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Rhinology - the nose / Epistaxis / Trauma Flashcards

(76 cards)

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1
Q

What does types of discharge suggest

A

Watery = allergic rhnitis

Green / pus = rhino sinusitis

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2
Q

How can you examine the nose

A

Rhinoscope
Otoscope in children
Flexible endoscopy

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3
Q

What bloods can be done when investigating nasal issues

A

FBC, ESR
ANCA
Serum ace
RAST

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4
Q

What is CT used for

A

Gold standard nasal surgery
Chonal atresia
Rarely diagnostic

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5
Q

Are X-ray’s useful

A

Not in viewing sinuses

May show adenoidal hypertrophy

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6
Q

What do you biopsy

A

Unilateral single polyp to rule out malignancy

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7
Q

What is Rhinitis and what causes non-allergic

A

Inflammation of lining of nose
Can be allergic vs non-allergic
Normal to have 8 a year
Children more prone

Non-allergic

  • Irritant
  • Gustatory - spicy food
  • Rebound nasal congestion due to prolonged topical decongestant
  • Infection
  • Sarcoid / macroscopic vasculitis
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8
Q

What are symptoms of non-allergic rhinitis

A 
Blocked nose / congestion 
Anosmia as blocked 
Runny nose
Sneezing
Itch 
Post nasal drip 
May have pain
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9
Q

What is important to ask

A

Any risk of FB
Feeding - breast or bottle
Snoring
QOL

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10
Q

How do you examine and manage

A

Otoscope
Look for foreign body
Can do allergy testing to exclude allergic

Management
Avoid trigger e.g. smoking
Intra-nasal steroid
Ipatroopium / Decongestant = short term only

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11
Q

What are causes of nasal obstruction

A 
Rhinitis 
Foreign body
Adenoidal hypertrophy
Nasal polyps
Rhinosinusitis
Choanal atresia
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12
Q

How do you RX

A

Decongestations
Nasal hygiene - saline spray
Nasal steroid sprray - reduce obstruction
Anti-histamine
Surgery - reduce turbinate / adenoidectomy
Correct choanal atresia

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13
Q

If adenoidal hypertrophy what do you check for

A

OSA

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14
Q

How does foreign body present

A

Unilateral nasal discharge

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15
Q

What does it need

A 
EUA
Battery = emergency as corrodes
Posterive pressure through mouth
Forceps
Removal under GA and refer ENT
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16
Q

What is choanal atresia

A

Membrane in nose persists resulting in blockage

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17
Q

How does it present

A

Recurrent infection
Obstruction if both blocked
Sinus issues

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18
Q

How do you Rx

A

Surgery if both blocked

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19
Q

What causes nasal polyps

A 
Unknown
Chronic inflammation
Infectious sinusitis
Rhinosinusitis
CF
Churg Strauss / Kartagener syndrome
Autonomic dysfunction
Genetic predisposition
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20
Q

What can polyps be

A

Allergic vs non-allergic

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21
Q

What allergic conditions are polyps associated with

A

Asthma = strong association
Allergic rhinitis = small
Aspirin intolerance
Alcohol intolerance

Santer’s triad

  • Asthma
  • Atopy
  • Aspirin allergy
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22
Q

What is rare association in children

A

Angiofibroma

- Refer if polyp <10 as unlikely

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23
Q

What are the features of polyps

A 
Nasal obstruction
Rhinorrhoea
Sneezing 
Poor sense of taste and smell
Associated eosinophilia 
Post-nasal drip
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24
Q

What requires further investigation urgently

A

If unilateral or bleeding

Sign of nasopharyngeal cancer - SCC

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25
How do you investigate
``` Refer ENT routine Sweat test CF RAST / skin test Nasal smear Coronal CT MRI Naso-endoscopy ```
26
What does nasal smear show
Eosinophils suggest allergic | Neutrophils suggest chronic sinusitis
27
When is coronal CT useful
CF patient | Can't see sinus as filled with mucous and polyps
28
How do you Rx
Refer ENT for full examination routinely Oral and nasal steroids to shrink Immunotherapy Surgery - endoscopic sinus or polypectomy
29
What epithelium lines the nose
Respiratory ciliated columnar epithelium with goblet cells
30
Function of nose
``` Airway in respiration = primary Warm inspired air Humidification Filtration of large matter Mucous production Cilary clearance Immune protection Olfaction Drainage of middle ear via Eustacian tube Drainage of sinuses and nasolacrimal duct Voice modification ```
31
What are sinuses and role
``` Ethmoid and maxillary develop at 4 months Air cavity in nasal bones Decrease weight of skull Help vocal resonance Buffer for trauma ```
32
What is external nose made up of
1/3 bone - Nasal bone - Frontal process of maxilla 2/3 cartilage
33
What causes deformity
Congenital | Trauma= most common
34
When can turbinates block nasal passage
Infection or inflammation i.e. allergic rhinitis
35
How do you deal
Topical steroid spray | Turbinate reduction
36
What is anterior nasal supply
Branch of ICA | Opthalmic - anterior / posterior ethmoid
37
Where does blood supply enter
Naval cavity at cribriform plate
38
What is posterior nasal supply
Branch of ECA Splenopalantine All anastomose at front of nose
39
Where do most nose bleeds come from an causes
Little area's at front of nose - Where anterior ethmoid, facial and splenopalatine anatomise Splenopalantine = idioapthic Anterior ethmoid = trauma
40
What is visible
Anterior bleeds | Usually easier to treat
41
Who are posterior bleeds more common in
Elderly
42
What are they at higher risk of
Aspiration and airway compromise
43
What should you ask in Hx of nose bleed
``` When did it begin How much blood If unilateral or bilateral If it coming out of nose only or trickling down back (posterior bleed) Frequency Drug use if septum looks atrophied Comorbid - HTN / cardiac disease Trauma? Any anti-coagulant ? RF - smoker / occupation ```
44
What is uni
More likely malignancy
45
What are causes of nose bleeds
``` Idiopathic = most Trauma - nose picking / blowing / FB Infection - Rhinitis / sinusitis Allergy Iatrogenic - surgery Drugs - anti-coagulant / cocaine Haematological abnormality Malignancy HTN Jevenile Angiofibroma Vasculitits HHT in elderly ```
46
What haematological
Thrombocytopenia / ITP Leukaemia Haemophilia
47
What will make nose bleeds more difficult to manage
Anti-coag | HTN
48
What is HHT
Haemorrhagic hereditary telangiectasia | AV malformation so patient's tend to bleed and don't respond to Rx
49
How does it present
Regular nose bleed Visible red spots over body Anaemia From childhood
50
How do you Rx
Laser coagulation Iron if anaemic Septodermoplasty or Young's
51
What is an angiofibroma
Rare benign vascular tumour that only affects men
52
How does it present
Nasal obstruction Epistaxis Headache and facial swelling
53
What do you never do
Biopsy as highly vascular
54
How do you Rx
Pre-op embolisation | Surgery
55
When do you admit to ED
If unstable If unknown source If posterior source If nasal packing
56
How do you manage unstable
``` ABCDE See in resus room if active bleeding First aid - head forward and squeeze top of nose for 15 minutes Manage as per ATLS Give O2 Suction any visible clot IV access + bloods IV fluid Nasal packing ```
57
What do you do if stable
``` ABCDE History Examination - rhinoscopy to look inside the nose Medication Hx First aid ```
58
What can you do for recurrent
Ax ointment - najsoseptin / bactroban to reduce crusting or vaseline Chemical nasal cautery if can see bleeding point
59
If bleeding does not stop after 10-15 minutes what do you do
Cautery with silver nitrate or diathermy Nasal packing if can't do cautery Surgical ablation
60
Complications of packing
Septal perforation
61
What are complications of epistaxis
Aspiration Airway compromise Infection into cranial cavity due to drainage of veins into sinus of brain Septal haematoma which can lead to necrosis
62
Nerve innervation
Olfactory nerves which travel through cribriform plate
63
What can cause dysfunction
Rhinosinusitis Post viral anosmia Trauma
64
Do you X-ray broken nose
No
65
What must you exclude in nasal trauma
Significant head or C-spine injury
66
Most common cause of nasal fracture
Trauma
67
How does it present
Defomrity | Black eye + bruising
68
What should you always look for and how does it present
Septal hameatoma - Boggy swelling - Usually bilateral - Obstruction - Pain - Poor breathing
69
How do you treat haematoma
Iv Ax and drainage
70
What causes septal perforation
``` Septal surgery = most common Too much packing Trauma - FB / nose picking Septal haematoma as necrosis Inhalation - steroid / Spray / cocaine Infection Churg Strauss Malignant ```
71
How do you tret
Irrigation | Surgical closure
72
Complication of nasal trauma
``` Haematoma Leakage of CSF if meninges perforated Meningitis Brain abscess Olfactory nerve damage ```
73
When would you send nasal fracture home
No epistaxis No haematoma No deformity No obstruction
74
When do you refer ENT
5-7 days after swelling down for discussion of Rx
75
What Rx for fracture
Usually 6-12 months after injury as elective Septalplasty Rhinplasty
76
Why is FB dangerous in the nose
Can inhale and block airway

ENT (14 decks)

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