Transcript Rhinology - ENT for medical students
Rhinology
Teaching Topics for Mary’s Medics Steve Lewis 2003/4
St Mary’s Hospital ENT Department
Founded by Joseph Toynbee in 1851
Physiology • Filtration • Warming • Humidification • Olfaction • Vocal resonance (hairs/mucus/cilia) (30C) St Mary’s Hospital ENT Department
Founded by Joseph Toynbee in 1851
Anatomy (outside) • Bony upper 1/3 • Cartilage lower 2/3 • Alar • L Lat • U Lat St Mary’s Hospital ENT Department
Founded by Joseph Toynbee in 1851
Anatomy (cavity) • Septum • Turbinates (x3) • Ciliated epithelium • Sinus drainage to around middle turbinate St Mary’s Hospital ENT Department
Founded by Joseph Toynbee in 1851
Use of the bony septum!
St Mary’s Hospital ENT Department
Founded by Joseph Toynbee in 1851
Anatomy (sinuses) • Anterior drain to middle meatus – Frontal – Maxillary – Ant Eth • Posterior drain superior meatus/sphenoethmoidal recess – Post Eth – Sphenoidal St Mary’s Hospital ENT Department
Founded by Joseph Toynbee in 1851
Anatomy (sinuses) St Mary’s Hospital ENT Department
Founded by Joseph Toynbee in 1851
Anatomy (sinuses) St Mary’s Hospital ENT Department
Founded by Joseph Toynbee in 1851
Anatomy (sinuses) St Mary’s Hospital ENT Department
Founded by Joseph Toynbee in 1851
Anatomy (sinuses) St Mary’s Hospital ENT Department
Founded by Joseph Toynbee in 1851
Blood Supply • Very extensive anastamoses • Int Carotid & Ext Carotid branches • Ethmoidal arteries above MT • Sphenopalatine/Palatine/Labial below MT • Little’s Area • Kiesselbach’s plexus St Mary’s Hospital ENT Department
Founded by Joseph Toynbee in 1851
Examination
• Point to yourself!
• Rigid scope (0/30/90) • Flexi ‘scope St Mary’s Hospital ENT Department
Founded by Joseph Toynbee in 1851
Epistaxis • ABC – Hx Ex Ix as you go – Basic first aid – Bloods (FBC/G&S/INR/U) – Fluids – Consider co-morbidity in the elderly St Mary’s Hospital ENT Department
Founded by Joseph Toynbee in 1851
Epistaxis • Beavis and Butthead St Mary’s Hospital ENT Department
Founded by Joseph Toynbee in 1851
Epistaxis • Find the bleeder and cauterise it • Pack the nose – merocel uni/bi lateral – BIPP – Foley catheter and BIPP • Cautery or packing under GA • Ligation of feeding vessels (EC if necessary) • Antibiotics if pack staying >24hrs • Naseptin when settled St Mary’s Hospital ENT Department
Founded by Joseph Toynbee in 1851
Trauma • # Nasal bones (not urgent) – see in 1/52 – MUA in 2/52 – Rhinoplasty >3/52 • Septal haematoma (URGENT) – prompt drainage – poor cosmetic result possible St Mary’s Hospital ENT Department
Founded by Joseph Toynbee in 1851
Obstruction • Congenital/Acquired • Deviated septum • Rhinitis • Polyps • Foreign body • Neoplasia St Mary’s Hospital ENT Department
Founded by Joseph Toynbee in 1851
Rhinitic Mucosa St Mary’s Hospital ENT Department
Founded by Joseph Toynbee in 1851
Rhinitis • Allergic (10-20% people) – Obstruction – Vasodilatation – Oedema – sneezing Type I hypersensitivity IgE & Mast Cells • Discover and avoid allergen • Prevent swelling/oedema • Stabilise mast cells – MEDICAL problem with treatment, not cure St Mary’s Hospital ENT Department
Founded by Joseph Toynbee in 1851
Rhinitis • Intrinsic (10-15% population) – Obstruction – Vasodilatation – Oedema – sneezing • Imbalance of ANS supply to mucosa • PNS overrides SNS • watery rhinorrhoea St Mary’s Hospital ENT Department
Founded by Joseph Toynbee in 1851
Rhinitis • Medicamentosa • OTC decongestants are usually designed for short term use • Like heroin • Very difficult vicious circle to break free from St Mary’s Hospital ENT Department
Founded by Joseph Toynbee in 1851
Polyps • Inflammatory origin most common – neoplastic – CF – idiopathic • Aspirin/Asthma/Obstruction • Hx Ex Ix • Steroids/Surgery • Recurrence St Mary’s Hospital ENT Department
Founded by Joseph Toynbee in 1851
Polyps St Mary’s Hospital ENT Department
Founded by Joseph Toynbee in 1851
Acute Sinusitis • Inflammation of the MM lining the paranasal sinuses • May be in conjunction with CAUSATIVE FACTOR • Medical Rx resolves most: – Analgesia – Decongestants – Steam – Antibiotics • Surgical Rx includes sinus washout St Mary’s Hospital ENT Department
Founded by Joseph Toynbee in 1851
Chronic Sinusitis • Retained secretions – blocked nose – frequent acute episodes – sinofacial pain • Take careful pain history before diagnosis • Visualise drainage system by CT • FESS St Mary’s Hospital ENT Department
Founded by Joseph Toynbee in 1851
Nasopharyngeal Carcinoma • High incidence in those of Eastern origin – Hong Kong boat people (male) • Associated with: – Dried, salted, smoked fish – EBV – Genetic • Radiotherapy • Little place for surgery (not curative) St Mary’s Hospital ENT Department
Founded by Joseph Toynbee in 1851
Foreign Bodies • Pictures of FBs St Mary’s Hospital ENT Department
Founded by Joseph Toynbee in 1851
Cosmetics • Pictures of septorhinoplasty • Pictures of facial proportions • Grades of uglyness St Mary’s Hospital ENT Department
Founded by Joseph Toynbee in 1851
The End
St Mary’s Hospital ENT Department
Founded by Joseph Toynbee in 1851