- topical steroid spray - nasal douches-- neilmed + streimar - surgery-- diathermy/ turbinate reduction - FESS

BILATERAL - anosmia - nasal obstruction - sneezing - rhinorrhea - pale - boggy edematous mucosa

- lateral nasal XR - CXR: inspiratory and expiratory

Nose-ENT Flashcards by Jinesa moodley

differential for nasal obstruction

congenital- choanal atresia
anatomical- deviated septum
FB
inflammatory
neoplastic

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inflammatory causes for nasal obstruction

polyp
sarcoid
wegners

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neoplastic cases for nasal obstruction

papilloma
SCC
juvenile nasopharyngeal angiofibroma
inverted papilloma

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empiric tx nasal obstruction

STEROIDS- spray
DECONGESTANT- spray or drops
ANTIBIOTICS

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dx of nasal obstruction

pan-endscopy

fog-up mirror test

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red flag symptoms for nasal obstruction

UNI-epistaxis
UNI-blockage
UNI-swelling
ear effusion
neck swelling
atypical pain

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tx allergic rhinitis

topical steroid spray
nasal douches– neilmed + streimar
surgery– diathermy/ turbinate reduction
FESS

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nasonex

mometasone furoate monohydrate + glucocorticoids

>12yo

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avamys

fluticasone furoate + glucocorticoids

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rynacrom

sodium cromoglycate

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atrovent

ipratropium bromide

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PC nasal polyps

BILATERAL

anosmia
nasal obstruction
sneezing
rhinorrhea
pale
boggy edematous mucosa

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tx nasal polyps

steroids

surgery– FESS, polypectomy

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steroids for nasal polyps

spray– 6 months
drops– 2-3weeks
oral– 10 days

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MCC unilateral polyp

inverted papilloma

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Dx- inverted papilloma

MUST BIOPSY– since can go on to SCC

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inverted papilloma associated with

MENINGOCELE

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dx nasal polyps

endoscopy–pale and grey polypoid mass

- bogy and oedematous mucosa

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dx nasal polyps imaging:

CT paransal sinuses= radio-opaque

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dx of nasal FB

lateral nasal XR

- CXR: inspiratory and expiratory

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tx of nasal FB

GA–removal

bronchoscopy if aspirate

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dx of choanal atresia

fogging metal spatula
NGT/catheter
fibreoptic scope
CT: bony or membranous mixed

vaso-motor rhinitis=

NON-allergic rhinitis

risk factors for non-allergic rhinitis

fumes/ pregnancy/ drugs

DIAGNOSIS OF EXCLUSION

MAJOR symptoms for rhinosinusitis

- nasal obstruction - rhinorrhea - facial pressure - fever - olfactory changes

minor symptoms for rhinosinusitis

- headache - fatigue - cough - hallitosis - dental pain - ear pain

endoscopy findings rhinosinusitis

MOON Mucopurulent discharge in middle meatus Oedema / Obstruction in middle meatus Nasal polyps

CT findings rhinosinusitis

mucosal changes--> osteomeatal complex and/or sinuses

duration of acute rhinosinusitis

duration of chronic rhinosinusitis

> 12 weeks-- incomplete resolution

patient causes of rhinosinusitis

``` STRUCTURAL - nasal tumor - septal deviation - nasal polyp MUCOCILIARY CLEARANCE - CF - immotile cilia IMMUNODEF - HIV ```

environmental causes of rhinosinusitis

``` SOC-FAM smoke occupational chemicals fungi allergens medications ```

dx of acute sinusitis

endoscopy/rhinoscopy | = PUS IN MIDDLE MEATUS

tx of acute sinusitis

- Abx: co-amox or vibramycin - decongest: ephedrine or otrovine - steroids - bed rest/ analgesia

causes of chronic sinusitis

ANAEROBES | S.AUREUS

dx of chronic sinusitis

allergy test; | exclude: polyp/ tumor/ septal deviation

tx of chronic sinusitis

1. abx 2. cause 3. steroids-- topical/oral (decreases inflammation, increases drainage)

infective viral causes of chronic sinusitis

rhinovirus adenovirus RSV parainfluenza

infective bacterial causes of chronic sinusitis

simple syphilis TB

non-allergic rhinitis= non-infective rhinitis=

non-allergic eosinophilic rhinitis - occupational - hormonal - drug induced - gustatory - vasomotor

ARIA

allergic rhinitis and its impact on asthma

seasonal causes of allergic rhinitis

POLLENS

perennial causes of allergic rhinitis

- house dust mite - animal dander - chemicals - food - fungospores

tx allergic rhinitis

1. avoid allergen 2. saline douching 3. anti-histamine 4. surgery-- obstruction only: septoplasty or turbinate reduction 5. immunotx-- desens--> sc, sublingual

3 big indications for rhinitis surgery

1. COMPLICATIONS 2. FUNGAL 3. NEOPLASM suspected

3 complications indicating need for rhinitis surgery | the intra-cranial complications

1. meningitis 2. abscess - brain - subperiosteal orbital 3. cavernous sinus thrombosis

3 surgical options for rhinitis

- septal surgery - polypectomy - FESS

basis behind FESS

unblocks osteometal complex--> aeration and drainage of sinuses; performed under image guidance

FESS nasal complications

- epistaxis - infection - adhesions - anosmia/hyposmia

FESS orbital complications

- haematoma | - optic nerve trauma

FESS intra-cranial complications

- CSF leak | - meningitis

rhinitis miscellaneous complications

- LRTI - AOM - osteomyelitis= POTTS PUFF TUMOR

orbital complications of rhinitis

- abscess | - periorbital cellulitis (mc in kids, with URTI before)