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Nasal Topics - Rhinitis and epistaxis

Terms in this set (27)

septum
separates left and right nasal cavities
turbinates
projections in nasal cavity
sinuses
drain into meatus of different turbinates
Nasal Mucosa
The cellular lining of the nose consisting of the Goblet cells with cilia and seromucous glands. The lining has a Sol layer under a Gel layer. The Sol layer covers and protects the cells while the cilia whisk the Gel layer to remove trapped particles.
Nasal functions
Provides an airway for respiration, moistens and warms entering air, cleanse air of foreign particles, resonating chamber for speech, and houses olfactory receptors.
Nasal structure
Vestibule, Cavity, and Naso-pharynx. The cavity contains the Inferior, Middle, and Superior Turbinates. I&M are visible from vestibule.
Rhinitis
Inflammation of the nasal mucosa caused by both non-allergic and allergic sources.

Effects 1/5 Americans and is the MC chronic condition in the US.
Rhinitis S&Sx (general)
Obstruction (Mucus), hyperirritability, hypersecretion, inflammation, redness, nosebleeds, obstruction due to inflammation.
Rhinitis S&Sx (Non-Allergic) (general)
Clear rhinorrhea, nasal obstruction - potential causes (nasal sprays, trauma history, chemical exposure, drugs, dust, smoke)
Rhinitis S&Sx (Viral) (Non-Allergic specific)
Body aches, headache, malaise, cough, Clr / Wht drainage, obstruction, +/- sneezing (Common cold)
Rhinitis S&Sx (Occupational - Non-allergic)
dust, sulfur dioxide, cigarette smoke, garden sprays, ammonia

Nasal dryness or rhinorrhea, decreased ciliary movement, decreased airflow, +/- sneezing
Rhinitis S&Sx (Vasomotor- Non-Allergic)
Caused by activation of sympathetic / parasympathetic innervation due to changes in temperature (indoor vs outdoors), odors, ETOH. Response is obstruction, clear drainage and may or may not last beyond intial response.
NARES
Non-Allergic Rhinitis w/ Eosinophilia Syndrome - Presents with a > 20% composition of eosinohpils on nasal smear. More severe - sinusitis / polyposis.
no allergy to inhalants
Rhinitis Medicamentosa
Rebound nasal congestion commonly associated with overuse of over-the-counter nasal decongestants. Vasocontrictive nasal sprays.
Pregnant Rhinitis
Side effect of hormonal changes during pregnancy. Feels like the common cold.
worse in 2nd and 3rd trimesters
Rhinitis (Non-Allergic) Tx:
Avoidance of irritant
mask
saline irrigation
topical steroids (not as effective vs Allergic)
Phenylamines - oral decongestants
topical vasocontrictors (Imidazolines & Oxymetazoline)
Anticholinergic (ipratropium) - vasomotor
Anti-Histamine - (Astepro & Patanase) - vasomotor
Mast cell stabilizers (Cromolyn)
surgery as needed.
Rhinitis (Allergic)
Type -1 Hypers - IgE mediated immune response after repeated contact with otherwise harmless substance.
Associated with Asthma, OM, rhinosinusitis, nasal polyposis.
MC allergens: pollen, mold, animal dander, dust mites, foods, stinging insects.
1/4 of population, any age, decreases with age. M>F in children.
Rhinitis S&Sx (Allergic)
Watery eyes, sneezing, shiners (eyes), nasal crease, mouth breathing due to congestion, congestion, other areas irritated or itchy, watery rhinorrhea, bluish, wet, swollen turbinates.
Rhinitis Allergic - Types
Seasonal / Perennial. Seasonal presents with most of the above S&Sx while perennial may be structural (polyps) and present with a typically normal nasal exam.
seasonal allergic rhinitis
increased in certain seasons depending on pt's allergy
sneezing, watery rhinorrhea, itchy nose, eyes, ears, red throat, watery eyes
typically worse in the morning

blueish/pale hue, boggy turbinates, wet swollen mucosa
perennial allergic rhinitis
usually constant
nasal congestion, blockage, post nasal drip
rhinorrhea/sneezing and eye symptoms are less common
Examples: indoor inhalants, dust mites, dander, roaches, mold, food

nasal congestion or typically normal nasal exam, possible anatomical abnormality
Rhinitis Dx
In VIVO: prick / intradermal / patches
In VITRO: battery of 10-12 allergens, RAST (radioallergosorbent test)
Introduction of allergen on skin can / will react with mast cell degranulation, histamine release, and the formation of wheals.
no imaging required
Rhinitis Tx
Allergic:
- Environmental control/trigger avoidance
- pharmacotherapy (oral anti-H, intranasal 2nd gen steroids, ocular anti-H, intranasal anticholinergic, oral steroids if severe, leukotriene antagonist.
- Immunotherapy (sublingual / subcutaneous immunotherapy)
Epistaxis
Potential area of bleed - Kiesselbach's Plexus.
Bimodal (young or old). M>F.
Causes any thing that ruptures vessels, dries out membranes, damages tissue, HTN, various disease conditions.
MC unilateral anterior bleeds.
Epistaxis Dx
Review risk factors and inspect area of bleed. If anticoagulated check levels and scope as needed.
Epistaxis Tx
lean forward, apply pressure, short acting vasocontrictors, ice packs, cautery / silver nitrate / electrocautery, treat underlying cause (HTN).
Nasal saline sprays, sneeze with mouth open, don't pick nose, avoid hot spicy foods, smoking, aspirin / ibuprofen.
Epistaxis Tx (non-responsive)
Hemostatic sealant, pneumatic nasal tamponade, packing, Epistat ballooning, Rhino rocket.
Rule out maxillary, facial or external carotid artery bleed. If packing use Abx - cephalexin / clindamycin.
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