Nose

Question 1

what type of epithelium lines the nasal cavity?

Answer 1

roof = olfactory epithelium (allows receptor cells from the olfactory bulb to send information about smell
rest is lined by respiratory epithelium

Question 2

what bones form the nasal septum?

Answer 2

perpendicular plate of the ethmoid bone

vomer

Question 3

what nerve supplies the upper half of the nasal cavity?

Answer 3

CN V1

Question 4

what nerve supplies the lower half of the nasal cavity?

Answer 4

CN V2

Question 5

describe arterial supply to the lateral wall of the nasal cavity

Answer 5

superior :
- anterior ethmoidal arteries
- posterior ethmoidal arteries
posterior = sphenopalatine artery (traverses sphenopalatine foramen)
inferior = greater palatine artery
anterior = lateral nasal branches of facial artery

Question 6

what is kieselbachs area?

Answer 6

area on nasal septum which is rich an anastomosing arteries
common site of bleeding
- anterior and posterior ethmoidal arteries
- septal branch of labial artery
- greater palatine artery
- branch of sphenopalatine artery

Question 7

where is the sphenoethmoidal recess and what drains here?

Answer 7

above the superior nasal concha

drains the sphenoidal sinus

Question 8

where is the superior meatus and what drains here?

Answer 8

below the superior nasal concha

drains posterior ethmoidal air cells

Question 9

where is the middle meatus and what are the 2 parts of it?

Answer 9

below the middle meatus
2 parts
- semilunar hiatus
- ethmoidal bulla

Question 10

what drains into each part of the middle meatus?

Answer 10

semilunar hiatus
- frontal sinus
- maxillary sinus
- anterior ethmoidal cells
ethmoidal bulla
- middle ethmoidal air cells

Question 11

where is the inferior meatus and what drains here?

Answer 11

below the inferior nasal concha

drains nasolacrimal duct

Question 12

how may a nasal fracture present and how is it managed?

Answer 12

bruising, swelling, tenderness, deviation, epistaxis

review after 2-3 weeks once swelling has reduced and manipulate under anaesthetic

Question 13

4 risks which accompany nasal fracture?

Answer 13

recurrent epistaxis
CSF leak/meningitis
anosmia
septal haematoma

Question 14

what are the dangers of a septal haematoma?

Answer 14

can lead to perichondrium separation, de vascularisation of the cartilage, necrosis and infection

Question 15

where does epistaxis usually occur from?

Answer 15

kiesselbachs area (anastomising arteries on the septal wall)

Question 16

how is mild epistaxis managed?

Answer 16

lean forward
external compression
ice

Question 17

how is moderate epistaxis managed?

Answer 17

silver nitrate vessel cautery or electrocautery

Question 18

how is severe epistaxis managed?

Answer 18

nasal packing
post nasal packing
topical vasoconstriction 
rhino packs
consider arterial ligation in severe bleeds

Question 19

viral vs bacterial vs secondary bacterial sinusitis?

Answer 19

viral = lasts less than 10 days
bacterial = lasts over 10 days, but less than 4 weeks
secondary bacterial = viral infection which seems to get better then worsens a few days later

Question 20

symptoms of sinusitis?

Answer 20

purulent nasal discharge
nasal obstruction
facial pain/pressure over sinuses

Question 21

how is acute viral sinusitis managed?

Answer 21

analgesia
decongestants
intranasal corticosteroids
ipratropium
mucolytics

Question 22

how is acute bacterial sinusitis managed?

Answer 22

watchful waiting for >10 days and then commence antibiotics
- 1st line = penicillin for 7 days
- 2nd line = doxycycline for 7 days
plus same management as viral

Question 23

how is sinusitis managed in immunosuppressed?

Answer 23

immediate antibiotic treatment and ENT specialist referral

Question 24

what is chronic sinusitis?

Answer 24

lasting more than 12 weeks

Question 25

how is chronic sinusitis investigated?

Answer 25

``` anterior rhinoscopy flexible nasoendoscopy imaging - sinus CT (for pre surgical staging) sinus MRI (shows intracranial spread, fungal infections etc) ```

Question 26

how is chronic sinusitis managed medically?

Answer 26

antibiotics decongestants intranasal corticosteroids oral corticosteroids (if oedema or polyps present) anti-histamines/anti-leukotrienes if complicated with allergic rhinitis

Question 27

how is chronic sinusitis managed surgically?

Answer 27

FESS (functional endoscopic sinus surgery) | - increases diameter of sinus opening to allow drainage of sinuses

Question 28

what are the 2 groups of rhinitis?

Answer 28

allergic | non-allergic

Question 29

what is allergic rhinitis?

Answer 29

inflammation of the nasal cavity due to a type 1, IgE associated response to indoor and/or outdoor environmental allergens e.g - pollens, mould spores, animals, feathers, dust mites

Question 30

how is allergic rhinitis investigated?

Answer 30

skin prick allergy test | RAST testing

Question 31

how is allergic rhinitis managed?

Answer 31

``` oral anti-histamines (cetirizine) intranasal antihistamines (azelastine) intranasal corticosteroid (beclomethasone) 2nd line = leukotriene receptor antagonists (e.g montelukast) - helpful in patients with persistent asthma ```

Question 32

what are the 2 types of non-allergic rhinitis?

Answer 32

vasomotor | NAR eosinophilic syndrome

Question 33

how does non-allergic rhinitis occur?

Answer 33

regulated by autonomic innervation of the nasal cavity | reacts to changes in temperature, humidity, stress, hormonal changes

Question 34

how is non allergic rhinitis diagnosed?

Answer 34

negative findings in skin prick testing and serological IgE testing

Question 35

how is non allergic rhinitis managed?

Answer 35

iptrtropium for vasomotor nasal saline irrigation, intranasal antihistamines + intranasal corticosteroids + oral decongestant surgical = CO2 laser turbinectomy

Question 36

what are nasal polys and where do they usually come from?

Answer 36

swellings in the nasal cavity formed of oedematous mucosa usually occurs from the ethmoidal sinuses - presenting bilaterally in the middle meatus causing obstruction can sometimes occur from maxillary sinuses (antrochoanal polyps)

Question 37

what causes nasal polyps?

Answer 37

samter's triad (aspirin intolerance, asthma, nasal polyps) | EGPA

Question 38

what presentation of nasal polyps required further investigation?

Answer 38

if occurring in children | if unilateral

Question 39

how are nasal polyps managed?

Answer 39

intranasal corticosteroids (beclomethasone) oral corticosteroids if severe surgical polypectomy

Question 40

what are inverting papillomas?

Answer 40

wart like unilateral projections into the nasal cavity or paranasal sinuses benign but can become malignant in 5-15% of cases

Question 41

symptoms of inverting papillomas?

Answer 41

anosmia bleeding irritation occlusion

Question 42

what causes inverting papillomas?

Answer 42

unknown can be virus (HPV) industrial contaminants pollution

Question 43

how are inverting papillomas managed?

Answer 43

all papillomas are removed | radiotherapy may be required for malignant inverting papillomas

Question 44

what is the most common cancer of the nasal cavity?

Answer 44

SCC | 2nd = adenocarcinoma

Question 45

risk factors for nasal cancers?

Answer 45

``` work exposure hard woods (saw dust) - adenocarcinoma risk glues dyes chemicals HPV infection smoking ```

Question 46

how are nasal cancers managed?

Answer 46

complete surgical resection and adjuvant radiotherapy