Rhinology Flashcards
(44 cards)
What symptoms should be screened for in a history regarding the nose?
Nasal obstruction Nasal discharge Epistaxis Facial pain Nasal deformity Anosmia Sneezing
What aspects of past medical history are of importance when discussing the nose?
Medical treatment Nasal surgery Nasal trauma Asthma Aspirin sensitivity
What occupation history may be of particular importance for rhinology?
Woodworkers
What social history may be of particular impotence for rhinology?
Cocaine use (degenerates nasal septum)
What instruments are used in a nasal examination?
Otoscope and endoscope for posterior cavity
What investigations can be carried out when a nasal pathology is suspected?
Bloods FBC, ANCA in small blood vessel damage, ESR, ACE, RAST
CT (gold standard)
Skin tests
Nasal smear
Rhinomanometry (not often used - assesses smell)
Flexible/rigid nasendoscopy
List some common nasal disorders:
Traumatic Vascular Infections Malignant Congenital
Nasal trauma
Epistaxis (nose bleeds)
Rhinosinutsitis (very common)
Nasal polyps / tumour
Choanal atresia - nasal cavity not open in posterior aspect - leads to breathing issues
What is the treatment for nasal trauma?
Rhinoplasty
What is septal haematoma? How can it occur?
Swelling/bruising of the nasal septum. Can occur due to trauma of anterior nasal septum
What is the potential complication for septal haematoma?
If left untreated can become septic (therefore requires draining)
Can lead to chronic nasal congestion
Can cut off blood supply to cartilage -> necrosis -> saddle-nose deformity
What are the aetiologies of nasal polyps?
Idiopathic Chronic inflammation Autonomic dysfunction Genetic predisposition Allergic vs non-allergic
Nasal polyps are associated with what allergic conditions?
20-50% have asthma
8-26% have aspirin intolerance
50% have alcohol intolerance
What conditions may cause secondary polyposis to occur in the nose?
Cystic fibrosis (6-48% have polyps) Allergic fungal sinusitis (85% have polyps) Churg-Strauss syndrome (autoimmune vasculitis)
What components are there to a nasal smear test; what can these reveal?
Microbiology - infection?
Eosinophils - allergic component
Neutrophils - chronic sinusitis
What is the treatment of polyps?
Oral and nasal steroids - high dose prednisolone
Surgical - polypectomy or microdebrider
What are the classifications and characteristics of adult sinusitis?
Acute - fast onset, duration of symptoms <12 weeks, completely resolves
Recurrent acute - 1-4 episodes of rhinosinusitis per year , complete recovery between episodes
What is the difference between sinusitis and rhinosinusitis?
Sinusitis is the inflammation of the paranasal air sinuses
Rhinosinusitis is the inflammation of the nasal cavity and paranasal air sinuses
What are the classifications and characteristics of adult rhinosinusitis?
Chronic - duration >12 weeks, persistent inflammation on imaging after a month of appropriate treatment
Acute exacerbation of chronic - worsening of existing symptoms/appearance of new symptoms
What are the two most common microbes responsible for acute rhinosinusitis?
Strep. pneumoniae (31%)
H. influenzae (21%)
New guidelines for the diagnosis of rhinosinusitis are based on:
Nasal blockige/discharge plus the addition of reduced sense of smell/headache
What anitmicrobial therapy is available for the treatment of rhinosinusitis?
beta-lactams - penicillins, cephalosporins
Macrolides - erythromycin, clarithromycin
What class of antibiotics shows greater penetration into the sinuses?
Macrolides
What treatment options are there for sinusitis?
Nasal decongestants,
antibiotics (co-amoxiclav, clarithromycin), steroid nasal spray, steam inhalations
What is Potts Puffy Tumour?
A life threatening complication of infectious sinusitis which develops into osteomyelitis of the frontal bone with associated subperiosteal abscess causing swelling and oedema over the forehead and scalp.
