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1

Fxns of the nose?

- olfaction
- air filtration and warming

2

Deficiency in ability to perceive smell?

- 2.7 million adults have some deficiency
- impaired olfaction increases with age, and impairs sense of taste

3

Consequences of deficiency in ability to perceive smell?

- impairs sense of taste
- leads to nutrtional deficiences
- impairs social interactions
- depression
- can be dangerous - can't smell gas

4

What is anosmia? Hyposmia?
dysomia?

- anosmia: inability to detect odors
- hyposmia: decreased ability to detect odors
-dysosmia: distorted ID of smell
parosmia: altered perception of smell in the presence of odor, usually unpleasant
phantosmia: perception of smell w/o odor present
agnosia: inability to classify or contrast odors, although able to detect odors

5

PP of decreased olfaction?

- in conductive defects, transmission of an odorant stimulus to olfactory neuroepithelium is disrupted
- sensorineural defects involve more central neural structures
- overall - most common cause of primary olfactory deficity are nasal and or sinus disease, prior viral URIs and head trauma

6

Etiologies of anosmia?

- absent smell fxn
congenital:
-midline facial abnormalities - cleft palate
-SNHL

7

Etiologies of dysosmia?

distortion of smell fxn
-nasal and paranasal sinus disease (39%)
-head trauma (30%)
- URI
- meds
- exposure to toxins

8

Etiologies of parosmia and hyposmia?

- aging and neurodegenerative process: sense of smell decreases with normal aging, number of sensory cells in olfactory bulb decrease
- nasal obstruction
- URIs
- head trauma
- facial trauma
- central olfactory damage

9

air filtration and warming fxn of the nose physiology?

- removes most all particles greater than 5 micrometers and 50% of those 2-4 micrometers
- microorganisms are enclosed in droplets and inactivated by abs present in mucus
- warms and humidifies air to body temp by time it reaches nasopharynx
- respiratory cilia - beat 1000x a min and surface materials are moved 3-25 mm/min

10

Mucociliary movement?

- mucus blanket is double layer with superficial viscid fluid and serous layer underneath
- proper movement of mucous blanket is impt in preventing infection and other problems
- to obtain movement the cilia and mucus blanket must fxn as a unit
- cilia beat in serous inner layer and just touch the outer layer propelling the thick gel layer

11

What is rhinitis? Etiologies of rhinitis?

- inflammation of nasal mucosa
- 15-20% of pop
- allergic rhinitis
- infection: viral, bacterial, fungal (rare)
- vasomotor rhinitis
- mechanical obstruction
- effects of certain drugs/meds: rhinitis medicamentosa - afrin
- enviro irritants: perfume and smoke
- hormonal changes: hypothyroidism, pregnancy (increased fluids)
- chronic inflamatory disease (granulomatosis)

12

Rhinitis presentation?

- nasal congestion
- rhinorrhea/d/c
- epistaxis: pt on O2
- pain (nasal, sinus, pharyngeal, dental)

13

Common cold - inflammatory reaction can involve what tissues?

- inflammation of nasal passages commonly due to any number of respiratory - viruses
- inflammatory rxn may involve:
nasal and nasopharyngeal tissues, oropharyngeal, laryngeal tissues, down to and including the bronchial mucosae

14

Incidence/prevalence in USA of common cold?

- vast majority are self tx
- preschool children 6-10/year
- kindergarten 12/year
- school aged children 7/yr
- adolescents/adults 2-4/yr

15

Presentation of infectious rhinitis?

- pharyngitis: frequently the prodromal/first sx
- nasal congestion, rhinorrhea and/or obstruction
- sneezing
- facial and or ear pressure
- loss of smell/taste
- cough: mucus drainage, more coughing at no
- hoarseness: mucus coating larynx
- HA
- malaise (rare)
- fever over 100 (rare)

16

causes of common cold?

- weather: no proof
- exercise, diet, enlarged tonsils/adenoids: no proof, Vit C?
- psych stressors
- allergic disorders

17

VIral etiology of URIs?

- over 200 virus strains:
most cause mild illness

- rhinovirus (over 100 serotypes) - 80% of adult colds
- coronavirus - common cause in adults 10-20%
- adenoviruses (common cause in children) - 5% in adults
- no agent ID in 40% of cases

18

Viral etiologies of URIs that can cause more severe illness?

- orthomyxoviruses (influenza A and B) - 10-15%
- paramyxovirus (parainfluenza)
- echoviruses
- RSV
- enteroviruses: polio
- coxsackieviruses: heart muscle (myocarditis)

19

Transmission of the cold?

- touching your skin to enviro surfaces
- inhaling drops of aerosolized mucous material containing viral particles

20

DDx of common cold?

- seasonal allergic rhinitis
- sinusitis: bacterial
- pharyngitis: GAS
- CMV
- EBV (mono)
- mumps: pronounced swelling of parotid glands
- rubeola: rash starts at head and moves down
- influenza: systemic sxs often overshadow URI complaints and include:
fever over 101
myalgias
malaise
severe HA
lower respiratory tract congestion/cough

21

Supportive tx of common cold?

- rest
- drink plenty of fluids - thins the mucus
- gargle with warm salt water
- use throat sprays, lozenges
- petroleum jelly for sore nose (aquaphor)
- aspirin, Ibuprofen, or acetaminophen for HAs and fevers

22

Warning about aspirin for fevers in children?

- never use for HAs and fevers in children and adolescents with viral infections
- Reyes syndrome: usually occurs after influenza or chicken pox, when HAs and fevers are more pronounced. ASA promotes this:
N/V, liver inflammation, progressive mental changes (delirium and confusion)

23

Antihistamine MOA in rhinitis management?

- these are drugs that combat histamine released during an ab-ag that would have caused release of histamine from mast cells. The drug rxn blocks the action of histamine on target tissue
- antihistamines don't stop formation of histamine nor do they stop conflict b/t IgA and IgE and ag
- cold: ag is virus
- allergy: ag is allergen

24

antihistamines used in rhinits?

- 1st gen only: decrease mucus production
- chlorpheniramine (CTM, Chlor-Trimeton)
- Diphenhydramine (benadryl)
- Brompheniramine (dimetapp)
- 2nd gen: zyrtec, allegra don't seem to work

25

Meds used to relieve fever, myalgias, and HAs?

- NSAIDs:
ibuprofen (motrin, advil)
naproxen (aleve, anaprox)

26

MOA of decongestants in rhinitis? What do we use?

- decrease nasal congestion by causing blood vessel constriction and reduced blood flow to nasal passage
- pseudoephedrine (sudafed): oral
- phenylephrine (4 way fast acting nasal spray) and oxymetazoline (afrin) - 12 hr formulas, shouldnt be used for more than 3 consecutive days, cause rhinits medicamentosa

27

Unwanted SEs of decongestants?

- they may cause unwanted SEs in individuals with the following conditions:
narrow-angle glaucoma
poorly controlled HTN
coronary artery disease

28

dangers of cold medicines and children?

- cough and cold meds send about 7000 children to ER every year
- sxs are from unintentional overdosage: hives, drowsiness, unsteady walking
- during cold season approx 10% of children are on these meds

- always use ibuprofen for fever and pain, esp if using cold medicine that already contains tylenol

29

Pt education with common cold?

- reassurance: usual course is 6-10 days (up to 2 weeks)
- rest
- increase fluids
- d/c use of tobacco and ETOH
- tobacco doesnt increase risk of URI but does prolong duration of sxs

30

Possible complications of common cold?

- lower respiratory tract infections: bronchitis, pneumonia
- bronchial hyperreactivity: reactive airway
- exacerbation of chronic lung disease - asthma (give steroids) or chronic bronchitis/COPD
- otitis media (2% of colds): bacterial
- acute sinusitis (0.5% of colds): bacterial
- rhinitis medicamentosa