Flashcards in The stuffy nose Deck (16):
What are the main symptoms to ask for nose problems?
¥ Loss of smell
¥ Facial pain
Other nasal symptoms:
Secondary symptoms – from breathing out of mouth instead of nose:
¥ dry mouth
¥ sore throat
¥ loss of taste
What are the aetiologies of a 'stuffy nose'?
Non-infective and allergic:
Non-infective and non-allergic:
For allergic rhinitis:
what are triggers for intermittent and what are triggers for persisten?
-House dust mite
What classification is used for allergic rhinitis?
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
-no impairments of lifestyle/function
-no troublesome symptoms
Moderate-severe = 1 or more
-impairment daily activities/sport/leisure
What type of hypersensitivity is allergic rhinitis?
type 1: igE mediated
what is the treatment for allergic rhinitis?
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:
What is a nasal polyp?
These are composed of nasal mucosal tissues. They can cause complete nasal obstruction.
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
What is the treatment of nasal polyps?
• Treat with oral then topical steroids
• If no better = surgery
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
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
What are the symptoms of acute infective rhinosinusitis?
• Facial pain
• Nasal blockage
What is the treatment for acute infective rhinosinusitis?
• Adequate analgesia
• If persisting/worsening add antibiotic – cefaclor is useful 1st line
What are the 6 complications of acute infective rhinosinusitis?
• Orbital complications e.g. abscess /cellulitis
o Marked oedema of eyelids, diplopia, redness, chemosis REFER
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 Poor sinus drainage can cause bony swelling as secretions build up in obstructed sinus
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