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Flashcards in The stuffy nose Deck (16):
1

What are the main symptoms to ask for nose problems?

Core symptoms:
• Blockage
¥ Loss of smell
¥ Discharge
¥ Facial pain
Stuffy/smell/snot/sore

Other nasal symptoms:
¥ sneezing
¥ itch
¥ crusting
¥ epistaxis
Secondary symptoms – from breathing out of mouth instead of nose:
¥ dry mouth
¥ sore throat
¥ snoring
¥ halitosis
¥ loss of taste
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2

What are the aetiologies of a 'stuffy nose'?
-non-infective
-infective

Non-infective and allergic:
-intermittent rhinitis
-persistent rhinitis

Non-infective and non-allergic:
-vasomotor rhinitis
-polyps

Infective:
-rhinosinusitis

3

For allergic rhinitis:
what are triggers for intermittent and what are triggers for persisten?

Intermittent
-Grass pollen
-Tree pollen
-Fungal spores

Persistent
-House dust mite
-Cat
-Dog

4

What classification is used for allergic rhinitis?

ARIA classification:

Intermittant = symptoms:
-less than 4 days a week
-symptoms for less than 4 weeks

Persistent = symptoms:
-more than 4 days a week and last longer than 4 weeks

Mild = ALL
-normal sleep
-no impairments of lifestyle/function
-no troublesome symptoms

Moderate-severe = 1 or more
-abnormal sleep
-impairment daily activities/sport/leisure
-missing work/school
-troublesom symptoms

5

What type of hypersensitivity is allergic rhinitis?

type 1: igE mediated

6

what is the treatment for allergic rhinitis?

-allergen avoidance

Step 1: antihistamine
¥ anti-histamines e.g. cetirizine

Step 2: topical steroids
¥ topical corticosteroids e.g. beclomethasone

Step : Both steroids and antihistamine

decongestant for symptomatic relief:
-pseudoephedrine

7

What is a nasal polyp?

These are composed of nasal mucosal tissues. They can cause complete nasal obstruction.

8

What are the clinical features of nasal polyps?

• Nasal polyposis will usually be accompanied by evidence of widespread mucosal disease throughout the sinuses when seen on a CT scan – which will only be needed to help plan surgery (diagnosis is clinical)
• They may be a feature of long-standing rhinitis of any cause and are often associated with non-allergic asthma
• Beware of unilateral polyps – may be a neoplastic lesion

9

What is the treatment of nasal polyps?

• Treat with oral then topical steroids
• If no better = surgery

10

What can cause acute coryza? what is the treatment?

The common cold is the result of a viral infection.
• Self-limiting and no treatment is required other than paracetamol
• Discourage prolonged use of vasoconstrictor nose drops – can cause harmful effects on nasal mucosa

11

What is the cause of acute infective rhinosinusitis?

• Many cases are secondary to acute viral illness (coryza) – this causes nasal mucosal oedema and interferes with ventilation and mucous clearance of the sinuses (98%)
• Paranasal sinuses become infected
• Usually more than one sinus is involved
• Bacterial infection supervenes causing purulent rhinorrhea:
⎯ Strep. Pneumonia
⎯ Heamophilus influenzae
⎯ Staph. Pyogenes
⎯ Anaerobes may be involved esp. in dental infections

12

What are the symptoms of acute infective rhinosinusitis?

• Facial pain
• Discharge
• Nasal blockage

13

What is the treatment for acute infective rhinosinusitis?

• Adequate analgesia
• Decongestants
• If persisting/worsening add antibiotic – cefaclor is useful 1st line

14

What are the 6 complications of acute infective rhinosinusitis?

• Orbital complications e.g. abscess /cellulitis
o Marked oedema of eyelids, diplopia, redness, chemosis REFER

• Meningitis
o Extradural and subdural abscesses may occur = neurosurgical emergency

• Cerebral abscess (frontal lobe)
o Any patient with history of recent frontal sinus infection headache or who exhibits any abnormality of behavior

• Osteomyelitis of frontal bone
o Persistent headache, oedema of scalp in vicinity of frontal sinus

• Cavernous sinus thrombosis
o Rare

• Mucocoele
o Poor sinus drainage can cause bony swelling as secretions build up in obstructed sinus

15

What is vasomotor rhinitis? and what can be used as treatment?

Autonomic imbalance favoring the parasympathetic system increases nasal blood flow, edema, and secretions, creating an overall presentation of rhinorrhea and nasal obstruction.

Can use anticholinergics: ipratriopium

16

What warrants a referral for a stuffy nose?

Unilateral discharge in child: foreign body in nose REFER

Unilateral discharge in adult: nasal or paranasal tumour REFER