DISORDERS OF THE NOSE .

GROUP MEMBERS
1. Emmanuel Seron
2. Yusuf Dawood
3. Beatrice Chiyumba
4. Teresia Mbai
5. Mwende wambua
6. Daisy Ruto
7. Samuel Ebela
Rhinitis:

• Inflammation of the nasal mucosa, often due to allergies (allergic rhinitis) or infections (infectious
rhinitis).
• Classified as acute or chronic.
• Management:
• Allergen avoidance strategies.
• Antihistamines, intranasal corticosteroids, and decongestants for symptom relief.
• Immunotherapy for severe allergic rhinitis.
 Acute rhinitis
Affects almost everyone at some time and most often in the winter with additional high
incidence in early fall and spring.
Common cause;
Rhinovirus
Corona virus
Adeno virus
Influenza virus
Parainfluenza virus.
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It is highly contagious because virus is shed for about 2 days before the symptoms
appear and after 3 days of the symptom.
 Common cold is spread by ;
Droplet nuclei from sneezing
Contaminated hand or formites.
 Secondary invasion may cause ;
Pneumonia
Acute bronchitis
Sinusitis
Otitis media
 Management;
 Usually self limiting and lasts for about 1 week .
 Goal of management ;
To relieve symptoms .
Inhibit spread of the infection.
Reduce risk of bacterial complication.
Sinusitis:
 Inflammation of the sinuses, often caused by infections.
 Can be;Acute bacterial,sub acute or chronic.
 ACUTE SINUSITIS.
 Common types include;
Allergic usually seasonal.
Viral .
Acute bacterial.
 Management:
 Aim is to relief pain and shrinkage of nasal mucosa.
 Medication;
 Analgesics e.g ibuprofen
 Oral decongestants pseudoephedrine
 Antibiotics i.e Amoxilin for 10-14 days.
Chronic bacterial sinusitis
 Develops when irreversible mucosa damage occurs.
 Damage can resut from recurrent attacks of acute sinusitis or from
suppurative sinusitis either being untreated or inadeately treated during the
acute or subacute phase.
 Cause
S.Aureus
H.Influenza
Anaerobes(Klebsiella)
Management
 Medication.
Decongestant
Antibiotic according to result of the culture.
 Nasal saline irrigation and surgery are the major treatments.
 Patient benefits from things that increase the drainage.
 Increasing the humidity (steam bath hot shower ,facial sauna)
 Increasing fluid intake applying local heat (hot wet packs).
Nasal Polyps:
 Non-cancerous growths in the nasal passages, associated with chronic
inflammation.
 Form in areas of dependent mucous membrane.
 Usually bilateral and stem like base makes them moveable.
 It may enlarge and cause nasal obstruction.
Management:

 Topical corticosteroids nasal spray to reduce inflammation.

 Low dose oral corticosteroids.
 Surgery
Polypectomy under local anesthesia.
Laser surgery to remove polyps.
May require multiple surgeries as polyps tend to recur.
Tonsillitis:

 Tonsillitis is typically caused by viral or bacterial infections. The most

common pathogens associated with tonsillitis are:
 Viral Infections:
 Rhinovirus (common cold virus)
 Influenza virus
 Adenovirus
 Epstein-Barr virus (causing infectious mononucleosis)
 Bacterial Infections:
 Group A Streptococcus (Streptococcus pyogenes) - known as strep throat, a
common bacterial cause of tonsillitis.
 Other bacteria, such as Staphylococcus aureus or Haemophilus influenzae.
Management of Tonsillitis:

 The management of tonsillitis depends on the underlying cause (viral or bacterial) and the
severity of symptoms.
 Supportive Care:
1. Rest: Adequate rest is crucial for the body to fight off infections.
2. Hydration: Encourage the patient to drink plenty of fluids to stay hydrated.
Pain Relief:
3. Analgesics: Over-the-counter pain relievers such as acetaminophen (Tylenol) or ibuprofen
(Advil, Motrin) can help alleviate pain and reduce fever.
4. Throat Lozenges: Soothing lozenges or gargling with warm saltwater can provide relief.
 Antibiotics (Bacterial Tonsillitis):
 If the tonsillitis is caused by bacteria (usually Streptococcus), antibiotics like
penicillin or amoxicillin are prescribed.
 Completing the full course of antibiotics is crucial to prevent recurrence and
complications, such as rheumatic fever.
 Corticosteroids:
 In some cases, corticosteroids may be prescribed to reduce inflammation and
swelling.
Surgical Intervention (Tonsillectomy)
Indications: Tonsillectomy, the surgical removal of the tonsils, may be recommended
in certain situations, including:
 Recurrent episodes of tonsillitis.
 Chronic or severe cases.
 Complications such as difficulty breathing or swallowing.

 Procedure: Tonsillectomy is usually an outpatient surgery performed under general

anesthesia.
 Preventive Measures:
 Good Hygiene Practices: Encourage good hand hygiene to prevent the spread of
infections.
 Avoiding Irritants: Avoid exposure to tobacco smoke and other irritants that can
worsen symptoms.
Pharyngitis:

 Pharyngitis is inflammation of the pharynx, which can be caused by various factors,

including viral and bacterial infections. The most common causes include:
 Viral Infections:
 Rhino-viruses: Often associated with the common cold.
 Influenza viruses: Can cause severe sore throat.
 Adenoviruses: Common cause of pharyngitis, especially in children.
 Epstein-Barr virus: Associated with infectious mononucleosis (mono).
 Bacterial Infections:
 Group A Streptococcus (Streptococcus pyogenes): Common cause of bacterial pharyngitis
(strep throat).
 Other Bacteria: Less common causes include Mycoplasma pneumoniae and
Corynebacterium diphtheriae.
 Non-Infectious Causes:
 Allergies: Allergic reactions can lead to throat irritation.
 Environmental Irritants: Exposure to smoke, pollutants, or dry air.
 Gastroesophageal Reflux Disease (GERD): Stomach acid reflux into the throat can cause
irritation.
Management;
 The management of pharyngitis depends on the underlying cause:
 Supportive Care:
 Rest: Adequate rest is essential to help the body recover.
 Hydration: Drinking plenty of fluids helps soothe the throat and prevent dehydration.
 Pain Relief:
 Analgesics: Over-the-counter pain relievers such as acetaminophen (Tylenol) or
ibuprofen (Advil, Motrin) can help alleviate pain and reduce fever.
 Throat Lozenges or Sprays: Soothing lozenges or throat sprays can provide relief.
 Antibiotics (Bacterial Pharyngitis):
 If the pharyngitis is caused by Group A Streptococcus (strep throat), antibiotics like
penicillin or amoxicillin are prescribed.
 It's crucial to complete the full course of antibiotics to prevent complications and
reduce the risk of spreading the infection.
 Corticosteroids:
 In some cases, especially with severe inflammation, corticosteroids may be prescribed
to reduce swelling.
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 Allergy Management:
 If pharyngitis is related to allergies, identifying and avoiding allergens is essential.
 Antihistamines and other allergy medications may be recommended.
 GERD Management:
 Lifestyle modifications and medications to manage gastroesophageal reflux if GERD
is the cause.
 Environmental Modifications:
 Avoiding smoke and other environmental irritants.
 Fluids and Humidification:
 Drinking warm fluids and using humidifiers can help soothe the throat.
Laryngitis:

 Laryngitis is inflammation of the larynx (voice box), and it can be caused by various
factors, including infections, irritants, and overuse of the voice. Common causes
include:
 Viral Infections:
 Respiratory Viruses: Such as rhinoviruses, influenza viruses, and adenoviruses.
 Herpes Simplex Virus: Can cause laryngitis in some cases.
 Bacterial Infections:
 Bacterial infections are less common but can occur, especially in cases of secondary infection
following a viral illness.
 Irritants:
 Smoke and Environmental Pollutants: Exposure to tobacco smoke and air pollution.
 Chemical Irritants: Exposure to harsh chemicals or pollutants.
 Overuse of the Voice:
 Yelling, screaming, or excessive use of the voice, which can lead to strain and inflammation.
 Gastroesophageal Reflux Disease (GERD):
 Stomach acid reflux into the throat, irritating the larynx.
Management;
 The management of laryngitis focuses on relieving symptoms, reducing
inflammation, and addressing the underlying cause. Here are general
approaches:
 Voice Rest:
 Limiting Speech: Resting the voice by minimizing talking and avoiding whispering.
 Hydration:
 Drinking plenty of fluids helps keep the throat moist and soothes irritation.
 Humidification:
 Using a humidifier to add moisture to the air can ease throat discomfort.
 Avoidance of Irritants:
 Smoke: Avoiding exposure to cigarette smoke and other environmental pollutants.
 Chemical Irritants: Minimizing exposure to harsh chemicals or pollutants.
 Pain Relief:
 Analgesics: Over-the-counter pain relievers such as acetaminophen or ibuprofen
can help alleviate pain and reduce inflammation.
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 Corticosteroids:
 In cases of severe inflammation, corticosteroids may be prescribed to reduce
swelling.
 GERD Management:
 Addressing gastroesophageal reflux through lifestyle modifications and medications
if GERD is the cause.
 Treatment of Underlying Infections:
 If laryngitis is caused by a viral or bacterial infection, appropriate antiviral or
antibiotic medications may be prescribed.
 Avoiding Voice Strain:
 Speech Therapy: In cases of chronic or recurrent laryngitis due to voice misuse,
speech therapy may be beneficial.
 Epistaxis (Nosebleeds):

 Bleeding from the nose, often due to;

Trauma, dry air, Forceful nose blowing, HTN, Chronic infection, Substance abuse,
Arteriosclerosis , Liver disease, Chronic bleeding disorder e.g Leukemia and Hemophilia or
underlying medical conditions.
It can be;
 Anterior bleed
Kiesselbach’s plexus vessels.
Its easy to locate and treatment.
 Posterior bleed.
Larger vessels.
Characterised by severe bleeding.
Harder to locate and treat.
Management:

Anterior.
Simple first aid
• Applying pressure to the nostrils for 5-10 minutes.
• Apply ice packs to nose and forehead.
• Humidification of the environment.
• Sitting position leaning forward.
• Discourage swallowing of blood.
• Nasal packing using petroleum gauze for 24-72 hours commonly.
• cauterization in severe cases using silver nitrate or Gelfoam .
• Topical anesthetic (pre-packing) mainly tetracycline , lidocaine or cocaine.
• Endoscopic surgery by cauterizing bleeding vessel or ligation of internal maxillary artery.
Medications.
 Topical vasoconstrictors.
Cocaine
Neo-synephrine.
Adrenaline.
Nasal spray or on cotton swab held against bleeding site.
Deviated Septum:

Displacement of the nasal septum, often causing nasal congestion or obstruction and
difficulty breathing.
• Management:
• Nasal decongestants for symptom relief.
• Septoplasty or submucous resection.
• Rhinoplasty or surgical reconstruction of the nose.
• Reshaping of nose by manipulation of septal cartilage.
• Postoperatively
Bilateral nasal packing for 72hours
Temporary plastic splint for 3-5 days.
Obstructive Sleep Apnea (OSA):

Repetitive interruptions in breathing during sleep due to airway obstruction.

• Management:
• Lifestyle modifications (weight loss, positional therapy).
• Continuous Positive Airway Pressure (CPAP) therapy.
• Surgical options in some cases.
Foreign body in the nose;
 Children frequently put foreign bodies in their nostrils. Occasionally, the
foreign body (anything from a pea to a small bead or toy part) obstructs the
airway or becomes embedded, possibly causing significant infection.
 May present with; History of purulent rhinorrhea and difficulty with breathing
through the affected nostril–
 Typically, the parent or caregiver relates that a very foul smell is emanating
from the child–
 Fever and other systemic features uncommon.
 Obvious muco-purulent discharge.
 Nasal blockage may be so severe that adequate visualization of the foreign
body is impossible–
 Suction may be necessary to visualize the foreign body.
 It is important to explore the opposite nostril and ears for other foreign
bodies.
Non-pharmacologic Interventions1,2
 One must be cautious to not displace the foreign body posteriorly or into the airway.
 It is not recommended to attempt removal of a foreign body beyond that dictated by
common sense.
 The child will become increasingly frightened and the procedure increasingly difficult.
 Attempt to remove clearly visible foreign bodies and do not attempt to remove foreign
bodies that cannot be seen.
 Visible foreign bodies can be removed by:– Using a suction catheter– Using a cerumen
loop (curette)– Using a nasal speculum and forceps,
 Ask the child to exhale forcibly through the nostril containing the foreign body while
the opposite nostril is occluded.This technique may be difficult for the very young
patient.–
 Providing oral positive pressure. Have the child sit or stand, depending upon their
preference. Occlude the unaffected side of the nose and instruct the parent to firmly
seal their mouth over the child’s mouth and give a short, sharp puff of air into the
child’s mouth. This technique has the advantage that it does not require physical
restraint.
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 If a foreign body is embedded with granulation tissue, consultation with an
ENT specialist and removal under general anesthesia may be necessary.
 Educate the parents or caregiver about the problems associated with foreign
bodies, particularly the risk of aspiration and the need to remove foreign
bodies under general anesthetic.