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Systems 2 - Head and Neck > Rhinology > Flashcards

Flashcards in Rhinology Deck (33):
1

What symptoms should be screened for in a history regarding the nose?

Nasal obstruction
Nasal discharge
Epistaxis
Facia plain
Nasal deformity
Anosmia
Sneezing

2

What aspects of past medical history are of importance when discussing the nose?

Medical treatment
Nasal surgery
Nasal trauma
Asthma
Aspirin sensitivity

3

What occupation history may be of particular importance for rhinology?

Woodworkers

4

What social history may be of particular impotence for rhinology?

Cocaine use (degenerates nasal septum)

5

What instruments are used in a nasal examination?

Otoscope and endoscope for posterior cavity

6

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

7

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

8

What is the treatment for nasal trauma?

Rhinoplasty

9

What is septal haematoma? How can it occur?

Swelling/bruising of the nasal septum. Can occur due to trauma of anterior nasal septum

10

What is the potential complication for septal haematoma?

If left untreated can become septic (therefore requires draining)

Can lead to chronic nasal congestion and saddle-nose appearance

11

What are the aetiologies of nasal polyps?

Idiopathic
Chronic inflammation
Autonomic dysfunction
Genetic predisposition
Allergic vs non-allergic

12

When associated with allergic conditions - what are the important considerations when approaching treatment?

20-50% have asthma
8-26% have aspirin intolerance
50% have alcohol intolerance

13

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)

14

What components are there to a nasal smear test; what can these reveal?

Microbiology - infection?
Eosinophils - allergic component
Neutrophils - chronic sinusitis

15

What is the treatment of polyps?

Oral and nasal steroids - high dose prednisolone

Surgical - polypectomy or microdebrider

16

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

17

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

18

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

19

What are the two most common microbes responsible for acute rhinosinusitis?

Strep. pneumoniae (31%)
H. influenzae (21%)

20

New guidelines for the diagnosis of rhinosinusitis are based on:

Nasal blockige/discharge plus the addition of reduced sense of smell/headache

21

What anitmicrobial therapy is available for the treatment of rhinosinusitis?

beta-lactams - penicillins, cephalosporins
Macrolides - erythromycin, clarithromycin

22

What class of antibiotics shows greater penetration into the sinuses?

Macrolides

23

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.

24

What is the treatment protocol for PPT?

Emergancy referral
Frontal sinus surgery

25

Sinusitis can lead to the development of mucous filled cysts in the ethmoid air sinus, what is this called? What complications can arise?

Ethmoidal mucocele; presses on orbit causing double vision

26

What is the treatment for ethmoidal mucoceles?

Endoscopic Sinus Surgery (ESS)

27

What is the commonest cause of epistaxis?

Idiopathic

28

What are other common causes of epistaxis?

Infectious, traumatic, allergic, hypertension, hereditary haemorrhagic telangiectasia, tumour

29

Outline the management of epistaxis

ABCs
Vitals management
Physical exam (anterior rhinoscopy or posterior endoscopy)
Laboratory exam
Nasal Packs
Surgery

30

What are nasal packs?

Either anterior or posterior

Used when bleeding has not stoped despite first aid/therapy to stop bleeding

Nose balloon inflated to physically stop bleeding

31

What is the surgical intervention for epistaxis?

LIgation of artery to stop bleeding

Usually sphenopalatine artery (main blood supply of the nose)

32

What is hereditary haemorrhagic telangiectasia?

Autosomal dominant disorder causing abnormal blood vessel development around the face (including the nose)

33

What is the treatment for HHT?

Not standard epistaxis treatment; laser treatment and skin grafts are indicated