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ENT Disorders of the sinuses - Coggle Diagram
ENT
Disorders of the sinuses
Infective/Inflammaory
Viral rhinitis
System/description
"The common cold"
Pathophys
Pathogen/Pathology
a bunch of viruses.
Transmission/Risk factors
it just happens bro
Symptoms
Clear nasal congestion
Self-limiting to ~10 days
Facial pressure
Complications
Predispose to bacterial infection
Diagnosis
PE
History
Lab tests
Imaging
Treatment
Supportive care
Nsaids, fluids, rest
Pseudoephedrine
NO ABX
Saline irrigation
Decongestant Sprays (afrin)
overuse BAD
No antiviral or vaccine
Sinusitis
(bacterial rhinosinusitis)
Pathophys
Complications
Coinfection to eye via lacrimal duct
Preseptal/orbital cellulitis
Osteomyelitis
Intracranial abscess or clot
Pathogen/Pathology
MC Strep pneumo, H. influenza, other strep
can also be staph but less common
Transmission/Risk factors
Symptoms
Altered/absent sense of smell
Purulent drainage, congestion
Cough, fever, headache, halitosis
System/description
Acute
Sinusitis more than 10 days
but less than 4 weeks
Maxillary most common affected
Adenoiditis MC in peds
Chronic
4 weeks, inflammation of turbinates
"There's something else going on"
Anatomical abnormality
Underlying disease; Ciliary dysmotility
Immune compromise
Severe reflux
More likely staph or gram negative,
may be fungal
Mucormycosis, especially in
immune compromised
Requires emergent surgical debridement
May require surgical intervention
Will require ENT referral
Edema and obstruction of osteomeatal complex leading to inflammation and subsequent bacterial overgrowth
Diagnosis
PE
History
Lab tests
Imaging
CT following
failure of treatment
Treatment
Acute
Augmentin 7-10 days
Doxy if PCN allergic
NSAIDs, saline, corticosteroids
Chronic
Augmentin 2-3 weeks
OR Cephalosporin,
fluoroquinolone, clindamycin
Symptomatic care
Oral steroids
Allergic Rhinitis
Pathophys
Complications
Pathogen/Pathology
Transmission/Risk factors
Adenoids in children
Symptoms
Sneezing, congestion, rhinorrhea
Watery, itchy eyes
Postnasal drip, facial pain from edema
System/description
Nasal manifestation of body's
response to allergic triggers
Non-allergic causes:
Idiopathic
Exposure to sun, chemicals, exhausts
Gustatory
Pregnancy
Heat or cold exposure
Diagnosed via skin-testing with
lack of positive response
Rhinitis Medicamentosa
Afrin is bad actually
Chronic use may result in septum degeneration/perforation
Diagnosis
PE
Pale/Boggy/Swollen nasal mucosa
History
Lab tests
Imaging
Treatment
OTC antihistamines
Nasal steroid spray
1st line
Leukotriene antagonist
Dysplastic/neoplastic
Inverted Papilloma
Pathophys
Complications
~10% chance for malignant transformation
Pathogen/Pathology
HPV
Transmission/Risk factors
smoking, workplace chemical exposure
Symptoms
System/description
Locally aggressive benign
tumor caused by HPV
Diagnosis
PE
Unilateral obstruction, esp. with rhinorrhea
History
VERY likely to reoccur
Lab tests
Biopsy to R/O SCC
Imaging
Treatment
Total surgical excision
Nasal Polyps
Pathophys
Complications
high chance of recurrence
predispose to sinusitis, etc
Pathogen/Pathology
inflammation
Transmission/Risk factors
Chronic allergic rhinitis
Symptoms
pressure, pain, obstruction
System/description
Non-cancerous growths in the nose or sinuses
causes obstruction of sinus drainage
Diagnosis
PE
"resemble peeled grapes"
May be seen on rhinoscopy;
more likely endoscopy
History
May form as reaction of
aspirin/nsaid in asthma pt
Typically bilateral
Lab tests
Consider testing for CF if found in peds
Imaging
consider to r/o inverted papilloma if unilateral
Treatment
Consider surgery
Oral/intranasal steroid
ABX if signs of infection
Malignant
Nasopharyngeal Tumor
Pathophys
Complications
Boy that's real close to the brain
and eyes and stuff
Pathogen/Pathology
May be related to EBV
Transmission/Risk factors
Alcohol and tobacco
Reflux, barrett's esophagus
More common in eastern europe, china
HPV infection
workplace exposure
(asbetos, chemical vapor)
Symptoms
Late disease:
neck mass, nasal obstruction w/ epistaxis,
serous otitis media
Early disease:
typically asymptomatic
System/description
what it says on the tin
Diagnosis
PE
History
Otitis media in adult w/o prior episode
Recurrent epistaxis and pain
Lab tests
Imaging
Direct visualization
Treatment
Surgical excision if viable
Chemo & radiation in conjuction or if non-surgical candidate
Traumatic
Epistaxis
Pathophys
Complications
Pathogen/Pathology
Transmission/Risk factors
"digital manipulation"
Blood thinners
Dehydration/dryness
Blood pressure
Symptoms
System/description
Keisselbach's plexus
anterior
Woodruff's plexus
posterior
Diagnosis
PE
Bleeding from front or back?
History
Family history, alcohol
Cocaine
Lab tests
CBC, PTT/INR, Platelets
Imaging
Treatment
Control
Cauterize
Silver Nitrate IF able to visualize
hemostatic gauze/foam
Direct pressure, lean forward
Nasal Decongestant Spray (afrin)
Nasal Packing
Call ENT; balloon packing,
surgical management
Avoid causes
Nasal Trauma
Pathophys
Complications
Septal hematoma
causes separation of septal
cartilage from perichondrium
Loses blood supply, necroses and collapses
Prompt I&D, packing, ABX
Cosmetic appearance
Deviated septum/trouble breathing
Pathogen/Pathology
Trauma
Transmission/Risk factors
Athletes
Symptoms
duh
System/description
Diagnosis
PE
History
Lab tests
Imaging
Not really needed?
Doesn't really do anything?
Unless risk of complication
Treatment
Surgical repair
Athletes; wait until risk of recurrence down
Wait until bones finished
developed around 18yo
Foreign body
Pathophys
Complications
Septal perforation
Pathogen/Pathology
Transmission/Risk factors
MC in pediatrics
Symptoms
Unilateral purulent rhinorrhea
Facial pain/swelling
halitosis
System/description
Object causing direct inflammation, damage, or necrosis leading to septal perforation
Diagnosis
PE
observe for erosion, inflammation, infection
History
Lab tests
Imaging
Direct visualization
Treatment
Remove object
Forceps
ENT for surgery
Positive pressure
Consider abx
Anatomy
Sphenoid Sinus is important because of proximity to brain
Pediatric pt only have maxillary and ethmoid sinuses
Sphenoid sinus develops around age 5
Frontal sinus develops around age 12
"Kids get adenoiditis, adults get sinusitis"
Lacrimal duct drains into nose; common co-infection between eye and nose