16a NOSE and SINUSES

symptoms of rhinitis medicamentosa

severe congestion and pain. discharge is typically minimal.

Triad asthma (Samter's triad) consists of asthma, nasal polyposis, and ____________.

sinus disease

Associated symptoms with rhinorrhea

sneezing, watery eyes, mouth breathing, malodorous breath, conjunctival burning or itching

symptoms of vasomotor rhinitis

stuffiness and rhinorrhea, symptoms are labile and can clear quickly.

Kiesselbach's plexus

the anterior part of the septum which holds a rich vascular network and is the most common site for nosebleeds.

Clinical features of cerebrospinal rhinorrhea:

unilateral discharge of clear spinal fluid after head injury or surgery. the fluid may be blood tinged but is really distinguished from a brisk nosebleed.

Typical presentation of epistaxis:

unilateral, anterior

By age 5: sinuses present =

maxillary, ethmoidal, sphenoidal

nasal ulcers

may result from nasal use of cocaine

Ethmoidal Acute purulent bacterial sinusitis

medial to the eye, deep in the head/orbit. not localized tenderness. palpebral edema = common

history of chronic congestion and decreased sense of smell. allergic rhinitis. all indicative of...

nasal polyps

Symptoms of allergic rhinitis

confused with common cold symptoms, itching of the nose and watery eyes, sneezing, dry cough, nasal congestion

Maxillary Acute purulent bacterial sinusitis

dull/throbbing pain in the cheek or in the upper teeth on the affected side. thumb pressure discloses localized tenderness in the maxillary area.

Symptoms of sinusitis

fever & malaise. severe local pain and pressure over involved sinues. sneezing and watery discharge at the beginning, then nasal secretion purulent after --> green or yellow. nasal obstruction & congestion.

PE: pale, boggy masses on the nasal mucosa

Nasal polyps

Tip from Dr Ley about inspecting the nose:

Stabilize the chin.

Sinusitis Physical Exam

Tenderness to palpation over the affected sinus. Inability to transilluminate the sinuses --> Indicates local fluid accumulation.

Causes of septal perforations:

Trauma, Surgery, Anphetamines, Cocaine

Babies are obligate nose breathers. True or false?

True

Whats the first thing you look for with nose bleed? and then decide whether or not it is ____ or ______?

Unilateral or bilateral. Anterior or posterior bleed.

Why is use of cocaine risk factor for nose bleed?

Vasoconstriction. and lead to possible nasal septal perforation.

Risk factors for anterior nose bleeds:

1) trauma/nose picking 2) dry nasal mucosa 3) hypertension 4) nasal cocaine 5) alcohol use

Allergic "shiners" and "nasal crease"

-dark circles around the eyes related to vasodilation or nasal congestion -horizontal crease across bridge of nose from repeated upward rubbing ("allergic salute")

Unilateral rhinorrhea causes

1) Foreign Body 2) Neoplasm (Nasal Polyp) 3) Cerebrospinal Rhinorrhea

Risk factors for rhinosinusitis:

1) cigarette smoke or shs 2) trauma 3) FB

Note what about nasal mucosa?

Color typically more red than the oral mucosa. Note if any swelling, bleeding, excudates (clear, mucopurulent, purulent)

1 year olds have which sinus cavity?

Maxillary

Frontal sinus does not develop until a child is around how old?

7 years old.

Rhinosinusitis

= acute rhinitis. inflammation of the nasal and paranasal sinus mucosa

What is typically contraindicated when patient has nasal polpys and asthma because of the chance severe bronchospasm?

Aspirin

Not what about nasal septum?

Deviation, inflammation, or perforation. Ulcers. or Polyps.

T/F: Rhinosinusitis can only be viral?

False. Both viral and bacterial.

Acute bacterial sinusitis

Frontal sinuses and maxillary sinuses. Local tenderness and symptoms such as pain, fever, nasal chischarge. Signs on exam:L transillumination of the sinuses.

Posterior nose bleeds can be associated with:

HTN and atherosclerosis

allergic rhinitis causes

IgE mediated reactivity to airborne antigens (pollen, mold, dust) People with other atopic disease (asthma, eczema, atopic dermatitis, family history)

External examination of the nose:

Inspect: note any assymmetry or deformities Palpate: gentles pressure on tip with thumb. if tip tender manipulate as little as possible.

Compression of ______ will increase the flow of the CSF fluid

Jugular Vein

Internal exmaination of the nose:

Nasal speculum or Otoscope. Tilting patients head back a bit and insert speculum gently into nostril. Avoid contact with sensitive nasal septum. Try to see inferior and middle turbinates, the nasal septum and narrow passage between them. Some asymmetry is normal.

Clinical feature of what? produces a bloody discharge, in distinction tothe brisk bleeding or epistaxis

Neoplasms, Carcinoma

Epistaxis

Nosebleed

Sphenoidal Acute purulent bacterial sinusitis

Pain generated behind the eye or occiput

Examination of the sinuses:

Palpate/percuss over the maxillary, frontal, and ethmoid sinuses with both thumbs. Avoiding pressure on the eyes. Press up on the maxillary sinuses.

Less frequent type of nose bleed?

Posterior bleeding from the woodruff plexus

If children put object in their nose what can you expect due to the FB?

Produces a foul purulent discharge

rhinitis medicamentosa

Quizlet: rebound nasal congestion commonly associated with overuse of over-the-counter nasal decongestants. creates a vicious cycle

Sinusitis --> Acute Rhinitis -->

Rhino-sinusitis: infection of the paranasal sinuses will cause mucosal swelling obstructing the sinus drainage. frequently follows and upper respiratory infection, can be viral or bacterial.

Vasomotor Rhinitis

Rhinorrhea caused by increased secretion of mucus from nasal mucosa cause by 1) changes in temperature or humidity 2) odors 3) alcohol 4) neurovascular imbalance

nasal polyps

Semitransparent, pale masses that usually come from the middle meatus

Severe pain in the face and signs & symptoms of an acute URI suggests -->

Sinusitis

If you see babies mouth breathing, Abnormal? Y or N?

Yes

Transillumination of sinuses

absense of a glow on one or both sides suggest a thickened mucosa or secretions in the sinus, but it may also result from develpmentsal absence of one or both sinuses (frontal). See text for description of methods for transillumination of sinuses

Bilateral rhinorrhea causes

acute rhinitis allergic rhinitis vasomotor rhinitis rhinitis medicamentosa

Signs of allergic rhinitis

allergic shiners, nasal membranes pale to bluish and boggy secondary to edema, children allergic salute

signs of vasomotor rhinits

bogginess of nasal mucosa

Allergic rhinitis nasal mucosa:

pale bluish

Test for nasal obstruction

pressing on each ala nasi in turn and asking the patient to breathe in

Frontal Acute purulent bacterial sinusitis

produces pain in the forehead above the supraorbital ridge. worse leaning forward. pressure in this region elicits tenderness.

Subacute or chronic sinusitis

purulent nasal discharge that persists for > 3 weeks. pain over the sinuses is NOT A PROMINENT SYMPTOM. tenderness is usually absent.

Viral rhinitis nasal mucosa:

red and swollen

Cerebrospinal rhinorrhea is a complication of

removal of pituirtary gland

rhinorrhea

runny nose or nasal discharge associated with nasal stuffiness and a sense of obstruction