Rhinology Flashcards
(37 cards)
List some specific symptoms associated with rhinology
o Nasal obstruction o Nasal discharge – colour, viscosity, rhinorrhea (profuse clear fluid), pus (infection) o Epistaxis (nose bleeds) o Facial pain – can mimic sinusitis o Nasal deformity o Anosmia (lack of smell) o Sneezing – allergic rhinitis o Wound – cocaine use and nasal septum perforation
List some specific aspects of past medical history associated with rhinology
o Medical treatment
o Nasal surgery
o Nasal trauma
o Asthma/aspirin sensitivity
Describe methods of examining the nose in rhinology
o Lift and look up nose e.g. if kid doesn’t like otoscopes
o Otoscopes
o Cold spatula test
o Rigid endoscopy of nose – examines posterior aspect of nose
o Fibroscope – examines posterior aspect of nose
List some investigations used in rhinology
Blood tests e.g. FBC, ESR, ACE, RAST CT scanning MRI Skin tests for allergens Rhinomanometry
What is rhinomanometry?
Rhinomanometry - form of manometry used in evaluation of the nasal cavity. Rhinomanometry is a standard diagnostic tool aiming to objectively evaluate the respiratory function of the nose. Increased pressure during respiration is a result of increased resistance to airflow through nasal passages (nasal blockage), while increased flow, which means the speed of airstream, is related to better patency. Nasal obstruction leads to increased values of nasal resistance. Rarely used in clinic, more for research
Why might ACE levels in the blood be increased?
Sarcoidosis
What does RAST test for?
A radioallergosorbent test (RAST) is a blood test using radioimmunoassay test to detect specific IgE antibodies, to determine the substances a subject is allergic to.
List some nasal disorders
- Nasal trauma
- Epistaxis
- Rhinosinusitis
- Nasal polyps
- Nasal deformity
- Nasal tumors – red flags are unilateral epistaxis obstruction, smoker, chronic discharge
- Sleep apnoea
- Choanal atresia - a congenital disorder where the back of the nasal passage (choana) is blocked, usually by abnormal bony or soft tissue (membranous) due to failed recanalization of the nasal fossae during fetal development.
What are some red flag symptoms of a nasal tumour?
red flags are unilateral epistaxis obstruction, smoker, chronic discharge
What is choanal atresia?
Choanal atresia - a congenital disorder where the back of the nasal passage (choana) is blocked, usually by abnormal bony or soft tissue (membranous) due to failed recanalization of the nasal fossae during fetal development.
What are some complications associated with nasal trauma?
o Psychological issues
o Difficulty breathing
o May be predisposed to sinusitis now later in life – eustachian tube disruption
o Septal haematoma – can follow trauma, needs to be drained and packing inserted, as well as perhaps antibiotics, as it can develop into an abscess and cause necrosis of the nose, leading to collapse of the nose (saddle nose)
What can cause septal perforation?
o Cocaine
o Trauma
o Previous septoplasty
What is Samters triad?
Samter’s Triad - This is a condition in which patients have a combination of symptoms such as airway problems like asthma; nasal problems like blockage and discharge with nasal polyps; and then develop a hypersensitivity reaction to aspirin. This hypersensitivity reaction is non-allergic.
A 40-year-old man presents with constant blocked nose, PN drip and hyposmia. He also has history of asthma and aspirin sensitivity. On examination, nasal polyps are seen. What do you suspect is the diagnosis?
Samter’s triad - a condition in which patients have a combination of symptoms such as airway problems like asthma; nasal problems like blockage and discharge with nasal polyps; and then develop a hypersensitivity reaction to aspirin. This hypersensitivity reaction is non-allergic.
How are nasal polyps treated?
Oral and nasal steroids
o High dose prednisolone and nasal steroid for 20 days will eliminate 50% of polyps
o Lower bioavailability in modern nasal steroids
o Poor response in certain groups
o Intranasal injection not effective
o Lifelong nasal steroids to prevent recurrence
Immunotherapy – used in aspirin sensitive individuals (Samter’s triad)
Surgery
How are nasal polyps caused by Samters triad treated?
Immunotherapy
Describe the possible surgical treatments of nasal polyps
- Traditional polypectomy
- Microdebrider
- Endoscopic sinus surgery
How likely is recurrence of nasal polyps?
o Multiple small polyps = common
o Large and antro-coanal = less so
23yr old presents with runny nose, nasal blockage, facial pain, general malaise and sore throat for 10 days. Otherwise fit and well, with no systemic upset.
What do you suspect is the diagnosis?
Sinusitis
How is sinusitis treated?
- Antibiotics
- Steam inhalation
- Nasal decongestants – only used for a couple days as it can cause rebound congestion
- Steroid spray
- Antihistamines
Describe the clinical classification of acute sinusitis
– Acute onset of symptoms
– Duration of symptoms <12 weeks
– Symptoms resolve completely
Describe the clinical classification of chronic sinusitis
– Duration of symptoms >12 weeks
– Persistent inflammatory changes on imaging >4 weeks after starting appropriate therapy
Describe the clinical classification of recurrent acute sinusitis
– >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
Describe the clinical classification of an acute exacerbation of chronic sinusitis
– Worsening of existing symptoms or appearance of new symptoms
– Complete resolution of acute (but not chronic) symptoms between episodes
