COURSE: E.N.

T FOR NURSING
CHAPTER: TEN
INFLAMMATORY CONDITIONS OF NOSE & PNS

Lecturer: Ali Adan Mohamed (ALI-ABA)

B.Sc. Nursing & Midwifery At Plasma University Mogadishu Somalia
MPH: Major in Epidemiology at Daffodil International University Dhaka Bangladesh
IELTS Preparation at Dima Collage Nairobi Kenya
 1 RHINITIS:
Rhinitis: also known as “coryza” is irritation and
inflammation of the mucous membrane inside the nose.
 CLASSIFICATION:
Acute V/s Chronic:

Acute rhinitis: commonly results from viral infections but

may also be a result of allergies, bacteria, or other causes.

Chronic rhinitis: usually occurs with chronic sinusitis

(chronic rhino-sinusitis).

Allergic V/s Non allergic:

 ALLERGIC RHINITIS:
Allergic rhinitis is caused by a reaction of the body’s
immune system to an environmental trigger.
The most common environmental triggers include:
Dust
Molds
Pollens
Grasses
Trees
Animals
 SYMPTOMS OF ALLERGIC RHINITIS:
Itching

Sneezing

Runny nose

Stuffiness (congested)

Itchy and watery eyes

Headaches and swollen eyelids

Cough and wheeze.

 TREATMENT OF ALLERGIC RHINITIS:
Avoiding the substance that triggers the allergy

Nasal corticosteroid sprays e.g. (budesonide nasal spray)

decrease nasal inflammation

Antihistamines e.g. (oxymetazoline) help prevent the allergic

reaction

Nasal irrigation

Antibiotics do not relieve the symptoms of allergic rhinitis.

 NON ALLERGIC RHINITIS:
1: Acute viral rhinitis
Acute viral rhinitis can be caused by a variety of viruses, usually
the common cold
SYMPTOMS consist of:
 Runny nose
 Sneezing
 Congestion
 Postnasal drip
 Cough
 A low-grade fever
 TREATMENT :
Stuffiness can be relieved by taking decongestants

Antihistamines help control a runny nose

Antibiotics are not effective for acute viral rhinitis.

 2. CHRONIC RHINITIS:
Chronic rhinitis: is the nasal inflammation of long

term, lasting for more than four consecutive weeks.

Causes: Chronic Rhinitis is caused by hay fever.

 CLINICAL FEATURES:
s/s: Chronic rhinitis nasal obstruction and, in severe cases
crusting, frequent bleeding, and thick, foul-smelling, pus-
filled discharge from the nose.

TREATMENT:

Decongestants may relieve symptoms (Oxymetazoline)

Treatment of underlying cause (Pollen, mold, dust mites.

pet dander, cockroach residue)
 3. ATROPHIC RHINITIS:
Atrophic rhinitis: is a form of chronic rhinitis in which the mucous
membrane thins (atrophies) and hardens, causing the nasal passages to
widen (dilate) and dry out. This atrophy often occurs in older people.
 C/F & Mnt.:
Crusts form inside the nose, and an offensive odor develops.

People may have recurring severe nosebleeds and can lose their
sense of smell (anosmia).

TREATMENT:

Treatment is aimed at reducing the

Crusting, eliminating the odor

Reducing infections.
 4. VASOMOTOR RHINITIS:

Vasomotor rhinitis:  is chronic rhinitis that is characterized by intermittent

(coming and going) episodes of sneezing, watery nasal drainage (rhinorrhea),
and blood vessel congestion of the nasal mucus membranes.

Trigger VR: Changes in temperature, Perfumes, smoking, air pollution, odors,

Spicy foods, alcohol, Some medications, like some blood pressure tablets.
S/S: stuffy nose, runny nose, mucus in the throat, or postnasal drip.
Dx: nasal endoscope to look inside of the nose or a CT scan of the sinuses.
Treatment of vasomotor rhinitis is by trial and error and is not always
satisfactory.
If inflammation of the sinus is not severe, treatment is aimed at relieving
symptoms.
 NURSING MANAGEMENT OF RHINITIS:
Patient education
Instruct client to avoid exposure to allergens

Instruct about use of medications and nasal spray

Teach about steam inhalation

Teach about use of nasal instillation of drugs

In case of infective rhinitis teach about infection control measures including hand hygiene

Provide information about influenza vaccines

Give special attention to vulnerable population including Immuno-compromised patients.

 BACTERIAL NASAL INFECTIONS:
1. NASAL VESTIBULITIS

Definition: Minor infections at the opening of the nose, called nasal

vestibulitis, may result in pimples at the base of nasal hairs (folliculitis) and
sometimes crusts around the nostrils.

Causes: Staphylococcus is usually caused.

S/S: The infection may result from nose picking or excessive nose blowing and
causes annoying crusts and bleeding when the crusts slough off.
Treatment: Bacitracin ointment or mupirocin ointment usually cures nasal
vestibulitis.
 2. NASAL FURUNCLES:
Nasal furunculosis: is a localized infection of the hair-bearing nasal vestibule.
More serious infections result in boils (furuncles) in the nasal vestibule. Nasal
furuncles may develop into a spreading infection under the skin (cellulitis) at
the tip of the nose

It is usually caused by the bacteria S aureus. It can occur as a primary infection

or secondary to chronic rhinorrhea, upper respiratory infections, and nose
picking. Patients usually present with painful swelling in the vestibule.

Treatment - Antibiotics
 2 NASAL POLYPS:
Def. Nasal polyps are soft, painless, noncancerous growths on the lining of
the nasal passages or sinuses. They hang down like teardrops or grapes.

Causes:  chronic inflammation and are associated with asthma, recurring

infection, allergies, drug sensitivity or certain immune disorders.
 SYMPTOMS:
 Sneezing
 Nasal congestion
 Drainage of fluid down the throat (postnasal drip)
 Facial pain
 Excessive discharge from the nose
 Loss of smell (anosmia)
 Reduced ability to smell (hyposmia)
 Itching around the eyes
 Chronic sinus infections
 TREATMENT:
Medications:

 Corticosteroids

 Sometimes surgery

Surgery:

Most surgical procedures are done with an endoscope.

 3 INTRODUCTION SINUSITIS:
Paranasal sinuses are a group of 4 paired air-filled spaces that surround the
nasal cavity.

 Frontal sinus

 Ethmoid sinus

 Sphenoid sinus

 Maxillary sinus

They reduce the weight of the skull and they humidify the inspired air.
 DEFINATION:
Sinusitis: Sinusitis is inflammation of the sinuses, most
commonly caused by a viral or bacterial infection or by an
allergy.

Pansinusitis: is infection of more than one sinus.

Rhinosinusitis: is referred to as an inflammatory disease of

the nose or sinuses.

It may be acute (short-lived) or chronic (long-standing).

 ETIOLOGY:

Viral infection: 90% of sinusitis . Rhinovirus, coronavirus

Bacteria: streptococcus pneumonia, H. influenza others

Pollutants: chemical / irritants may trigger the build of

mucus.

Fungi: rare
 RISK FACTORS:
 URIs such as common cold

 Nasal polyps

 Deviated nasal septum

 Dental infection

 Swimming

 Smoking and intranasal cocaine

 Tonsillar and adenoid hypertrophy

 Pregnancy, hormonal changes with puberty

 Iatrogenic factors such as mechanical ventilation, NG tubes nasal packing etc.

 ACUTE SINUSITIS:
Sinusitis is defined as acute if it is totally resolved in less than 30

days.

In people who have a normally functioning immune system, acute

sinusitis is usually caused by a viral infection.

Sometimes acute sinusitis is caused by bacteria.

 CHRONIC SINUSITIS:
Sinusitis is defined as chronic if it has been ongoing for more

than 90 days.

Causative Factors include chronic allergies, nasal polyps, and

exposure to environmental irritants (such as airborne pollution

and tobacco smoke).

 SUB ACUTE $ RECURRENT:

Sinusitis may also be sub acute (lasting from 30 to 90 days)

recurrent (4 or more episodes of acute sinusitis per year).

 CLINICAL MANIFESTATIONS:
COMMON SIGN & SYMPTOMS:

Acute and chronic sinusitis have similar symptoms

 Yellow or green pus discharged from the nose

 Pressure and pain in the face

 Congestion and blockage in the nose

 Tenderness (pain when touched) and swelling over the affected sinus

 Reduced ability to smell (hyposmia)

 Bad breath (halitosis)

 A productive cough (especially at night)

 SIGN AND SYMPTOMS ACCORDING TO THEIR SITES:

A. Maxillary sinusitis: pain in the upper jaw.

B. Frontal sinusitis: pain in the forehead

C. Ethmoid sinusitis: pain over nasal bridge

D. Sphenoid sinusitis: pain over the occiput or vertex

 DIAGNOSIS:
History

Physical Examination

watchful waiting: if sinusitis less than 10 days without symptoms then viral.

More than 10 days bacterial sinusitis.

Paranasal sinuses X- ray (finding confirms)

Computer Tomography (CT scan)

Sinus radiography shows opacification of the sinus thickened mucous membrane.

Culture and sensitivity test

 MEDICAL MANAGEMENT:

 Treatment depends on the how long condition lasts most

acute cases resolves without treatment.

 In most of sinusitis antibiotic are not recommended because

viral causes.

 Symptomatic treatment is given to the patient.

 Treatment of sinusitis is aimed at improving sinus drainage
and curing the infection

 Steam inhalation

 Hot, wet towels over the affected sinuses and hot beverages
may help relieve the swollen membranes and promote drainage.

 Nasal irrigation or using a Saline nasal spray also can help

symptoms.
 SURGICAL MANAGEMENT:

A. Functional endoscopy sinus surgery.

B. Nasal antrostomy

C. External sphenoethmoidaectomy

D. Caldwell- lue procedure.

 NURSING MANAGEMENT:
 Warm compresses apply in the sinus area.

 Increase fluid intake

 Educate the patient to avoid cold environment

 Promote good oral hygiene

 Avoid smoking

 Avoid blowing nose.

For the firs 24 hrs after sinus surgery, observe the client for nasal
bleeding, respiratory distress, orbital and facial edema.

Explain the client to engage in minimal physical exercise, avoid strenuous

activity

Teach the client to sneeze only with the mouth open.

Nasal saline spray may be started 3 to 5 days after surgery to moisten

mucosa.

A nasal drip pad is taped beneath the nares to absorb drainage after nasal
or sinus surgery.
 COMPLICATION:

 Spread of a bacterial infection to adjacent tissue

 Changes in vision or swelling around the eye, Eye pain

 Meningitis and cause severe headache and confusion.

 READ IT FOR YOURSELF:
1. Rhinosporidiosis:  (is a granulomatous disease affecting the mucous
membrane of nose)

2. Rhinoscleroma: is a chronic inflammatory disease of the mucosa of the

nasal cavity that is caused by infection with a bacterium of the genus
Klebsiella)

3. Rhinitis medicamentosa:  is inflammation of the nasal mucosa caused by

the overuse of topical nasal decongestants

4. Rhinolith : (from the Greek rhino meaning nose, and lithos meaning stone)

are rare. They are calcareous concretions that are formed by the deposition of
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