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ENT: rhinitis
rhinitis ENT
36
Anatomy
Graduate
10/08/2011

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Term
Babys can get sinusitis but it is abnormal. Babies have frontal and maxiallary sinuses.
Definition
Term
In __ sinusitis, pts teeth may hurt.
Definition
maxillary
Term
Allergic rhinitis is __ common between men and women. 80% have the onset before age __. Mean age of onset is __.
Definition
- equally
- 20
- 10

If baby has it and not sure to diagnose it or not, ask family history of allergic dermatitis. If mom has allergies or dad, probably allergies in baby.
Term
Allergic rhinitis is a __ __ interaction. It may take years to become __. It is __ mediated and __ __ __ occurs.
Definition
- antibody-antigen interaction
- sensitized
- IgE
- mast cell degranulation

primary inflammatory mediators: histamine, kinin, heparin

secondary inflammatory mediators: prostaglandins, LTRs
Term
With allergic rhinitis, inflammatory agents induce:
Definition
- mucuous glands
- vasodilation
- increased vascular permeability
- sensory nerve stimulation
Term
Whats involved with allergic rhinitis:
Definition
NOT JUST THE NOSE

- nose
- eyes
- ears
- skin
Term
REMEMBER BLOOD PRESSURE AND ALLERGY MEDICINE INTERACTIONS. HAVE TO TELL YOUR PATIENT THAT THE MEDS CAN RAISE THERE BLOOD PRESSURE. Must consider the meds they are currently on. If they have frequent URIs need to know why, could be lymphoma or other cancers.
Definition
Term
symptoms of allergic rhinitis:
Definition
- sneezing
- rhinorrhea
- nasal congestoin
- scratchy sore throat
- pruritis
- tearing
- cough
- snoring
- sniffles
- anosmia
- headache
- fatigue
Term
signs of allergic rhinitis:
Definition
- allergic shiners
- nasal crease
- pale/bluish boggy mucosa
- cobble stoning
- clear mucous
- polyps
- septal issues
Term
DDx of allergic rhinitis:
Definition
- vasomotor rhinitis
- rhinitis medicamentosa
- immotile cilia syndrome
- CSF leakage
- Granulomatous rhinitis

(Very Right Is Commonly Good).
Term
vasomotor rhinitis:
Definition
smell reactions to perfume/garlic/onions etc.

ANTIHISTAMINES WON'T WORK FOR THIS
Term
Rhinitis medicamentosa occurs in pts who use __ too often, to the point that when they don't use it, their nose gets clogged.
Definition
Afrin
Term
GRANULOMATOUS RHINITIS: WEGENERS GRANULOMATOSIS AND LYMPHOMA CAN CAUSE THIS
Definition
Term
diagnostic studies for allergic rhinitis:
Definition
NOT ROUTINE

Allergy testing
In vitro
In vivo
Nasal smear and eosinophil count (both uncommon)

eusionphils- orange granules with purple nucleus
Term
3 tmt options for allergic rhinitis:
Definition
Basically three options:
Environmental control (allergen avoidance)
Pharmacotherapy
Immunotherapy
Term
6 possible classes of drugs used to treat allergic rhinitis:
Definition
- Steroids
- Antihistamines
- Decongestants
- Mast cell stabilizers
- LTR antagonists

(SADAML)
Term
steroids for allergic rhinitis can be give __, __, or __.
Definition
- intranasaly
- orally
- parenterally
Term
Antihistamines
1st generation
Diphenhydramine, et al
2nd generation
Cetirizine, et al
3rd generation
Levocetirizine
Intranasal
Azelastine, et al
Intraocular
Olopatadine, et al
Definition
Term
Antihistamine pneumonic: (Did Carl Leave An Option)
Definition
- 1st generation: Dephenhydramine
- 2nd generation: Cetirizine
- 3rd generation: Levocetirizine
- Intranasal: Azelastine
- Intraocular: Olopatadine
Term
A decongestant used for allergic rhinitis is __.
Definition
pseudoephedrine
Term
An anticholinergic used for allergic rhinitis is ___. This is rarely used though b/c it dries out the nose so much and can cause __ __.
Definition
- Ipatropium
- nose bleeds
Term
A mast cell stabilizer that can be used with allergic rhinitis is __.
Definition
Cromolyn
Term
A LTR antagonist that can be used for allergic rhinitis is __.
Definition
Montelukast
Term
Immunothearpy is aka __ __.
Definition
allergy vaccination
Very effective
Long term
Expensive but…
Shots
Some risk
<1 death/million
Many never complete the course of Tx
Term
Viral rhinitis:
Strongly seasonal
Symptoms >> findings
Vitals normal
Mucous
Pink to reddish mucosa
Oral exam normal-ish
Chest clear
Definition
Bacterial rhinitis:
Less seasonal
Symptoms = findings
Temp… but
Mucous
Red mucosa
Purulent postnasal drip
Chest variable
Term
Viral they don’t look that bad its just a cold.
Bacterial- they look as bad as they feel.

Common cold can live on a surface 20 hours.
Definition
Term
viral rhinitis, who is likely to get this:
Definition
- very young and very old
- chronic illnesses
- immunocompromised
Term
demographics of sinusitis:
Definition
- all races equally affected
- equal b/w men and women
- no specific age
- all parts of country
Term
Pathogenesis of acute sinusitis:
Definition
- viral infection
- Strep. pneumoniae (31%)
- H. influenzae (21%)
- M. catarrhalis

TEST KNOW IT
Term
pathogenesis of chronic sinusitis:
Definition
- Osteaomeatal complex
- S. pneumonia
- H. influenzae
- M. catarrhalis
- Anaerobes
- Fungus

TEST KNOW IT
Term
signs and symptoms of acute sinusitis:
Definition
- purulent nasal d/c
- sinus pain
- fever
- halitosis
- headache
- often specific symptoms
Term
Signs and symptoms of chronic sinusitis:
Definition
- long history
- maybe nasal d/c
- NO sinus pain
- Halitosis
- DENTAL PAIN
- often non-specific symptoms
Term
Dx studies for acute sinusitis:
Definition
- maybe X-ray
- maybe CT
- no culture
- no venipunction
- no surgery
Term
Chronic sinusitis dx studies:
Definition
- X-ray
- CT scan
- MR
- maybe culture
- maybe venipuncture
- maybe surgery
Term
Treatment of acute sinusitis:
Definition
- Decongestants: oral, topical
- Analgesia
- Steroids

(don't rush to antibiotics, referral uncommon)
Term
Treatment of chronic sinusitis:
Definition
- control predisposing factors like allergies or GRED
- Decongestants
- Antihistamines
- Steroids
- Antibiotics possibly
- Surgery
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