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Iran ENT Specialty Board study materials
Iran ENT Specialty Board study resources

Iran ENT Specialty Board: Rhinology and Sinus Surgery: Phenotype, Anatomy, and Safe FESS

Iran ENT Specialty Board · Work through your exam, one topic at a time.

All guide sections

Rhinology and Sinus Surgery: Phenotype, Anatomy, and Safe FESS

Scope

Rhinology and sinus surgery tests chronic rhinosinusitis phenotyping, nasal obstruction, epistaxis, sinonasal anatomy, and complication avoidance in functional endoscopic sinus surgery (FESS). Questions usually ask for the next best step rather than a complete list of options.

Core rules

  • Chronic rhinosinusitis: at least 12 weeks of two or more of nasal obstruction, discharge, facial pain or pressure, and hyposmia, plus endoscopic or CT evidence. Distinguish CRSwNP from CRSsNP because phenotype drives biologic therapy.
  • Aspirin-exacerbated respiratory disease: CRSwNP plus asthma plus NSAID sensitivity. Avoid NSAIDs; consider aspirin desensitization or a biologic; surgery for refractory disease.
  • Nasal obstruction causes include septal deviation, inferior turbinate hypertrophy, concha bullosa, and nasal valve collapse. A positive Cottle maneuver supports valve collapse.
  • Epistaxis: anterior bleeding is usually from Kiesselbach plexus; posterior bleeding arises from sphenopalatine branches and may need posterior packing or endoscopic cautery. Check anticoagulation and blood pressure.
  • FESS safety: stay lateral to the middle turbinate, identify the lamina papyracea, skull base, and sphenoid ostium; avoid the lateral sphenoid wall near the carotid.
  • Post-FESS: saline irrigation and topical steroids; orbital signs such as proptosis or vision change are emergencies.

Worked example

A 38-year-old with nasal polyps, asthma, and aspirin-induced bronchospasm has opacified sinuses on CT. The diagnosis is aspirin-exacerbated respiratory disease. Start intranasal corticosteroid and saline, assess asthma control, and consider a biologic or aspirin desensitization. FESS is reserved for failed medical therapy. Antibiotics are not indicated for this eosinophilic inflammatory pattern.

Traps

Diagnosing chronic rhinosinusitis from CT alone; treating polyps with antibiotics; missing posterior epistaxis; misreading a concha bullosa as a polyp; and failing to recognize orbital complications after FESS.