Rhinology Flashcards
What is typical presentation in rhinology?
Signs and symptoms such as
Nasal obstruction
nasal discharge
epistaxis
facial pain
nasal deformity
anosmia
sneezing
MEDICAL TREATMENT
NASAL SURGERY
NASAL TRAUMA
ASTHMA/ASPIRIN SENSITIVITY
What occupation commonly presents to rhinology?
Woodworkers
What do all smokers have?
Some degree of Rhinitis
Which turbinate are you most likely to see on nasal endoscopy?
Inferior turbinate, and probably middle
What is the cause of nasal polyps?
Unknown
What prevents nasal polyps from coming back after resection?
Steroid spray
What are the relevant investigations in Rhinology?
Blood tests-FBC, ANCA, ESR, ACE, RAST
CT SCAN
MRI SCAN
SKIN TESTS
RHINOMANOMETRY
When are CT scans most likely to be used?
Pre-operatively - ensures safe surgery
Allows identification of anatomical relationships of the key structures (optical nerve, orbital contents and carotid artery)
Shows nature and extent of disease as well as anatomical abnormalities
What is rhinomanometry?
Rhinomanometry is a standard diagnostic tool aiming to objectively evaluate the respiratory function of the nose. It measures pressure and flow during normal inspiration and expiration through the nose.
What are common nasal disorders?
Nasal trauma
Epistaxis
Rhinosinusitis
Nasal Polyps
Nasal Deformity
Nasal Tumours
Choanal artresia - feeding problems
What nasal pathology can happen as a result of nasal trauma?
Septal haematoma
Why is early detection of septal haematoma important?
Early diagnosis and treatment is important to prevent abscess formation, septal perforation, saddle-nose deformity, and potentially permanent complications
What exactly is a septal haematoma?
Perichondrium is pulled away from the cartilage which tears submucosal blood vessels. Blood now collects between perichondrium and septal cartilage. Stagnant blood can easily result in infection.
40 year old man with constant blocked nose, PN drip and hyposmia. He also has history asthma and aspirins sensitivity.
WHAT IS IT?
Nasal Polyps
What is the cause of nasal polyps?
Unknown, involves chronic inflamamtion, autonomic nervous system dysfunction and genetic predisposition.
What are the two clases of nasal polyps?
Allergic and non-allergic
What are associated allergic conditions with nasal polyps?
Associated with allergic conditions
20-50% have asthma
Allergic rhinitis
8-26% have aspirin intolerance
50% have alcohol intolerance
What are non-allergic conditions associated with nasal polyps?
Non allergic conditions
Cystic Fibrosis 6-48% have polyps
AFS (allergic fungal sinusitis) 85% have polyps
Churg-Strauss syndrome
What are investigations for nasal polyps?
Sweat test (to see if cystic fibrosis is present)
RAST / skin testing
Nasal smear
- Microbiology
- Eosinophils (allergic component)
- Neutrophils (chronic sinusitis)
Coronal CT scan
MRI
Flexible nasoendoscopy
Rigid nasoendoscopy
What is non-surgical treatment for nasal polyps?
Oral and Nasal steroids
(¡High dose prednisolone and nasal steroid for 20 days will eliminate 50% of polyps)
Immunotherapy
What is surgical treatment for nasal polyps?
Traditional polypectomy
Microdebrider - tube used to cut tissue
Endoscopic sinus surgery
What is the likelihood of recurrence of nasal polyps?
Recurrence:
Multiple small polyps common
Large and antro-coanal less so
What is the condition?
23yr old presents with runny nose, nasal blockage, general malaise and sore throat for 10 days. Otherwise fit and well, with no systemic upset.
Acute sinusitis