Flashcards in Rhinology Deck (24)
What may come up on a rhinology history?
What investigations may you carry out in rhinology?
-ANCA (antineutrophil cytoplasmic antibodies
-RAST (for allergy)
What is the aim of CT imaging in rhinology?
To identify the anatomical relationship of the key structures (optic nerve, orbital contents and carotid artery)
Nature and extent of disease
Name some nasal disorders
What causes nasal polyps?
Autonomic nervous system dysfunction
Allergic vs. non-allergic
What is the pathophysiology of nasal polyps?
Associated with allergic conditions:
-20-50% have asthma
-8-26% have aspirin intolerence
-50% have alcohol intolerance
-Cystic Fibrosis 6-48% have polyps
-AFS 85% have polyps
What are the investigations for nasal polyps?
RAST/ SKIN TESTING
-Eosinophils (allergic component)
-Neutrophils (chronic sinusitis)
CORONAL CT SCAN
What is the medical treatment for nasal polyps?
Oral and nasal steroids
-High dose prednisolone and nasal steroid for 20 days will eliminate 50% of polyps
-Lower bioavailability in modern nasal steroids
-Poor response in certain groups
-Intranasal injection not effective
What is the surgical treatment of nasal polyps?
-ENDOSCOPIC SINUS SURGERY
---Multiple small polyps common
---Large and antro-coanal less so
How do you diagnose rhinosinusitis?
Poor visualisation of the osteomeatal complex and the anterior ethmoidal sinuses.
-High rate of false positive findings
-Less expensive, but not as accurate as newer imaging
What are positive findings of rhinosinusitis on sinus radiographs?
What is the clinical classification of adult sinusitis?
Acute exacerbations of chronic
Describe acute adult sinusitis
-Acute onset of symptoms
-Duration of SYMPTOMS
Describe recurrent acute adult sinusitis
->1 TO 8 weeks between acute attacks in absence of medical treatment
Describe chronic adult sinusitis
-DURATION OF SYMPTOMS >12 WEEKS
-Persistent inflammatory changes on imaging >4 weeks
-After starting appropriate therapy
Describe acute exacerbations of chronic
-Worsening of existing symptoms or appearance of new symptoms
-Complete resolution of acute (but not chronic) symptoms between episodes
What is the microbial aetiology of acute rhinosinusitis?
-S. pneumoniae (31%)
-H. influenzae (21%)
-S. pneumoniae + H. influenzae (5%)
-M. catarrhalis (2%)
-S. aureus (4%)
-S. pyogenes (2%)
-Gram negatives (9%)
What are the major factor in the rhinosinusitis symptom complex?
-Facial pain and pressure
-Nasal congestion/ obstruction
-Purulent postnasal drain
-Cough not due to asthma (children only) cough (adults)
What are the minor factors in rhinosinusitis symptom complex?
What are the antimicrobial choices for rhinosinusitis
-B-lactams = penicillins, cephalosporins
-Macrolides = e.g. erythromycin, clarithromycin
What is the aetiology of epistaxis?
-Hypertension and atherosclerotic vascular disease
-Hereditary haemorrhagic telangiectasia
-IATROGENIC (drug induced)
-Congenital or acquired nasal defects
What is the initial management of epistaxis?
-Medical history/ Medications
-Vital sign's (need IV?)
What is the surgical treatment of epistaxis?
-ENDOSCOPIC SPHENOPALATINE ARTERY LIGATION
-Transmaxillary IMA ligation
-Intraoral IMA ligation
-ANTERIOR/POSTERIOR ETHMOIDAL LIGATIONS
-EXTERNAL CAROTID ARTERY LIGATION