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OTORHINOLARYNGOLOGY
1.1A NOSE & PARANASAL SINUSES
CHOANAL ATRESIA
IMAGING STUDIES
Plain Films
Cheap, inaccurate, overlapping structures
CT Scan
More expensive, more accurate and detailed, no overlapping
of structures
MRI
Most expensive, accurate especially to extent of soft tissue
and fluid, poor in bone delineation
Infectious diseases
Endocrine changes or diseases
Hemorrhagic diathesis
Coagulopathies
Platelet Disorders
Thrombocytopenia
hypertension
Influenza, measles, typhus
Pheochromocytoma, pregnancy,
diabetes mellitus
Congenital: e.g. hemophilia A
and B, Willebrand diseas
Acquired: e.g. anticoagulant
therapy, hepatocellular
insufficiency
Idiopathic thrombocytopenic
purpura, platelet proliferation
disorders, platelet distribution
disorders
Surgical Excision
Sclerosing agents
Propanolol
Vascular endothelial growth factor
EPISTAXIS
Neoplasma
RHINOLITH
MANAGEMENT OF RHINOLITH
ORBITAL
- Orbital cellulitis
- Cavernous sinus thrombosis
VESTIBULITIS
Idiopathic
RHINOSINOGENIC COMPLICATIONS
Atherosclerosis, arterial
ENT
OSTEOMYELITIS / SUBPERIOSTEAL
- Abscess
ALLERGY
"ALLOS" - Other than
"ERGON" - reaction
Immediate hypersensitivity - very quick reaction of the immune
system to harmless foreign, substance, 5-15 minutes
Ex. Hay fever, asthma, food & drug allergy
Delayed hypersensitivity - Much slower reaction of the immune
system, 2 or more days.
Ex. Contact dermatitis2
Allergy
Symptoms
- Rhinorrhea
- Nasal obstruction
- Nasal itching
- Sneezing
Reversible spontaneous or with treatment
Localized to nose; affects both sides
Watery and clear nasal discharge
Boggy and pale turbinates
Rhinorrhea
Stuffiness / Nasal obstruction
Nasal itching
Sneezing
ALLERGENS
House dust mites - tiny insects that live in dust
Proteins in Danders - Dry skin of human / pets
Molds & Milder
Cockroach
Pollens - grass, flowers & trees
Food - milk, wheat, soy, eggs, nuts, seafoods
DELAYED HYPERSENSITIVITY
SYMPTOMS
RHINITIS MEDICAMENTOSA
Rebound vasodilation
Prolonged used of sympathomimetic decongestant nose drops
& nasal spray (oxymetazoline)
Initial vasoconstriction -> Vasodilation -> Nasal obstruction &
excessive mucous secretion
Discontinue medication & substitute topical steroids
(mometasone, flucasone, ciclesonide) for allergy
VASOMOTOR RHINITIS
Exact cause is unknown
Triggers:
- Dry atmosphere
- Air pollution
- Alcohol
- Spicy foods
- Strong emotions
Primary treatment: Avoiding triggers
- Decongestants
- Antihistamines
- Corticosteroid nasal sprays
IMMEDIATE HYPERSENSITIVITY
ATROPHIC RHINITIS
Atrophy of nasal mucosa
Loss of cilia
Etiology : Unknown
Symptoms: Crusting, viscid secretions, fetid nasal odor
Endoscopy: Broad nasal cavity lines with dry, crusted mucosa
Management:
- Nasal douche
- Medical (steroids, antibiotics)
- Surgical (submucous implantation of cartilage)
ALLERGIC RHINITIS
INTRACRANIAL
- Epidural, subdural and intracerebral abscesses
- Clinical manifestations are nonspecific
SUBCUTANEOUS IMMUNOTHERAPY
Provides symptomatic relief
Modifies allergic disease by targeting the underlying
immunological mechanism
Efficacy and safety established
Treatment of
- Asthma
- Allergic rhinitis / rhinoconjunctivitis
ENT
- Hypersensitivity
Numerous controlled clinical trials
SUBLINGUAL IMMUNOTHERAPY
Small doses of allergen sublingually
Boost tolerance allergen
2009 World Allergy Organization (WAO)
Widely accepted in Europe, South America, and Asia
Safety nor the efficacy yet to be considered by the US FDA
SLIT VS SCIT
SLIT Cochrane meta-analysis demonstrated efficacy in control
of rhinitis symptoms in patients older than 12 years
Safety profile: Much safer than subcutaneous IT
SCIT: Scandanavian study compared the effectiveness and
safety of injection therapy with SLIT using birch pollen antigens
No difference between subcutaneous and sublingual in terms of
efficacy
ACUTE RHINITIS
Viral
- Transient signs and symptoms
- Self limiting
- Both sides, watery and clear discharge, congested turbinates
- Rhinovirus and Coronavirus
Bacterial
- Follows viral infection
- Pneumococcus, Staphylococcus
Streptococcus
- Thick, yellow-green discharge
- May be one side, congested turbinates and mucosa
- Antibiotics are warranted
CHRONIC RHINITIS
FUNGAL
Aspergillosis
Mucormycosis
Rhinoscoridosis
BACTERIAL
VASOMOTOR RHINITIS
Exact cause is unknown
Triggers
- Dry atmosphere
- Air pollution
- Alcohol
- Spicy foods
- Strong emotions
Primary treatment: Avoiding triggers
Decongestants
Antihistamines
Corticosteroid Nasal Sprays
RHINOSINUSITIS
A group of disorders generally characterized by inflammation of
mucosa of the nose and para-nasal sinuses
ACUTE RHINOSINUSITIS
An inflammatory condition involving the paransal sinuses, as
well as the lining of the nasal passages, which last up to 4
weeks (28 days)
Most common pathogens
- Streptococcus pneumoniae
- Haemophilus influenzae
- Moraxella catarrharalis
- Staphylococcus aureus
- Anaerobic bacteria
Inflammation and edema formation causes increased secretion
which are retained in the sinuses
Symptoms: Severe nasal discharge
Rhinoscopy: Greenish or purulent foul smelling nasal discharge
over congested turbinates
X-ray: Air fluid level, mucosal thickening, mucosal opacification
CHRONIC SINUSITUS
Inflammation of the nasal cavity and paranasal sinuses and/or
the underlying bone that has been present for at least 12 weeks
Symptoms:
- Nasal congestive/obstructive or blockage
- Facial pain or pressure
- Discolored discharge (Anterior or Post-nasal drip)
- Hyposia or anosmia
Fungal
- Aspergillosis
- Mucormycosis
- Rhinoscoridosis
Bacterial
- Tuberculosis
- Leprosy
- Rhinoscleroma
- Sarcoidosis
- Syphilis
- Actinomycosis
ENT
INVERTING PAPILLOMA
Benign
Locally invasive
May resemble nasal polyp but may contain areas of carcinoma
Inverts into the surface epithelium
Treatment: Surgical excision
ANGIOFIBROMA
Benign
Young male
Originates in the nasal chamber near nasopalatine foramen
Symptom: Severe epistaxis, and nasal obstruction
- Neck mass
Neurological
- Facial Pain
Radiotherapy
Chemotherapy
Combination
MANAGEMENT
SCCA
MANAGEMENT
Nasal cavity
Upper Level
Midlevel
Tumor Stage
T1
T2
T3
T4
NASOPHARYNGEAL CA
SYMPTOMS OF NPCA
Nasal
- Obstruction
- Sanguineous discharge
Ear
- Deafness
- Pain
Eye
- Preptosis
- Diplopia
Neck