Sinonasal disorders Flashcards
(27 cards)
Rhinitis definition
inflammatory disorder of the nasal mucosa characterised by 2 or more of the following symptoms:
- rhinorrhoea
- blockage
- itching/sneezing
Describe the types of rhinitis
allergic:
- persistent
- intermittent
non-allergic:
- non-allergic rhinitis with eosinophilia syndrome (NARES)
- non-eosinophilic non-allergic rhinitis (NENAR)
- pregnancy rhinitis
- atrophic rhinitis
- rhinitis medicamentosa
What drugs can cause rhinitis medicamentosa?
beta blockers
decongestant sprays
Timespan of acute rhinosinusitis
10 days to 12 weeks
Rhinosinusitis symptoms
nasal blockage
hyposmia
mucopus discharge
facial pain or pressure
What constitutes recurrent acute bacterial rhinosinusitis?
complete resolution between episodes but more than 12 weeks per year
Symptoms of acute bacterial rhinosinusitis
headache
fever
halitosis
fatigue
dental pain
cough
ear pain/pressure/fullness
Key organisms that cause acute bacterial rhinosinusitis
streptococcus pneumoniae
haemophilus influenzae
moraxella catarrhalis
Acute bacterial rhinosinusitis treatment
nasal steroids
nasal douching
decongestants (topical +/- oral)
co-amoxiclav 625mg TDS for 2 weeks or clarithromycin 500mg BD if penicillin allergy
Sinusitis complications
mucucole/pyomucocoele formation
osteomyelitis (Pott’s puffy tumour)
periorbital cellulitis
silent sinus syndrome
meningitis
cranial nerve palsies
Timespan of chronic rhinosinusitis
> 12 weeks
Symptoms of chronic rhinosinusitis
nasal obstruction/congestion
rhinorrhoea (mucopurulent)
hyposmia and or facial pressure/pain
What endoscopic evidence may be seen in chronic rhinosinusitis
mucopus
polyps
middle meatal oedema
Causes of systemic inflammation
sarcoidosis
Wegener’s granulomatosis
tuberculosis
syphilis
cystic fibrosis
primary ciliary dyskinesias
Causes of bilateral nasal obstruction
rhinitis
rhinosinusitis
Causes of unilateral nasal obstruction
neoplasia
antro-choanal polyp
deviated nasal septum
foreign body
Isolated facial pain causes
trigeminal neuralgia
cluster headaches
migraine
tension headache
atypical facial pain
Red flag symptoms in sinonasal disorders
unilateral symptoms:
- bleeding
- crusting
- cacosmia
- blockage
orbital symptoms
neurological signs including CN palsies
severe frontal headaches
clear watery rhinorrhoea (CSF leak until proven otherwise)
How is rhinorrhoea tested to see if it is CSF?
test for tau protein
Causes of olfactory disturbance
Conductive:
- sinonasal pathology
- nasal obstruction
Sensorineural:
- URTIs
- Trauma
Iatrogenic
cerebrovascular disease
epilepsy (temporal lobe)
Parkinson’s disease
toxic exposure
medical comorbidity
chronic alcoholism
recreational drug use
psychogenic (eg. schizophrenia)
idiopathic
Anosmia definition
no sense of smell
Parosmia definition
distorted sense of smell
Phantosmia definition
olfactory sensation without stimulus
Troposmia definition
unpleasant parosmia
