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Rhinology Service

last modified on: Wed, 01/17/2024 - 08:41

Rhinology

Scott Graham

  • Clinic: every patient that is seen for the first time, or has not been evaluated for several years is considered a new patient. All new patients must have a letter dictated to their consulting physician regarding their visit, on behalf of Dr. Graham
  • Presentation: Name, age, occupation, consulting physician, CC, and then HPI.

Basic rhinosinusitis history

  • pressure/ pain/ headache, etc. - check onset, location, duration, etc
  • nasal obstruction - which side and does it switch
  • rhinorrhea - color, seasonality / timing
  • smell – if decreased, able to smell smoke in case of fire
  • environmental allergies, any testing?
  • Any current interventions (NSI, steroid sprays) or prior sinonasal procedures

Endoscopic sinus surgery

  • Pre-op
    • Document visual acuity and EOM
    • Usually will need maxface CT with stealth
    • Frontal sinus – take 6 foot Caldwell with coin and have radiology tell you which coin used. Have film room print out. Cut out along borders of frontal sinus in OR. Give to nursing to sterilize.
    • Nasal polyps pre-op meds
      • Augmentin 5 days (or Levaquin)
      • Prednisone 40mg qday 5 days
      • PPI (eg. OTC Zantac) while on prednisone
  • OR
    • tube to left, turn patient 180
    • O’brien: Cocaine (4ml of 4%) ledgets. Tegaderms to eyes in field
    • Graham: Afrin pledgets
  • Post-op
    • Oral abx for staph coverage while nasal packs are in place. Packs are usually removed (preliminarily soak with Afrin or saline before removal) on POD3 and start gentle nasal saline irrigations. Start steroid nasal sprays POD 7.
    • Endoscopically debridement weekly for one month, depending upon the patient's progress.