Operational Orthopedics

General Otolaryngology
Frequent Referrals:

Rhinitis (allergic & non-allergic)

Nasal Obstruction

Sinusitis

Peritonsillar Abscess

Tonsillitis

Snoring

Reflux (GERD/LPR)

Tympanic Membrane perforation

Otitis externa

Fractures

Allergic Rhinitis

Symptoms…Seasonal

Sneezing, itching, rhinorrhea, obstruction

May note specific allergen causing trouble

Perennial

Primarily obstruction, alternating

Nasal Obstruction

Positional

Seasonal

Resolves with Afrin

Responsive to Nasal Steroids

Exam

Polyps

Septal deviation/spurs

Rhinorrhea

Assess air flow

Allergic Rhinitis

Treatment…Antihistamine/topical steroid

Obstructive symptoms respond to daily nasal steroids (Flonase, Nasonex) for at least 6 weeks

Antihistamine for other sxs (Allegra 180mg or Zyrtec 10mg daily)

Vasomotor Rhinitis

May be associated with position, temperature, or other factors.

Does not usually respond to nasal steroids Nasal Ipratropium Bromide (Atrovent) is effective.

2 strengths: .03% for children, .06% for adults q-6-8h prn rhinorrhea

Non-formulary

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Sinusitis

Symptoms

Pain, pressure, nasal discharge, cough, fever, dental pain

Evaluation

Purulent rhinnorhea, pressure with forward flexion, sinus TTP

Management

Afrin, one drop per nostril for 7 days

Saline irrigations

Antibiotics

Acute rhinosinusitis…

7 - 30 days

H. flu, Strep pneumo, Moraxella

Hi dose amox, augmentin, Tequin

Chronic rhinosinusitis

>12 weeks

Refer to ENT with CT after 21 days of Abx treatment (Augmentin 2g po BID, Tequin 400mg QD or Clindamycin 300mg po QID)

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