Flashcards in Rhinology Deck (33):
What symptoms should be screened for in a history regarding the nose?
What aspects of past medical history are of importance when discussing the nose?
What occupation history may be of particular importance for rhinology?
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)
Rhinomanometry (not often used - assesses smell)
List some common nasal disorders:
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?
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 and saddle-nose appearance
What are the aetiologies of nasal polyps?
Allergic vs non-allergic
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
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?
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.
What is the treatment protocol for PPT?
Frontal sinus surgery
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
What is the treatment for ethmoidal mucoceles?
Endoscopic Sinus Surgery (ESS)
What is the commonest cause of epistaxis?
What are other common causes of epistaxis?
Infectious, traumatic, allergic, hypertension, hereditary haemorrhagic telangiectasia, tumour
Outline the management of epistaxis
Physical exam (anterior rhinoscopy or posterior endoscopy)
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
What is the surgical intervention for epistaxis?
LIgation of artery to stop bleeding
Usually sphenopalatine artery (main blood supply of the nose)
What is hereditary haemorrhagic telangiectasia?
Autosomal dominant disorder causing abnormal blood vessel development around the face (including the nose)