Nose Flashcards
What are the different types of Rhinorrhea?
Allergic rhinitisnon-allergic rhinitisVasomotor rhinitis Acute and chronic rhinosinusitis (sinusitis)
What is allergic rhinitis?
Clear rhinorrhea, sneezing, tearing eye irritationAssociated symptoms: cough, bronchospasm, eczematous dermatitisEnvironmental allergen exposure with the presence of allergen specific IgE
How common in allergic rhinitis?
14-40% prevalence
What are the seasonal allergies for rhinitis?
Most common: shrub and tree pollens Spring: flowering shrub and tree pollens Summer: flowering plants and grasses Fall:ragweed and molds
Symptoms of allergic rhinitis?
History of atopysneezingwatery eyesseasonal predilectionprolonged symptomscongestion and pale mucosa with clear discharge (d/c)Afebrile
What facial features are associated with allergic rhinitis?
Allergic shinersAllergic salute (crease over nose) Pale boggy turbinates
What tests are used to diagnose allergic rhinitis?
CBCNasal smear for eosinophilsELISARASTskin prick test (affected by antihistamine or steroid use)
What are the components of a differential for allergic rhinitis?
Nonallergic rhinitis w/ eosinophilia syndrome (NARES)Vasomotor rhinitisChronic sinusitis Nasal polyps or tumorFBmedications-rebound effect from topical nasal decongestants septal/anatomic obstruction
Treatment for allergic rhinitis?
Avoidance1rst line: nasal steriods (nasonex/flonase)2nd line: antihistamines oral or intranasal decongestants Leukotriene receptor antagonist (singulair)Intranasal antihistamines (omnaris)cromolyn sodium”Allergy shots”
what are the side effects of nasal steroids?
Epistaxisperforated septum taste perversionoral candidiasis
What is Non-Allergic Rhinitis?
a common condition characterized by the chronic presence of one or more of the following: nasal congestion, rhinorrhea, postnasal drainage
How is NAR distinguished from AR?
onset is at a later ageabsence of nasal and ocular itching and prominent sneezingnasal congestion and postnasal drainage are prominent symptoms symptoms are perennial (year round)
what are the typical triggers for NAR?
Irritant odors and strong fragrances tobacco smoke diesel and car exhaustcleaning productsnewsprintchanges in temperaturealcoholic beverages
What is vasomotor rhinitis?
intermittent symptoms of congestion and or watery rhinorrhea and exaggerated reaction to nonspecific irritants such as air pollution, temp changes, exposure to cold or dry air
What id gustatory rhinitis?
Episodic condition with prominent watery rhinorrhea triggered by hot or spicy foodscased by the vagal-mediated reflex
what is Rhinitis Medicamentosa?
occurs when there is use of intranasal decongestants for greater than 5 days
How do you treat RM?
strop/weanintranasal steroidsPO steroidsnasal salineantihistaminesdecongestants
causes of vasomotor rhinorrhea?
Fumesodorstempatmospheric changes smoke other irritants
What are the drugs involved in drug-induced rhinitis?
ACE inhibitorsreserpineguanethidine phentolaminemethyldopabeta-blockerschlorpromazinegabapentinpenicillamineASA NSAIDS cocaineExogenous estrogensOCP
what is mixed rhinitis?
a combination of allergic and NARmost common form of rhinitis, affecting ~ 45%of the population
What is occupational rhinitis?
Airborne allergens or irritants in patients workplacesymptoms are more prominent at work and improve on days offunderlying mechanisms may be allergic or irritant
what are common examples occupational irritants?
proteins from urine or fur of lab animalsfood proteinsenzymatic proteins in detergent manufacturers organic dusts in wood workers
what is CSF rhinorrhea?
Straw colored leakage of CSFmay cause one or more nasal symptomsusually results in unilateral or bilateral clear nasal discharge without signs and symptoms of mucosal inflammation
what can CSF rhinorrea result from?
skull or nasal fracturesintracranial surgery inferior extension of sella turscia
what are the postural reflexes?
increased congestion with supine position and increased congestion in the lower nasal passage when lying on one sidenormal nasal cycle in the vertical position produces alternating congestion in the nostrils
what is crutch reflex?
increased congestion with pressure in the ipsilateral axilla
Hot and cold cutaneous temp reflexes
sneezing upon sudden exposure of the skin to dramatic temp extremes
Visible and infrared light reflexes
sneezing upon sudden exposure to bright light
Bronchonasal reflex
brochoconstriction in response to nasal stimulation (such as with cold air)
Ovulatory rhinitis
increased nasal congestion in the periovulatory period of the menstrual cycle in women
What is the definition of acute sinusitis?
symptomatic inflammation of 1 or more paranasal sinuses resulting from impaired drainage and retained secretions < 4 weeks duration
how long subacute sinusitis?
symptomatic for 4-12 weeks
How long is chronic sinusitis?
symptomatic for > 12 weeks
what is Rhinosinusitis?
the term given to rhinitis and sinusitis because they usually coexist
how many annual cases of sinusitis are there each year?
31 million with an annual cost of 5.8 billion
what us the 5th leading reason for prescribing antibiotics?
acute bacterial rhinosinusitis about 0.2-2% episodes of viral rhinosinusitis have bacterial superinfection
When is incidence of sinusitis the highest?
early fall through early spring because it is related to viral URI (adults have 2-3 URIs per year- 90% accompanied by rhinosinusitis)
what is pathophysiology of sinusitis?
inflammation and edema of the sinus mucosaobstruction of the sinus ostiaimpaired mucociliary clearancesecretions that are no cleared become hospitable to bacterial growth inflammatory response damages mucosal surfaces