Nose Flashcards
most common area for epistaxis
little’s area - anterior septum
RF epistaxis
warfarin dry air hereditary haemorrhagic telangiectasia (seen quite a lot) trauma - nose picking, injury, surgery coagulopathy rhinitis neoplastic
multiple unilateral epistaxis. what to do
refer to ENT 2ww
rx epistaxis
20 mins pinching
cautery (silver nitrate)
packing - take out after 24 h, 48 if not on anticoag
surgery (tie of sphenopaleatine artery)
types of packing
baloon tamponade
absorbable packs
posterior packs
causes of rhinosinusitis
VIRAL
bacterial
allergy
(NB acute rhinosinustitis is the common cold. ENT usually see chronic)
symptoms of rhinosinusitis
nasal congestion/discharge
facial pain - worse leaning forwards
anosmia
polyps
treatment rhinosinustitis
antihistaimines
nasal douching
intranasal steroids if sx >=10 days
flexible endoscopic sinus surgery (FESS) if doesn’t get better
what can prolonged use of intranasal decongestants cause
tacyphylaxis (higer dose for affect) and hypertophy of nasal mucosa
if used for >7 days you get rebound congestion
what can occur secondary to chronic rhinosinusitis
nasasl polyposis
diseases associated with polyps
laste onset asthma, CF, aspiring inses, churg strauss
surgery to treat nasal polyposis
FESS + polypectomy
referral pathway for polyps
bilateral - routinely
unilateral - RED flag .,. 2ww
nasal ca types + associations
undifferentiated non keratinising SCC - southern ghina, hong kong (due to salted fish), EBV virus
differentiated, keratinising SCC - smoking, alc, HPV
symptoms nasal Ca
single sided epistaxis, nasal obstruction, recurrent middle ear effusion, CN palsy
what type of Ca is nearly all head and neck
SCC
why is periorbital cellulitis an ENT problem
spreads from sinusitis (especially ethmoiditis) through valveless ophthalmic venous system. may also spread intracranially (abscess, meningitis, cavernous sinus thrombosis)
treatment periorbital cellulitis
IV abx, nasal steroids
what to watch for with nasal trauma
septal haematomas. need URGENT drainage as compress cartilage causing necrosis. can lead to saddle deformity
treatment broken nose
moving back within 21 days
otherwise need rhinoplasty
