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Deseases of the Nose and Paranasal Sinus
Clinical Medicine
46
Medical
Graduate
06/06/2009

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Cards

Term

 

 

 

What is viral rhinitis?

Definition

 

 

common cold

non-specific illness

Term
what are the viral agents of viral rhinitis?
Definition
rhinovirus, adenovitus and other
Term
what are the s/s of viral rhinitis?
Definition
clear rhinorrhea, nasal congestion; decresed ability to smell/taste
Term
problems associated with viral rhinitis:
Definition
headache, cough, scratchy throat, generalized malaise
Term
Physical   Exam of patient with viral rhinitis:
Definition
  • varied pt presentation
  • Nasal mucosea will be erythemic & occasionally edematous
  • Watery nasal discharge – lack of yellow/green (purulent) discharge
Term
Tx of viral rhinitis:
Definition

no curative Tx = maily supportive à no value for antiviral chemotherapy

- Edu pts that they do not need an antibiotic -will only develop resistance

- Decongestants – psudoephedrine 30-60 mg q 4-6º prn (or 120 mg BID)

- Nasal prep (careful not to abuse --- no more than 3 days)

 

     Oxymetazoline (Afrin, Vicks, Sinex); Phenylephrine (Neo-Synephrine

 

- Fluids, analgesic and anti-inflamm. Meds

Term
Complications of viral rhinitis:
Definition

bacterial sinusitis;

acute otitis media,

acute exacerbations: asthma, COPD-related,

immunocompromized

Term

What is "Hyposmia"?

(olfactory dysfunction)

Definition

– most commonly occurs w/common cold

-          Blockage of the olfaction sensory receptors:  

20% idiopathic

 

Other causes:

CNS neoplasms, endocrine, Parkinson’s & Alzheimer’s, multiple meds

Term

(T/F)

 

sinusitis can be referred as rhinitis

Definition
FASLE
Term

(T/F)

Acute sinusistis

is less common than the common cold

Definition
TRUE
Term
What conditions does acute sinusitis follow?
Definition

-          Follows respiratory illness:

  1. Viral or allergic rhinitis
  2.  2’ to impaired mucocilliary clearance & obstruction of the osteomeatal complex
Term
How long do the symptoms of acute sinusitis persist:
Definition
longer that 7-10 days but less than 4 weeks
Term
s/s of acute sinusitis:
Definition
  • toothacke type pain in maxillary region
  • pain and pressure over the cheeks
  • less symptoms with frontal and ethmoid/sphenoid sinuses
  • change in secretion from watery to purulent  (green or thick yellow) or mucoid discharge
Term
What sinus is effected the most in acute sinusitis? Should it be considered an emergency?
Definition

Maxillary sinus

it is an emergency!!!

Term
what are the sites of infection in acute sinusitis?
Definition
  • Maxillary sinus effected the most
  • Dental infections can be the original site of infection
  • If ethmoid is infected, will usually also have maxillary infection
  •  2’ cellulitis can result
  • Sphenoid sinusitis most commonly present in pansinusitis
Term
Acute Sinusitis typical pathogens include:
Definition
  • S. pnemoniae
  • H. influenzae
  • less common: S. aureus and M. catarrhalis

Note: 25% of healthy people harbor these bacteria in the sinuses!!!

Term
How to diagnose acute sinusitits?
Definition
  • imaging not routinely performed
  • based on PE and S/Sx
  • if needed, coronal CT best viewed
  • if suspected malignancy, MRI with galoinium preferred
Term
Tx of acute sinusitis:
Definition
  • 2/3 of untreated pts resolve w/o Tx in ~14 days
  • Antibiotics à reduce incidence of clinical failure by 50% for clinically lasting symptoms > 10-14 days
  • Symptomatic Tx w/nasal preps & decongestants (oxymetazoline “Afrin”, pseudoephedrine “PSE”)
  • ABX duration for 10-14 days: Amoxicillin 500mg PO 3×day; Augmentin 875 mg 2×day
  • Penicillin allergy: Trimethoprim-sulfamethoxazole (Bactrim) 160/800 or  Doxycycline 100mg ×2 a day
  • Quinolones: Cipro, Levaquin, Avelox, Zegam
  • Macrolides: Azithromycin (Zithromax), Clarithromycin (Biaxin)
Term

Recurrent symptoms of acute sinusitis:

 

Definition
  • recurrent symptoms do not generally respond well to antibiotics
  • Referral to ENT is warranted for recurrent Dz or poor response to appropriate Tx
Term
Complications of acute sinusistis include:
Definition

-          orbital  cellulitis

-    osteomyelitis of the frontal bone from chronic sinusitis

  • Intracranial complications are rare: IV cavernous sinus thrombosis, meningitis, intraparenchymal brain abscess
Term
What does nasal vestibulitis result from?
Definition
  • results from folliculitits of the nasal region:
    • nasal manipilation
    • trimming of nasal hairs
Term

What is a causative agent of nasal vestibulitis?

 

Definition
S. aureus
Term
Tx of nasal vestibulitis:
Definition
  • Dicloxacillin 250 mg QID × 7-10 days;
  • topical mupirocin (Bactroban)
Term
what is Rhinocerebral Mucormycosis?
Definition
  • very rare condition !!!
  • Fungus spreads rapidly thru the mucosa and vascular channels:
    • lethal if not treated
    • Immuno-compromised or post bone marrow transplant pts are more susceptible
  • Medical and surgical emergency :
    • presents a lot like rhinitis and sinusitis à black eschar on middle turbinate
    • maintain a high degree of suspicion knowing there is a low likelihood
    • Tx with Amphotericin B IV following surgical debridment
Term
What is "Hay Fever"?
Definition
Allergic Rhinitis
Term
What are the S/S of allergic rhinitis?
Definition
  • same symptoms as viral rhinitis but last longer and can be seasonal depending on allergic (IgE) sensitivities
    • pollens (spring)
    • grass (summer)
    • ragweed  (fall)
  • pale mucosa on nasal turbinates -- yellowish
  • nasal polyps
Term
S/s of allergic rhinitis:
Definition
  • same nasal symptoms as in viral rhinitis

+

  • pale mucosa on nasal turbinates - yellow, boggy, nasal polyps
  • eye irritation, tearing, itchy throat, itchy ears and buzzing
Term
Tx of allergic rhinitis:
Definition
  • OTC antihistamins:
    • brompheniramine (Dimetapp)
    • chlorpheniramine "Actifed" - PO
    • clemastine "Tavist" - PO
  • H1 receptor antagonists:
    • Cetirizine "Zyrtec" - PO
    • Fexofenadine "Allegra" - PO
    • Loratadine "Claritin" - PO
  • Nasal spray
    • Levocabastine "Livostin"
    • Azelastine "Astelin"
  • Intranasal corticosteroids (mainstay Tx of AR):
    • beclomethasone "Beconase"
    • flunisolide "AeroBid"
    • mometasone furoate "Nasonex"
    • fluticasone propionate "Flonase"
  • leukotriene inhibitors
    • montelukast "Singulair"
  • mast cell stabilizers
    • cromolyn sodium
  • maintain allergy free environment
Term
are nasal polyps malignant or benign?
Definition
benign
Term
what are nasal polyps and who has them?
Definition
  • pale, edematous, mucosal covered masses
  • seen in pt with allergic rhinitis
Term
nasal polyps can result in:
Definition
nasal obstruction and diminished smell
Term
what should you remember when treating an asthma patients for nasal polyps?
Definition
avoid NSAIDs and ASA to prevent bronchospasm
Term
what is the most common site of epistaxis?
Definition
  • Anterior portion of the nose
  • Kiesselbach's plexus
Term
what is the most common reason of epistaxis?
Definition
  • nasal trauma: nose picking, forceful nose blowing or sneezing
  • rhinitis
  • dry mucosa
  • deviated septum
  • anticoagulant use
Term
list all sites of epistaxis and point which one is NOT in Kiesselbach's plexus
Definition
  1. anterior ethmoidal (ophtalmic)
  2. posterior ethmoid (opthalmic) -- NOT in Kiesselbach's  plexus
  3. sphenopalatine (maxillary)
  4. greater palatine (maxillary)
  5. branch of superior labial (facial)
Term
How to examine for epistaxis?
Definition
  • determine site: anterior or posterior...
  • if cannot see any site of bleeding, inspect the oropharynx (pt should be sitting upright)
Term
Tx of epistaxis
Definition
  • 1st onset - apply direct pressure to the nares (pt in sitting position, head leaning fwrd to prevent aspiration)
  • topical nasal preps:
    • Phenylephrine (Neo-Synephrine)
  • Vasoconstriction agent:
    • Cocaine 4% (topical, cotton ball/gauze) or oxymetazoline (Afrin)
Term
Tx for prolonged epistaxis:
Definition
  • pack with sponge product MeroCel or balloon of ther products
  • control anterior sites with cautery (electrocatery or chemical catery-Silver Nitrate Sticks)
  • if pt has HTN, get BP under control!
Term
Tx of posterior epistaxis
Definition

refer to ENT

 

- some sites need to be cauterized or ligated to prevent further bleeding -

Term
nasal trauma - interesting fact
Definition
most frequently fractured bone in the body
Term
Exam of nasal trauma often reveals:
Definition
crepitus and mobility of the bony fragments
Term
S/S of nasal trauma
Definition

epistaxis, pain, soft tissue hematoma

 

Note: septal hematoma can cause erosion of septal cartilage - saddle-nose deformity

Term
Tx of nasal trama
Definition
  • maintain airway for patency for long term
  • closed reduction w/i 1 week of injury
  • usually best to wait for swelling reduction
  • if suspected septal hematoma, quick referral to ENT for definitive management (I&D, drain)
  • plastic surrgery, cosmetic repair
Term
bening nasal tumors
Definition
  • inverted papilloma - HPV etiology
  • juvenile angiofibroma - consider in adolescent males with recurrent epistaxis
Term
Malignant Nasopharyngeal and Paranasal sinus tumors
Definition
  • Initially present as allergic / viral rhinitis
  • late diagnosis = poor prognosis
Term
Granulomatous Disease
Definition
  • Wegner's Granulomatous - necrotizing granulomatous vasculitis of the upper and lower respiratory tract, glomerulonephritis, and a varialbe degree of small0vessel vasculitis
  • NK Cell & T Cell EBV-Positive lymphoma - rare but present in young, most commonly
    Asian pts with non-Hodgkin Lymphoma
  • Sarcoidosis - microscopic, inflammatory granules that can occur in tissues and organs anywhere in the body
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