Rhinology Flashcards Preview

H+N - C > Rhinology > Flashcards

Flashcards in Rhinology Deck (24)
Loading flashcards...
1

What may come up on a rhinology history?

Nasal obstruction
Nasal discharge
Epistaxis
Facial pain
Nasal deformity
Anosmia
Sneezing

2

What investigations may you carry out in rhinology?

Blood tests:
-FBC
-ANCA (antineutrophil cytoplasmic antibodies
-ESR
-ACE
-RAST (for allergy)

CT Scan
MRI Scan
Skin Tests
Rhinomanometry (airflow)

Skin Tests

3

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
Anatomical abnormality

4

Name some nasal disorders

Nasal trauma
Epistaxis
Rhinosinusitis
Nasal Polyps
Nasal Deformity
Nasal tumours
Choanal atresia

5

What causes nasal polyps?

Unknown
Chronic inflammation
Autonomic nervous system dysfunction
Genetic predisposition
Allergic vs. non-allergic

6

What is the pathophysiology of nasal polyps?

Associated with allergic conditions:
-20-50% have asthma
-Allergic rhinitis
-8-26% have aspirin intolerence
-50% have alcohol intolerance

Non-allergic conditions:
-Cystic Fibrosis 6-48% have polyps
-AFS 85% have polyps
-Churg-Strauss syndrome

7

What are the investigations for nasal polyps?

Sweat test
RAST/ SKIN TESTING
Nasal Smear
-Microbiology
-Eosinophils (allergic component)
-Neutrophils (chronic sinusitis)

CORONAL CT SCAN
MRI scan
Flexible nasendoscopy
Rigid nasendoscopy

8

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

Immunotherapy

9

What is the surgical treatment of nasal polyps?

-Traditional polypectomy
-MICRODEBRIDER
-ENDOSCOPIC SINUS SURGERY
-Recurrence
---Multiple small polyps common
---Large and antro-coanal less so

10

How do you diagnose rhinosinusitis?

SINUS RADIOGRAPHS
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

11

What are positive findings of rhinosinusitis on sinus radiographs?

Air-fluid levels
Mucosal thickening
Sinus opacification

12

What is the clinical classification of adult sinusitis?

Acute
Recurrent Acute
Chronic
Acute exacerbations of chronic

13

Describe acute adult sinusitis

-Acute onset of symptoms
-Duration of SYMPTOMS

14

Describe recurrent acute adult sinusitis

->1 TO 8 weeks between acute attacks in absence of medical treatment

15

Describe chronic adult sinusitis

-DURATION OF SYMPTOMS >12 WEEKS
-Persistent inflammatory changes on imaging >4 weeks
-After starting appropriate therapy

16

Describe acute exacerbations of chronic

-Worsening of existing symptoms or appearance of new symptoms
-Complete resolution of acute (but not chronic) symptoms between episodes

17

What is the microbial aetiology of acute rhinosinusitis?

-S. pneumoniae (31%)
-H. influenzae (21%)
-S. pneumoniae + H. influenzae (5%)
-Anaerobes (6%)
-M. catarrhalis (2%)
-S. aureus (4%)
-S. pyogenes (2%)
-Gram negatives (9%)

18

What are the major factor in the rhinosinusitis symptom complex?

-Facial pain and pressure
-Hyposmia/anosmia
-Nasal congestion/ obstruction
-Purulent postnasal drain
-Olfactory disturbance
-Cough not due to asthma (children only) cough (adults)

19

What are the minor factors in rhinosinusitis symptom complex?

Headache
Fever
Fatigue
Halitosis
Dental pain

20

What are the antimicrobial choices for rhinosinusitis

-B-lactams = penicillins, cephalosporins
-Macrolides = e.g. erythromycin, clarithromycin

21

What is the aetiology of epistaxis?

-Infection
-TRAUMA
-Allergy
-Hypertension and atherosclerotic vascular disease
-Hereditary haemorrhagic telangiectasia
-IATROGENIC (drug induced)
-Atrophic rhinitis
-Tumour
-Congenital or acquired nasal defects

22

What is the initial management of epistaxis?

-ABC's
-Medical history/ Medications
-Vital sign's (need IV?)
-Physical exam
---Anterior rhinoscopy
---Endoscopic rhinoscopy
-Laboratory exam

23

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


-Septodermoplasty/Laser ablation
-Embolisation

24

What is the treatment for hereditary hemorrhagic telangiectasia?

Laser coagulation
Young's procedure
Septodermoplasty