Nose Conditions Flashcards
(42 cards)
Nasal Polyps: Definition
Benign swellings of nasal mucosa of paranasal sinus - associated with chronic sinusitis
Nasal Polyps: Risk Factors
Asthma
Aspirin sensitivity
Genetics
Cystic fibrosis
Often associate with chronic sinusitis
Not associated with allergy
Nasal Polyps: Symptoms
Nasal obstruction»_space; usually bilateral
Nasal discharge
Reduced sense of smell
Cough
Nasal Polyps: Signs
Visualization of nasal polyps during physical examination
Nasal Polyps: Investigation
Clinical diagnosis based on examination.
Nasal endoscopy: Useful if polyps are not visualized via anterior rhinoscopy.
CT scan of the sinuses: Indicated if polyps are unilateral (requires a 2-week referral for evaluation).
Nasal Polyps: Management
First-Line Treatment- Intranasal corticosteroids
Daily use for 3 months followed by re-evaluation.
Continue indefinitely with reviews every 6 months.
Second-Line Treatment- Surgical polypectomy
Allergic Rhinitis: Definition
Seasonal allergies
Acute phase»_space; minutes»_space; sneezing and nasal secretion or 15-20 minutes
Late phase»_space; nasal obstruction for 6-12 hours
Seasonal (hay fever), perennial (persistent), occupational (due to exposure to allergens at work)
Allergic Rhinitis: Epidemiology
It affects approximately 26% of UK adults and 10% of 6- and 7-year-olds.
Allergic Rhinitis: Aetiology
Allergic rhinitis is an IgE-mediated inflammatory disorder of the nasal mucosa.
When sensitized to allergens, the nasal mucosa releases histamines, causing typical symptoms of allergic rhinitis.
Allergic Rhinitis: Risk Factors
Genetic Predisposition
Environmental Triggers-
House dust mites
Grass, tree, weed pollen
Moulds
Animal dander
Allergic Rhinitis: Symptoms
Seasonal or perennial presentation
Sneezing
Nasal itching
Rhinorrhoea»_space; runny nose
Postnasal drip»_space; mucus drips down throat
Nasal congestion
Cough
Bilateral eye itching, watering, redness
Allergic Rhinitis: Signs
Oedematous nasal mucosa with greyish discoloration
Nasal discharge
Nasal polyps
Hypertrophic nasal turbinates»_space; enlarged turbinates
Transverse nasal crease»_space; across the bridge of the nose»_space; pushing nose up to clean
Allergic shiners»_space; darkened, swollen shadows under the eyes
Bilateral eye redness with clear discharge
Allergic Rhinitis: Investigation
Clinical Examination
Allergy test
Immunotherapy
Refer to ENT»_space; unilateral symptoms, blood-stained discharge, epistaxis (nose bleed)
Allergic Rhinitis: Management
General Measures-
Nasal irrigation with saline
Allergen avoidance
Mild Persistent or Intermittent Symptoms-
Intranasal corticosteroids»_space; anti inflammatory and immunosuppressive
Intranasal or non-sedating oral antihistamines»_space; reduce inflammation
Moderate-Severe Persistent Symptoms or Unresponsive Cases-
Daily intranasal corticosteroid with or without intranasal antihistamine»_space; full effectiveness up to 2 weeks
For eye symptoms: Antihistamine or chromone eye drops»_space; sodium cromoglycate
Allergic Rhinitis: Further Management
Consider stepping-up treatment-
Nasal congestion- add intranasal decongestant x5-7 days
Rhinorrhoea- add intranasal anticholinergic (ipratropium bromide)»_space; blocks acetylcholine reducing secretion from nasal passage.
Nasal itching, sneezing- add regular oral antihistamine or combination intranasal antihistamine with corticosteroid (Dymista)
Concurrent asthma- add leukotriene receptor antagonist (montelukast)
Severe symptoms affecting QOL-
Short-course oral corticosteroid (prednisolone)
Refer for immunotherapy-
Objective confirmation of IgE sensitivity to predominantly one allergen
Expose patient to increasing amounts of allergen over several weeks to induce tolerance
Allergic Rhinitis: Complications
Poor asthma control
Sinusitis
Nasal polyps
Chronic otitis media
Negatively affecting quality of life
Impaired school performance
Atopy: asthma, eczema, hay fever, allergies
Acute Sinusitis: Definition
Acute sinusitis, commonly known as a sinus infection.
Symptomatic inflammation of the paranasal sinuses and nasal cavity lasting less than 12 weeks.
Acute Sinusitis: Aetiology
Often follows a viral upper respiratory tract infection (URTI)
Bacterial infection occurs in 0.5-2% of cases, commonly caused by:
» Streptococcus pneumoniae
» Haemophilus influenzae
» Moraxella catarrhalis
Acute Sinusitis: Risk Factors
Allergy rhinitis
Asthma
Smoking
Anatomical variations»_space; deviated nasal septum, nasal polyps
Acute Sinusitis: Symptoms
Upper respiratory tract infection (URTI) symptoms»_space; sore throat, cough, malaise
Nasal blockage or congestion
Nasal discharge
Facial pain or pressure
Reduction or loss of smell
Acute Sinusitis: Signs
Maxillofacial sinus swelling, erythema, or tenderness
Discoloured or purulent nasal discharge
Oedematous nasal mucosa»_space; nasal mucosa becomes inflamed»_space; oedema
Fever
Acute Sinusitis: Investigation
Diagnose using symptoms-
Acute viral (common cold)»_space; symptoms less than 10 days
Post-viral acute sinusitis»_space; symptoms more than 10 days or worsening symptoms after 5 days
Acute bacterial sinusitis»_space; at least 3 present-
Symptoms more than 10 days
Discoloured or purulent nasal discharge
Severe localized pain
Fever
Double sickening
Acute Sinusitis: Treatment
Acute:
Symptoms less than 10 days: no antibiotics, paracetamol, nasal decongestant, saline spray
Symptoms more than 10 days: high dose nasal corticosteroid for 14 days
Consider back-up antibiotic prescription -evidence shows little effects on symptoms
» phenoxymethylpenicillin
» doxycycline if allergic to penicillin (not for pregnant women)
Chronic:
Supportive care, control underlying condition, stop smoking, avoid allergic triggers, nasal saline irrigation, intranasal corticosteroid for 3 months
Chronic Sinusitis: Definition
Symptomatic inflammation of the paranasal sinuses lasting for 12 weeks or more.
