Nose - Sinusitis, Rhinitis, Nosebleeds, Nasal septal hematoma, Nasal polyp

Question 1

Sinusitis
-causative organisms
-associated factors
-presentation
-management

Answer 1

Strep pneumonia
Haem influenzae

Nasal obstruction
Recent local infection
Swimming, diving
Smoking

Frontal facial pain worse on bending forward
Thick purulent nasal discharge
Nasal obstruction

Analgesia
IN CS - symptoms for 10 days
If severe - PO phenoxymethylpenicillin
-coamox if systemically unwell, high complication risk

Double-sickening - initial viral sinusitis worsens due to 2ndary bacterial infection

Question 2

Allergic rhinitis
-associated factors
-presentation
-management

Answer 2

Seasonal, occupational

Sneeze and itch
Bilateral nasal obstruction
Clear discharge
Post-nasal drip

Allergen avoidance
Mild - PO, IN antihistamines
Moderate - IN CS
Can use TOP nasal decongestants (oxymetazoline) for short periods of time
-dependance + rebound hypertrophy

Question 3

Nosebleed
-location
-causes
-first aid and management

Answer 3

Anterior - Kiesselbach plexus
Posterior -
-profuse bleeding with higher risk of aspiration and airway compromise

Local
-picking, blowing
-traumatic injury
-insertion of FB
-cocaine - VC of nasal vessels => destroys septum

Systemic
-bleeding disorders
-AC/AP use

First aid
-sit leaning forward, open and breathe through mouth
-pinch the soft part of your nose for 20mins

Question 4

Nosebleed
-if first aid not enough after 10-15mins

Answer 4

VC nasal spray - epinephrine, LA, oxymetazoline

Cautery - source visible and tolerated
-blow nose to remove clots
-LA spray
-apply silver nitrate for 3-10s
-clean and add chlorhexidine+neomycin

Packing - source not visible, cautery not an option
-LA spray
-pack
-examine mouth and throat for bleeding
-admit

Question 5

Nasal septal hematoma
-pathophysiology
-presentation
-management

Answer 5

Trauma => hematoma between septal cartilage and perichondrium
-cartilage relies on perichondrium for nutrients

MUST BE IDENTIFIED OTHERWISE WILL BECOME NECROTIC IN 3-4 DAYS => SADDLE NOSE

Nasal obstruction
Pain, runny nose
Bilateral red swelling from septum
Feels boggy
-different from deviated septum (hard)

IV ABx
Surgical drainage

Question 6

Nasal polyp
-presentation
-management

Answer 6

Painless nasal obstruction
Runny nose, sneezing
Poor taste and smell
If unilateral symptoms => investigate

Refer to ENT
TOP CS to shrink polyps