Rhinology in GP

Question 1

Dx? [1]

Answer 1

Turbinate inflammation

NB: nasal turbinates are also known as nasal conchae

Question 2

What are the symptoms of rhinitis [4]

Answer 2

Inflammation of the lining of the nose characterized by one or more of the following symptoms :
* Nasal congestion
* Rhinorrhoea
* Sneezing
* Itching
* hyposmia

Question 3

What are the three classifications of rhinitis? [3]

Answer 3

Allergic
Infective
Non-allergic, non-infective

Question 4

What are some causes of Non Allergic, Non Infective Rhinitis? [+]

Answer 4

Intrinsic
Pollution
Humidity, temperature
Drugs
Hormonal
Alcohol
Smoking
Emotion
Domestic/ cosmetic products

Question 5

Allergic rhinitis is linked to which conditions? [4

Answer 5

• asthma
• dermatitis
• conjunctivitis
• sinusitis
• OM

NB: think of rhinitis as the asthma of the nose

Question 6

Managment of allergic rhinits? [4]

Answer 6

Allergen avoidance

Medication:
- steroids (e.g. Fluticasone (topical). Often ask saline sprays to clear before steroid use.
- Anti-histamines (topical; oral) - cetirizine; loratadine (non-sedative); Chlorphenamine (sedative).

Desensitisation: although risk of anaphylaxis

Biologics: omalizumab (anti-IgE)

Immunotherapy - come back to this rom slide 31

Long term use of weak, topical steroids is entirely safe

Question 7

Why do you not suggest using decongestants for longer than 5 days? [1]

Answer 7

Decongestants improve nasal congestion but no other symptoms: risk of developing rebound phenomenon – rhinitis medicamentosa

Question 8

Which test would you perform to test for allergic rhinitis? [1]

Answer 8

Skin prick test:
- Specific IgE on dermal mast cells
- Saline is -ve control
DO more

Question 9

Which blood investigations can you perform for allergic rhinitis/

Answer 9

Total IgE
- always done with RAST
- if very high, RAST can be misinterpreted

Specific IgE (RAST)
- not immediate

Question 10

How do you define chronic rhinosinusitis (CRS) [4]

Answer 10

Two symptoms, one of which is:
* Blockage/obstruction/congestion
* Discharge-ant/post nasal drip
* +/- smell/cough or facial pain/pressure

AND either endoscopic or signs of CRS on imaging

Question 11

Which other pathologies should you be aware of when investigating CRS? [4]

Answer 11

Allergic dermatitis
Asthma
CRSwNP
EoE

Question 12

Which type of imaging do you use to investigate CRS? [1]

Answer 12

CT

Question 13

Management for CRS? [1]

Question 14

Describe the correct technique for nasal sprays [3]

Answer 14

• A good position is to lie on a bed with your head hanging back over the edge
• Stay like this for two minutes after putting in the drops before getting up.
• This is so that the liquid does not immediately run out of your nose or down the back of your throat but stays for a while in the nasal cavity.

NB: Avoid tipping the head backwards and putting the drops in the nose, as they usually pass straight into the back of the throa

Question 15

Dx L&R? [2]

Answer 15

Polyp on L; Inflammed turbinate on R