2.8: Stuffy Nose

Question 1

Describe a Type 1 hypersensitivity reaction?

Answer 1

Mast cell detects allergen (Eg: House dust mite)

Causes release of inflammatory mediators (Eg: Histamine, Leukotrienes)

Question 2

Some of the pharmacological treatments for stuffy nose?

Answer 2

Anti-histamine Eg: Cetirizine
Topical Corticosteroids: Beclomethasone
Decongestants: Pseudoephedrine
Anticholinergics: Ipratropium
LTR Blockers: Monteleukast

Question 3

What are the core nasal symptoms?

Answer 3

Blockage
Loss of smell
Discharge
Facial Pain

Question 4

What are the core nasal symptoms - 4Ss

Answer 4

Stuffy
Smell
Snot
Sore

Question 5

Name some other nasal symptoms (related)

Answer 5

Sneezing
Itching
Crusting
Epistaxis
Dry Mouth
Snoring
Halitosis
Loss of taste

Question 6

What are the two types of Rhinitis?

- What is Rhinitis?

Answer 6

Infective, Non-INfective

Inflammation of the mucous membrane inside the nose

Question 7

Describe the infective causes of Rhinitis

Describe the non infective causes?

Answer 7

Infective - Upper Respiratory Tract Infection

Non-Infective: Allergic or Non Allergic

Question 8

Allergic rhinitis has triggers that can be classed as …. or …
Examples

Answer 8

Intermittent - Pollen, Fungal Spores

Persistent - Dust Mites, Cat, Dog

Question 9

What is the allergic crease?

Answer 9

Common in those with allergic rhinitis

Crease on the top of their nose from rubbing

Question 10

Treatment for Allergic Rhinitis?

Answer 10

Avoidance
Symptomatic Therapy (Anti-Histamine, Topical Steroid)
Immunological Therapy (Only for a small number of patients)

Question 11

What is immunotherapy?

Answer 11

This is giving small, controlled doses of the allergen to the patient in an attempt to build up their immune system

Question 12

What are nasal polyps?

• Common in..?
• Treatment?

Answer 12

These are masses arising from the mucous membranes of the nose
Common in non-allergic asthma
- Topical Steroids
- Then oral steroids
- Then surgery

Question 13

What is infective rhinosinusitis?

• Symptoms
• Which sinus?

Answer 13

This is infection of the sinuses - often a complication from an upper respiratory tract infection
Often affects maxillary sinuses
- Face pain
- Discharge 
- Blockage

Question 14

Infective Rhinosinusitis

- Treatment

Answer 14

Most are viral so just supportive
Decongestants
Antibiotics if unresolving

Question 15

Complication of Infective Rhinosinusitis?

- Give two complications and commonly affected demographic

Answer 15

Infection of the orbit
Can lead to blindness
Common in children

Frontal sinus infection can lead to brain abscess (common in young men)

Question 16

What is VasoMotor Rhinitis?

Answer 16

Non-Allergic Rhinitis
Common in elderly
Causes runny nose, congestion

Question 17

*PHOTO

Answer 17

x

Question 18

Rhinitis Investigations?

Answer 18

Skin Prick Testing

Do not do nasal X-Rays or Sinus X-Rays

Question 19

Management for non-infective?

Answer 19

Avoidance
Topical Nasal Steroid
Anti-Histamine
Topical Anti-Cholinergenic

Question 20

Management for infective rhinosinusitis?

Answer 20

Nasal Decongestant
Analgesia
Antibiotics if needed

Question 21

What is a septal haematoma?

Cause?

Answer 21

This is accumulation of blood under the lining of the septum
Can lead to avascular necrosis of cartilage and deformity
Caused by trauma (punch)

Question 22

How do you treat a dislocate nose or mal-alignment?

Answer 22

Rhinoplasty

Question 23

Young child with stuffy nose and discharge from only one side?
Treatment?

Answer 23

Foreign Body

REFER

Question 24

Adult with stuffy nose and discharge from only one side?

Answer 24

Nasal or Paranasal Tumour

Question 25

Child presents with swollen eye

Has previously had stuffy nose for a few days

Answer 25

Orbital Cellulitis
Following acute sinusitis
EMERGENCY
Could lead to blindness