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Flashcards in Nose Deck (46)
1

what type of epithelium lines the nasal cavity?

roof = olfactory epithelium (allows receptor cells from the olfactory bulb to send information about smell
rest is lined by respiratory epithelium

2

what bones form the nasal septum?

perpendicular plate of the ethmoid bone
vomer

3

what nerve supplies the upper half of the nasal cavity?

CN V1

4

what nerve supplies the lower half of the nasal cavity?

CN V2

5

describe arterial supply to the lateral wall of the nasal cavity

superior :
- anterior ethmoidal arteries
- posterior ethmoidal arteries
posterior = sphenopalatine artery (traverses sphenopalatine foramen)
inferior = greater palatine artery
anterior = lateral nasal branches of facial artery

6

what is kieselbachs area?

area on nasal septum which is rich an anastomosing arteries
common site of bleeding
- anterior and posterior ethmoidal arteries
- septal branch of labial artery
- greater palatine artery
- branch of sphenopalatine artery

7

where is the sphenoethmoidal recess and what drains here?

above the superior nasal concha
drains the sphenoidal sinus

8

where is the superior meatus and what drains here?

below the superior nasal concha
drains posterior ethmoidal air cells

9

where is the middle meatus and what are the 2 parts of it?

below the middle meatus
2 parts
- semilunar hiatus
- ethmoidal bulla

10

what drains into each part of the middle meatus?

semilunar hiatus
- frontal sinus
- maxillary sinus
- anterior ethmoidal cells
ethmoidal bulla
- middle ethmoidal air cells

11

where is the inferior meatus and what drains here?

below the inferior nasal concha
drains nasolacrimal duct

12

how may a nasal fracture present and how is it managed?

bruising, swelling, tenderness, deviation, epistaxis
review after 2-3 weeks once swelling has reduced and manipulate under anaesthetic

13

4 risks which accompany nasal fracture?

recurrent epistaxis
CSF leak/meningitis
anosmia
septal haematoma

14

what are the dangers of a septal haematoma?

can lead to perichondrium separation, de vascularisation of the cartilage, necrosis and infection

15

where does epistaxis usually occur from?

kiesselbachs area (anastomising arteries on the septal wall)

16

how is mild epistaxis managed?

lean forward
external compression
ice

17

how is moderate epistaxis managed?

silver nitrate vessel cautery or electrocautery

18

how is severe epistaxis managed?

nasal packing
post nasal packing
topical vasoconstriction
rhino packs
consider arterial ligation in severe bleeds

19

viral vs bacterial vs secondary bacterial sinusitis?

viral = lasts less than 10 days
bacterial = lasts over 10 days, but less than 4 weeks
secondary bacterial = viral infection which seems to get better then worsens a few days later

20

symptoms of sinusitis?

purulent nasal discharge
nasal obstruction
facial pain/pressure over sinuses

21

how is acute viral sinusitis managed?

analgesia
decongestants
intranasal corticosteroids
ipratropium
mucolytics

22

how is acute bacterial sinusitis managed?

watchful waiting for >10 days and then commence antibiotics
- 1st line = penicillin for 7 days
- 2nd line = doxycycline for 7 days
plus same management as viral

23

how is sinusitis managed in immunosuppressed?

immediate antibiotic treatment and ENT specialist referral

24

what is chronic sinusitis?

lasting more than 12 weeks

25

how is chronic sinusitis investigated?

anterior rhinoscopy
flexible nasoendoscopy
imaging
- sinus CT (for pre surgical staging)
sinus MRI (shows intracranial spread, fungal infections etc)

26

how is chronic sinusitis managed medically?

antibiotics
decongestants
intranasal corticosteroids
oral corticosteroids (if oedema or polyps present)
anti-histamines/anti-leukotrienes if complicated with allergic rhinitis

27

how is chronic sinusitis managed surgically?

FESS (functional endoscopic sinus surgery)
- increases diameter of sinus opening to allow drainage of sinuses

28

what are the 2 groups of rhinitis?

allergic
non-allergic

29

what is allergic rhinitis?

inflammation of the nasal cavity due to a type 1, IgE associated response to indoor and/or outdoor environmental allergens
e.g - pollens, mould spores, animals, feathers, dust mites

30

how is allergic rhinitis investigated?

skin prick allergy test
RAST testing

31

how is allergic rhinitis managed?

oral anti-histamines (cetirizine)
intranasal antihistamines (azelastine)
intranasal corticosteroid (beclomethasone)
2nd line = leukotriene receptor antagonists (e.g montelukast) - helpful in patients with persistent asthma

32

what are the 2 types of non-allergic rhinitis?

vasomotor
NAR eosinophilic syndrome

33

how does non-allergic rhinitis occur?

regulated by autonomic innervation of the nasal cavity
reacts to changes in temperature, humidity, stress, hormonal changes

34

how is non allergic rhinitis diagnosed?

negative findings in skin prick testing and serological IgE testing

35

how is non allergic rhinitis managed?

iptrtropium for vasomotor
nasal saline irrigation, intranasal antihistamines + intranasal corticosteroids + oral decongestant
surgical = CO2 laser turbinectomy

36

what are nasal polys and where do they usually come from?

swellings in the nasal cavity formed of oedematous mucosa
usually occurs from the ethmoidal sinuses - presenting bilaterally in the middle meatus causing obstruction
can sometimes occur from maxillary sinuses (antrochoanal polyps)

37

what causes nasal polyps?

samter's triad (aspirin intolerance, asthma, nasal polyps)
EGPA

38

what presentation of nasal polyps required further investigation?

if occurring in children
if unilateral

39

how are nasal polyps managed?

intranasal corticosteroids (beclomethasone)
oral corticosteroids if severe
surgical polypectomy

40

what are inverting papillomas?

wart like unilateral projections into the nasal cavity or paranasal sinuses
benign but can become malignant in 5-15% of cases

41

symptoms of inverting papillomas?

anosmia
bleeding
irritation
occlusion

42

what causes inverting papillomas?

unknown
can be virus (HPV)
industrial contaminants
pollution

43

how are inverting papillomas managed?

all papillomas are removed
radiotherapy may be required for malignant inverting papillomas

44

what is the most common cancer of the nasal cavity?

SCC
2nd = adenocarcinoma

45

risk factors for nasal cancers?

work exposure
hard woods (saw dust) - adenocarcinoma risk
glues
dyes
chemicals
HPV infection
smoking

46

how are nasal cancers managed?

complete surgical resection and adjuvant radiotherapy