous cell carcinoma

Risk factors of nasopharyngeal carcinoma

Males Far east descent EBV HPV Volatile nitrosamines in food Smoking, alcohol Family history

Examples of food that has volatile nitrosamines

Cured meat Beer Processed fish

How aggressive is nasopharyngeal carcinoma

Highly aggressive - extensive local spread and early metastasis

What is subglottic stenosis

Narrowing of the airway below the vocal cords and above the trachea

Cause of subglottic stenosis

Idiopathic May be associated with vasculitis in adults

Symptoms of subglottic stenosis

Progressive breathing difficulty Breathing difficulty exacerbated by exertion

Management of subglottic stenosis

Division of stenosis Resection and reconstruction if severe