Essential Facts on Nasal Conditions: Sinusitis, Rhinitis, and Epistaxis

Posted on Nov 13, 2025 in Medicine & Health

Nasal Conditions: Furuncles, Anesthesia, and Epistaxis

1. Furuncle of the External Nose (5 Key Points)

   • Definition: A deep bacterial infection of a hair follicle, commonly caused by Staphylococcus aureus.
   • Anatomical Risk: Located in the facial danger triangle, posing a risk of serious complications like Cavernous Sinus Thrombosis.
   • Clinical Features: Presents as a red, swollen, painful nodule. May involve pus formation and systemic symptoms (e.g., fever).
   • Management:
     • ❌ Do not squeeze the lesion.
     • ✅ Requires systemic antibiotics.
     • ➕ Drainage by a professional if an abscess forms.
   • Prevention: Maintain good facial hygiene, avoid nose picking or squeezing lesions, and seek early treatment for facial infections.

2. Local Anesthesia of Nasal Mucosa (5 Key Points)

   • Purpose: Used for minor nasal procedures (e.g., endoscopy, cautery, biopsies). Ensures effective pain control and reduces reflexes (such as sneezing).
   • Common Agents: Lidocaine (1–4%) provides fast onset. Often combined with vasoconstrictors (e.g., epinephrine, oxymetazoline) to minimize bleeding.
   • Application Methods: Applied via topical spray, soaked cotton pledgets, or gel to the nasal vestibule, septum, and turbinates.
   • Anatomic Targets: Blocks the anterior ethmoidal, nasopalatine, and sphenopalatine nerves. The greater palatine nerve may be targeted for deeper procedures.
   • Risks & Precautions: Monitor for toxicity (especially with high doses). Avoid vasoconstrictors in patients with severe cardiovascular disease. Watch for allergic reactions or mucosal irritation.

3. Epistaxis (Nosebleed) (5 Key Points)

   • Definition: Bleeding originating from the nasal cavity. Classified as anterior (90%) or posterior (10%).
   • Common Causes:
     • Local: Trauma (e.g., nose picking), dry air, infections.
     • Systemic: Hypertension, coagulopathies, or anticoagulant medication use.
   • Anatomy of Bleeding Sites:
     • Anterior: Kiesselbach’s plexus (Little’s area).
     • Posterior: Woodruff’s plexus or branches of the sphenopalatine artery.
   • Management:
     • Initial: Pinch the nose, lean forward, apply a cold compress.
     • Advanced: Cauterization, nasal packing, or arterial ligation/embolization (for severe or posterior bleeds).
   • Prevention & Follow-up: Use air humidification, avoid nasal trauma. Control blood pressure (BP) and review medications. ENT follow-up is necessary if bleeding is recurrent.

Rhinitis and Sinusitis: Acute and Chronic Management

1. Acute Rhinitis (5 Key Points)

   • Definition: Acute inflammation of the nasal mucosa, typically viral (the common cold).
   • Etiology: Caused by viruses such as Rhinovirus, Coronavirus, and Adenovirus. Spread occurs via droplets or direct contact.
   • Clinical Features: Nasal congestion, rhinorrhea (watery discharge), sneezing, sore throat, mild fever, and headache.
   • Management:
     • Supportive Care: Rest, fluids, and nasal saline irrigation.
     • Symptom Relief: Decongestants and antipyretics.
     • Note: Antibiotics are not used unless a bacterial superinfection is confirmed.
   • Complications: Potential development of sinusitis, otitis media, or bronchitis. Lower respiratory tract infections are rare.

2. Chronic Rhinitis (5 Key Points)

   • Definition: Persistent nasal mucosal inflammation lasting more than 12 weeks. Causes nasal blockage, discharge, sneezing, and potential smell disturbance.
   • Types:
     • Allergic: IgE-mediated, seasonal or perennial.
     • Non-allergic: Includes vasomotor, hormonal, drug-induced, and atrophic types.
     • Often presents as mixed forms.
   • Clinical Features: Nasal congestion, postnasal drip, sneezing (especially allergic types), watery or thick discharge. Hyposmia/anosmia (reduced/lost sense of smell) in long-standing cases.
   • Diagnosis: Based on clinical history and nasal endoscopy. Requires allergy testing if allergy is suspected. Imaging (CT scan) is used if polyps or sinusitis are suspected.
   • Management:
     • Allergic: Antihistamines, intranasal steroids, and allergen avoidance.
     • Non-allergic: Saline sprays, ipratropium, and trigger avoidance.
     • Surgery (e.g., turbinate reduction) if medical treatment fails.

3. Acute Sinusitis (5 Key Points)

   • Definition: Acute inflammation of the paranasal sinuses, lasting less than 4 weeks.
   • Causes: Often follows a viral upper respiratory infection (URI). May become bacterial, commonly involving Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis.
   • Symptoms: Facial pain/pressure, nasal congestion, purulent nasal discharge, headache, and fever. Pain typically worsens when bending forward.
   • Diagnosis: Primarily clinical. Imaging (CT) is reserved for cases involving complications or poor response to initial treatment.
   • Treatment:
     • Mild Cases: Symptomatic care (analgesics, decongestants).
     • Bacterial Cases: Antibiotics (e.g., amoxicillin-clavulanate).
     • Monitoring is crucial for complications (e.g., orbital or intracranial spread).

4. Chronic Sinusitis (5 Key Points)

   • Definition: Persistent inflammation of the paranasal sinuses lasting more than 12 weeks, potentially occurring with or without nasal polyps.
   • Etiology: Often multifactorial: unresolved acute infection, allergies, anatomical blockages, or biofilms. Common organisms include Staphylococcus aureus, anaerobes, and fungi.
   • Symptoms: Nasal obstruction, facial pressure, postnasal drip, purulent discharge, and a reduced sense of smell. Symptoms are generally less severe but more persistent than acute sinusitis.
   • Diagnosis: Nasal endoscopy and CT scan are essential, revealing mucosal thickening, polyps, or sinus opacification.
   • Treatment:
     • Medical: Intranasal steroids, saline irrigation, and long-term antibiotics (if infection is suspected).
     • Surgical: Functional Endoscopic Sinus Surgery (FESS) if medical therapy fails.