Nose Diseases

EPISTAXIS

The blooding nose is a common emergency problem. The majority are spontaneous, with no identifiable cause, although many are traumatic. Causes such as hemophilia, other coagulopathies, leukemia, hereditary hemorrhagic telangiectasia or intranasal neoplasms must be considered. As usual, a complete history is taken.

Children and many adults often cause bleeding by nose picking. A pubertal male may have an angiofibroma. A person with a long history of smoking should be examined for an intranasal or paranasal sinus epidermoid cancer. Patients may require a laboratory examination. The complete blood cell count evaluates the hematocrit and signs of leukemia. Prothrombin time, partial thromboplastin time/INR, platelet count, and Ivy bleeding time or other platelet function evaluate coagulation.

The majority of nosebleeds occur anteriorly from the nasal septum and cease spontaneously. If the nose is actively bleeding, the origin can often be seen by visual examination .If a definite bleeding site is identified, it may be cauterized with a silver nitrate . Posterior bleeds are managed endodcopically.

SINUSITIS

Sinusitis is an incredibly common patient complaint. The thinking and understanding around sinusitis is changing.
The paranasal sinuses are a collection of air containing pockets in the frontal, ethmoid, sphenoid and maxillary bones.

ACUTE SINUSITIS

Acute sinusitis presents in one of two classic fashions. The first is on the tail of an acute upper respiratory tract infection (URI). Rhinitis in the form of an acute upper URI, Virtually everyone suffering from an upper URI initially develops a clear nasal discharge emanating both from the nose and the paranasal sinuses. This invariably develops into a bacterial super infection, manifest clinically as a green or yellow mucopurulent nasal discharge. During the upper URI, many patients have signs and symptoms of paranasal sinus disease. These include pressure, pain, nasal congestion, purulent rhinorrhea, both anterior and posterior, presenting as a postnasal drip. If following upper respiratory infection which is viral usually symptomatic treatment is enough.This includes oral & topical decongestants & steam inhalations.

If symptoms persist antibiotics are considered.

The other classic case of acute sinusitis is the individual with allergic rhinitis. Typically the allergic rhinitis worsens during the allergic season. Because one or another of the sinus ostia is obstructed, infection ensues and the patient develops acute sinusitis. This infection is exactly the same as that seen at the tail end of an URI. The evaluation and management are identical.

CHRONIC SINUSITIS

The thinking regarding chronic sinusitis has evolved rapidly in the past quarter century. We use to view sinusitis as a bacterial disease and research was focused on identifying the bacteria and prescribing the best antibiotic. Chronic sinusitis is not a bacterial disease, it is an illness caused by dysfunction of the mucociliary transport system and by osteal obstruction, either anatomic or inflammatory.
Endoscopic sinus surgeries are performed the gold standard in surgical management of chronic sinusitis.

ALLERGIC RHINITIS

The most common inflammatory nasal disorder is allergic rhinitis. Allergic rhinitis presents with itchy nose, sneezing, itchy eyes, congestion and a clear or white nasal discharge. The condition may be seasonal or perennial.

First and foremost part of management is environmental control. If specific allergens such as pets are present in the house, they should be removed, but in addition, almost everyone with an allergic diathesis has sensitivity to molds, fungi, mites, dust, and so forth, and to whatever degree the home and work environment can have their allergic load reduced, the patient will do better.

The most powerful allergic nasal medications available today are the nasal steroids.
There is no surgical therapy for allergy, but those individuals with compounding problems such as a deviated nasal septum or bacterial sinusitis may be advised to consider surgical correction of those problems.

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