ENT

45 y/o pt presents with a 2 week history of nasal congestion, purulent nasal discharge, and facial pain. He reports that the symptoms initially started as a cold but have worsened. He also reports a decreased sense of smell and mild fever. PE reveals tenderness over the maxillary sinuses and purulent drainage in the nasal cavity. What is the most likely Dx?

acute bacterial sinusitis

35 y/o male with a Hx of asthma presents with nasal congestion, anosmia, and a sensation of fullness in his face. He reports no fever or purulent discharge. On exam, multiple pale edematous masses are seen in both nasal cavities. What is the most likely Dx?

nasal polyps

42 y/o female presents with a Hx of recurrent sinus infections that have not responded well to antibiotic therapy. She also has a Hx of asthma and aspirin sensitivity. Which of the following is the most likely Dx?

Samter’s triad

Which classification of rhino-sinusitis has symptoms that last less than four weeks?

Acute

Which classification of rhino-sinusitis has symptoms that last 4 to 12 weeks?

Subacute

Which classification of rhino-sinusitis has symptoms that last more than 12 weeks?

Chronic

Which classification of rhino-sinusitis occurs more than 4 times a year with complete resolution in between episodes?

recurrent acute

Which sinus is most commonly affected by acute (rhino) sinusitis?

maxillary

What type of infection makes up the vast majority of acute rhino-sinusitis?

viral

What are the most common types of bacteria associated with ABRS?

• Streptococcus pneumonia

• haemophilus influenza

• moraxella catarrhalis

A fever is typically indicative of which type of acute rhino-sinusitis?

bacterial

What is the most diagnostic way to diagnose acute rhino-sinusitis?

CT scan

Patients whose symptoms fail to improve within 10 days are more likely to have which type of rhino-sinusitis?

acute bacterial

What is the best way to manage AVRS?

supportive care

What is the best way to manage ABRS?

antibiotics

Antihistamines help with rhino-sinusitis due to their ___ effect

drying

Which type of medication thin secretions to promote mucous drainage?

mucolytics

What are the symptoms of the ABRS triad?

1. HA

2. facial pain/pressure

3. fever

In addition to fever, which symptom usually indicates ABRS?

purulent rhinorrhea

Which form of ARS does a double sickening pattern indicate?

ABRS

Diagnostic criteria indicative of ABRS:

persistent, fever, purulent discharge, double-sickening pattern

How can you confirm the diagnosis of ABRS?

nasal culture

In the case of ABRS, antibiotics should be prescribed for how many days for adults? for kids?

5-7; 7-10

What type of antibiotics are usually prescribed for ABRS?

first line

When would you send an urgent or ER referral for ABRS?

suspected extension of disease outside the sinuses

List indications that ABRS has spread outside of the sinuses:

vision changes, periorbital edema/ erythema, abscess, mental status changes

Symptoms must persist for ____ to diagnose chronic sinusitis

3 months

For chronic sinusitis, antibiotics should be prescribed for ___

3-6 weeks

What are the symptoms of Samter’s Triad?

1. severe bronchial asthma

2. nasal polyps

3. aspirin sensitivity

Is Samter’s Triad viral or bacterial?

neither

Samter’s Triad presents as __

chronic rhino-sinusitis

Define atopy:

bodies immune response (eczema, asthma, polyps)

Pts with nasal polyps and asthma are advised to avoid use of __ and __

ASA or NSAIDS and alcohol

Hay fever is another name for __

allergic rhinitis

Allergic rhinitis is associated with …

asthma and eczema

What clinical findings are indicative of allergic rhinitis?

stringy mucous, pale/boggy inflamed turbinates, rhinorrhea, eye irritation

The classical allergic salute is indicative of…

rhinitis

The common cold is another name for

viral rhinitis

Rhinitis lack __ differentiating it from rhino-sinusitis

sinus sensitivity

Which form of rhinitis best fits the following description: non-allergic, chronic, common in elderly

vasomotor

Which form of rhinitis is caused by medicine?

medicamentosa

What is indicated by pale, edematous masses often covered with mucosa?

nasal polyps

What is the medical term for nose bleed?

epistaxis

Which form of epistaxis is more serious?

posterior

Where is the most common site of anterior epistaxis? is this anterior or posterior?

Kiesselbach plexus; anterior

First method to stop epistaxis:

direct pressure and lean forward x15 minutes

Most common site of posterior epistaxis:

sphenopalatine artery

Posterior epistaxis requires close observation due to the __ which can cause severe complications and death

naso-cardiac reflex

Vestibulitis is caused by?

Staph aureus

What type of infection is rhinocerebral mucormycosis?

opportunistic

Rhinocerebral mucormycosis is caused by?

saprophytic fungi

Black necrotic tissue, cranial neuropathies, and facial pain in immunocompromised pts indicates

rhinocerebral mucormycosis

What should you look for in a nasal fracture?

septal hematoma

Untreated septal hematomas can lead to what?

saddle-nose deformity

Symptoms of a Type 1 Le Forte fracture:

swelling of upper lip, buccal bruising, loosening of teeth, malocclusion

Symptoms of a Type 2 Le Forte fracture:

deformity/swelling of mid face, widening of intercanthal space, mobility of upper jaw/nose, epistaxis, malocclusion, periorbital edema

Symptoms of a Type 3 Le Forte fracture:

lengthening/flattening of face, orbital hooding, enopthalmos, masotoid bruising, ear drainage

What type of Le Forte fracture is this

1

What type of Le Forte fracture is this

2

What type of Le Forte fracture is this

3

What is rare and usually asymptomatic until late in clinical course?

malignant nasopharyngeal and paranasal sinus tumors

Where is squamous cell carcinoma most common?

maxillary and ethmoid sinuses

What is the etiology of inverted papilloma?

HPV

What appear as cauliflower-like growths in or around the middle meatus?

inverted papilloma

What is another name for Wegener’s?

granulomatosis with polyangiitis

What is involved in the Wegener’s Triad?

1. necrotizing granulomas of upper/lower airways

2. glomerulonephritis

3. disseminated vasculitis