Nose Conditions

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EPISTAXIS

Epistaxis also called nosebleed is a common medical emergency, which requires prompt management to avoid morbidity and mortality. Bleeding can be bilateral or unilateral, or posterior and anterior. Causes include trauma, repeated nose pickings, infections such as rhino sinusitis, systemic causes such as hypertension, bleeding disorders, anaemia and leukemia etc.

Clinical Features

SIGNS AND SYMPTOMS

  • Nose Bleeding

INVESTIGATIONS

  • FBC, sickling test, coagulation screen, liver function test, retroviral screen, if indicated.

Treatment:

NON-PHARMACOLOGICAL

  • Pinch the nose 5-10 minutes let the patient lean forward and breathe through the mouth

Alternative:

  • Apply cold pack or ice block to the forehead, using ribbon gauze impregnated with Petroleum Jelly or liquid paraffin.

PHARMACOLOGICAL

  • Cauterization of bleeding point by touching the bleeding point with silver nitrate

NASAL VESTIBULITIS

An inflammation of the skin within the nasal vestibule is referred to as nasal Vestibulitis. Diffuse infection of the skin of the anterior nares and may occur due to frequent trauma such as occurs in constant nose picking. Persistent nasal discharge leads to excoriation and infection of the skin of the nasal vestibule.

Clinical Features

SIGNS AND SYMPTOMS

  • Swelling
  • Pain
  • Mucous Drainage Bump at the opening of the nostril

Treatment

PHARMACOLOGICAL 

  • Give Analgesia
  • Give Amoxicillin 500mg 8 hourly for 5 days
  • Give Liquid Paraffin 2 drops each nose 3 times a day.

BACTERIAL SINUSITIS

This is an acute infection of the para-nasal sinuses. It may lead to complications with attendant morbidity and mortality. Early recognition of this clinical condition is mandatory. Swimming in dirty waters, dental infection or dental extraction, fractures involving the sinuses, nasal obstruction from polyps and allergic rhinitis are predisposing factors to developing acute sinusitis.

Clinical Features

SYMPTOMS AND SIGNS:

  • Purulent nasal discharge, persistent or intermittent, pain and tenderness over one or more sinuses, nasal obstruction, postnasal discharge, occasional fever.

INVESTGATIONS

  • FBC
  • X-ray of paranasal sinuses
  1. Sinusitis is uncommon in children under five years as sinuses are not fully developed
  2. Unilateral foul-smelling nasal discharge is a foreign body until proven otherwise

Treatment 

NON-PHARMACOLOGICAL 

  • Adequate hydration
  • Steam inhalation

PHARMACOLOGICAL

Adults:

  • Give Oxymetazoline 0.05% 2 drops twice a day for not more than one week
  • Give Cetirizine 10mg daily for 3-5 days
  • Give Amoxycillin 500mg 8 hourly for 5 days
  • Steam inhalations using Menthol are advised

Children:

  • Give Oxymetazoline 0.025% 2 drops twice a day for not more than one week
  • Give Amoxicillin 25 mg/kg/dose in exacerbations of chronic sinusitis and HIV positive children who are on Cotrimoxazole prophylaxis.

Alternatively: penicillin hypersensitivity:

  • Give Erythromycin 12.5 mg/kg/dose 6 hourly or Azithromycin 10mg/kg STAT then 5mg /kg daily for 7 day

If pain or fever:

  • Give Analgesic/Antipyretic treatment as required

Referral criteria

  • No symptomatic relief after 48-72 hours of antibiotics
  • CNS complications of sinusitis

ALLERGIC RHINITIS

Recurrent inflammation of the nasal mucosa due to hypersensitivity to inhaled allergens e.g., pollen, house dust, grasses and animal proteins.

Clinical Features

SYMPTOMS/SIGNS:

  • Blocked stuffy nose, watery nasal discharge, frequent sneezing often accompanied by nasal itching and irritation, conjunctival itching and watering, edematous pale grey nasal mucosa, mouth breathing, snoring at night.
  • Exclude other causes such as infections, vasomotor rhinitis, overuse of decongestants drops, side effects of antihypertensive and antidepressants.

Treatment

NON-PHARMACOLOGICAL

  • Avoid known triggers/allergens, such as dust (dust mite) where possible
  • Avoid smoking
  • Provide education on the correct technique of administering topical medicines and monitor from time to time. Incorrect technique is a common cause of treatment failure.
  • Allergen avoidance

PHARMACOLOGICAL

  • Give corticosteroid nasal sprays e.g., Beclomethasone nasal sprays 1 spray of 50 mcg in each nostril 12 hourly.
  • Give Cetirizine 10mg daily for 3-5 days
  • If predominant symptom is blocked nose, then add Oxymetazoline 0.05%, intranasal, administered 8 hourly for a maximum of 5 days.
  • If symptoms persist ADD Prednisone, oral, 30 mg daily for 5 days whilst continuing the topical steroid.