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MBChB - Y2 - Head and Neck > Rhinology > Flashcards

Rhinology Flashcards

1
Q

What is typical presentation in rhinology?

A

Signs and symptoms such as

žNasal obstruction

žnasal discharge

žepistaxis

žfacial pain

žnasal deformity

žanosmia

žsneezing

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2
Q
A

MEDICAL TREATMENT

NASAL SURGERY

NASAL TRAUMA

ASTHMA/ASPIRIN SENSITIVITY

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3
Q

What occupation commonly presents to rhinology?

A

Woodworkers

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4
Q

What do all smokers have?

A

Some degree of Rhinitis

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5
Q

Which turbinate are you most likely to see on nasal endoscopy?

A

Inferior turbinate, and probably middle

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6
Q

What is the cause of nasal polyps?

A

Unknown

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7
Q

What prevents nasal polyps from coming back after resection?

A

Steroid spray

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8
Q

What are the relevant investigations in Rhinology?

A

žBlood tests-FBC, ANCA, ESR, ACE, RAST

žCT SCAN

žMRI SCAN

žSKIN TESTS

žRHINOMANOMETRY

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9
Q

When are CT scans most likely to be used?

A

Pre-operatively - ensures safe surgery

Allows identification of anatomical relationships of the key structures (optical nerve, orbital contents and carotid artery)

Shows nature and extent of disease as well as anatomical abnormalities

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10
Q

What is rhinomanometry?

A

Rhinomanometry is a standard diagnostic tool aiming to objectively evaluate the respiratory function of the nose. It measures pressure and flow during normal inspiration and expiration through the nose.

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11
Q

What are common nasal disorders?

A

Nasal trauma

Epistaxis

Rhinosinusitis

Nasal Polyps

Nasal Deformity

Nasal Tumours

Choanal artresia - feeding problems

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12
Q

What nasal pathology can happen as a result of nasal trauma?

A

Septal haematoma

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13
Q

Why is early detection of septal haematoma important?

A

Early diagnosis and treatment is important to prevent abscess formation, septal perforation, saddle-nose deformity, and potentially permanent complications

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14
Q

What exactly is a septal haematoma?

A

Perichondrium is pulled away from the cartilage which tears submucosal blood vessels. Blood now collects between perichondrium and septal cartilage. Stagnant blood can easily result in infection.

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15
Q

40 year old man with constant blocked nose, PN drip and hyposmia. He also has history asthma and aspirins sensitivity.

WHAT IS IT?

A

Nasal Polyps

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16
Q

What is the cause of nasal polyps?

A

Unknown, involves chronic inflamamtion, autonomic nervous system dysfunction and genetic predisposition.

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17
Q

What are the two clases of nasal polyps?

A

Allergic and non-allergic

18
Q

What are associated allergic conditions with nasal polyps?

A

Associated with allergic conditions

ž20-50% have asthma

žAllergic rhinitis

ž8-26% have aspirin intolerance

ž50% have alcohol intolerance

ž

19
Q

What are non-allergic conditions associated with nasal polyps?

A

Non allergic conditions

žCystic Fibrosis 6-48% have polyps

žAFS (allergic fungal sinusitis) 85% have polyps

žChurg-Strauss syndrome

20
Q

What are investigations for nasal polyps?

A

žSweat test (to see if cystic fibrosis is present)

žRAST / skin testing

žNasal smear

  • Microbiology
  • Eosinophils (allergic component)
  • Neutrophils (chronic sinusitis)

Coronal CT scan

MRI

Flexible nasoendoscopy

Rigid nasoendoscopy

21
Q

What is non-surgical treatment for nasal polyps?

A

Oral and Nasal steroids

(¡High dose prednisolone and nasal steroid for 20 days will eliminate 50% of polyps)

Immunotherapy

22
Q

What is surgical treatment for nasal polyps?

A

žTraditional polypectomy

žMicrodebrider - tube used to cut tissue

žEndoscopic sinus surgery

23
Q

What is the likelihood of recurrence of nasal polyps?

A

žRecurrence:

Multiple small polyps common

Large and antro-coanal less so

24
Q

What is the condition?

ž23yr old presents with runny nose, nasal blockage, general malaise and sore throat for 10 days. Otherwise fit and well, with no systemic upset.

A

Acute sinusitis

25
Q

What is the treatment for sinusitis?

A

Usually self limiting virus

May require over the counter pain killers, over the counter decongestants, cleaning the inside of the nose with salt water solution.

GP therapy may be indicated if symptoms do not improve after 7-10- days or symptoms becomes worse, treatment includes corticosteroid drops or sprays / antibiotics.

Surgery may be indicated if these treatments don’t work - functional endoscopic sinus surgery

Surgery involves balloon catheter dilation / nasal polyp removal if blocking sinus

26
Q

What is the diagnosis of rhinosinusitis?

A

Sinus - radiographs

27
Q

What is meant by acute sinusitis?

A

Acute

– Acute onset of symptoms

– Duration of symptoms <12 weeks

– Symptoms resolve completely

• Recurrent acute

– >1 to <4 episodes of acute rhinosinutitis per year.

– Complete recovery between episodes.

– Symptom-free period of >8 weeks between acute attacks in

absence of medical treatment.

28
Q

What is meant by chronic sinusitis?

A

žChronic

ž– Duration of sysmptoms >12 weeks

ž– Persistent inflammatory changes on imaging >4 weeks after starting appropriate therapy

29
Q

What are acute exacerbations of chronic sinusitis?

A

žWorsening of existing symptoms or appearance of new

žsymptoms

ž– Complete resolution of acute (but not chronic)

žsymptoms between episodes

30
Q

What are the common causative organisms of acute rhinosinusitis?

A

S pneumoniae

H influenzae

31
Q

What are the major and minor factors for sinusitis?

A

Major Factors Minor Factors

žFacial pain and pressure Headache

ž

žHyposmia/anosmia Fever

ž

žNasal congestion/obstruction Fatigue

ž

žPurulent postnasal drain Halitosis

ž

žOlfactory disturbance Dental pain

ž

žCough not due to asthma (children only) Cough (adults)

32
Q

What are the antimicrobial choices for rhinosinusitis?

A

žβ-lactams – penicillins, cephalosporins

ž

žMacrolides - e.g erythromycin,clarithromycin

33
Q

What is the treatment for periorbital swelling of the eyes?

A

žEmergency referral

žOphthal opinion

žUrgent CT

žIV Antibiotics

žEmergency surgery

34
Q

What is the treatment for frontal sinusitis / pott’s puffy tumor?

A

žEmergency referral

žFrontal sinus surgery

žESS (endoscopic sinus surgery)

Pus can erode the bone of the frontal sinus, can affect the brain, frontal lobe oedema, abscess in frontal lobe.

35
Q

What are mucocele?

A

Cystic masses that generally affect the sinuses, results from obstruction of ostium of a sinus,

36
Q

Why can ethmoidal mucocele cause diplopia?

A

Cyst forms which presses on the orbit

37
Q

What are the causes of epistaxis?

A
  1. Infection
    a. Rhinitis
    b. Nasopharyngitis
    c. Sinusitis
  2. Trauma
    a. Accidental or self-induced
    b. Iatrogenic
  3. Allergy
  4. Hypertension and atherosclerotic vascular disease
  5. Hereditary hemorrhagic telangiectasia
  6. Blood dyscrasias
    a. Iatrogenic (drug induced)
    b. Disease mediated
    c. Alcoholism
  7. Atrophic rhinitis
  8. Tumor
    a. Primary
    b. Secondary
  9. Congenital or acquired nasal defects.

Telangectasia - a condition characterized by dilatation of the capillaries causing them to appear as small red or purple clusters, often spidery in appearance, on the skin or the surface of an organ.

Dyscrasia - an abnormal or disordered state of the body or of a bodily part.

38
Q

What is the initial management of epistaxis?

A

žABC’s

žMedical history/Medications

žVital signs—need IV?

žPhysical exam involving -

  • Anterior rhinoscopy
  • Endoscopic rhinoscopy

žLaboratory exam

Nasal packing

39
Q

What is surgical treatment of epistaxis?

A

Artery ligation (sphenopalatine, transmaxillary IMA, intraoral IMA, anterior/posterior ethmoidal, external carotid)

Septodermoplasty/laser ablation

Embolisation

40
Q

What is the treatment for HHT (hereditary haemorrhagic telangiectasia?)

A

LASER COAGULATION

YOUNG’S PROCEDURE

SEPTODERMOPLASTY - Definition: Operation to graft stratified squamous epithelium and dermis to replace the mucous membrane of the nasal septum, especially for patients with hereditary hemorrhagic telangiectasia.

41
Q

What is the treatment of angiofibroma?

A

Do not biopsy! Can lead to death

  • Pre-operative embolisation
  • Surgery
42
Q
A

MBChB - Y2 - Head and Neck (12 decks)

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