ENT Students Nose Miscellaneous
2Miscellaneous diseases
It includes:
1-Deviated septum.
2-Allergic rhinitis.
3-Nasal polyps.
51-Diseases of the nasal septum
It Includes:
1-Septal deviation.
2-Septal hematoma.
3-Septal abscess.
4-Septal perforation.
10A-Deviated nasal septum
Pathology & types:
1-Deviation.
2-Spurs.
3-Dislocation.

Clinical picture:
1-Asymptomatic.
2-Nasal obstruction.
3-Epistaxis.
4-Headache.
5-Atrophic rhinitis.
5-Examination shows deviated or dislocated septum. Endoscopy may show septal spurs.






Investigation: usually not needed: as CT PNS

Treatment:
Submucous resection (SMR) or septoplasty.

20B-Septal hematoma
It is collection of blood between the septal perichondrium & cartilage. It occurs usually following trauma either accidental or surgical.

Clinical picture:
1-Bilateral obstruction.
2-Hitory of nasal trauma.
3-Fluctuant nasal swelling & aspiration shows blood.


Investigations:
It is not needed but CT will reveal a homogenous opacity.




30C-Perforation
Etiology:
1-Trauma:
a-Accidental, as habitual nose picking, penetrating injuries or idiopathic.
b-Surgical as in following submucous resection of the septum or bilateral cauterization of the septum.
2-Inflammation as in septal abscess, syphilis, lupus & Wegner granuloma.
3-Tumors.
4-Cocaine addiction.

Clinical picture:
1-No symptoms or mild epistaxis & crustations.

Treatment: no treatment is effective.
402-Allergic rhinitis
It is IgE mediated hypersensitivity reaction of the nasal mucous membrane upon exposure to antigenic substance.
Mechanism of allergic reaction:

Clinical picture:
1-Symptoms as sneezing, itching, nasal obstruction & watery nasal discharge.
2-Examination will reveal bluish congested nasal mucosa.


Investigation:
1-Nasal challenge test.
2-Skin prick test, intradermal skin test.

3-Increased IgE in blood.
4-RAST, radioimmunosorbant assay.

Treatment:

1-Antihistaminics as cetrizine.
2-Mast cell stabilizers as Na cromoglycate.
3-Steroids especially local spray.
4-Antileukotrines.
5-Immunotherapy or desensitization.
503-Nasal polyps
It is pedeunculated nasal mucosa.
Types:
1-Allergic nasal polyps 90%.
2-Inflammatory polyps as antrochoanal polyp.
3-Allergic fungal polyps.
60A-Allergic nasal polyps
It is severe allergic rhinitis with formation of nasal polyps especially at the ethmoidal mucosa.
Clinical picture:
1-Allergic symptoms, nasal obstruction, anosmia & snoring.
2-Examination will reveal the nasal polyps smooth glistening, multiple & pale blue in color.


Investigations:
1-laboratory investigation as allergic rhinitis.
2-CT scan.

Treatment:
1-Medical as steroids and antihistaminics.
2-Surgical as endoscopic sinus surgery.

70B-Antrochoanal polyp
It is inflammatory polyp arises from the mucosa of the maxillary sinus & prolapses through the maxillary sinus ostium then grows to the nasopharynx & may be pedunculated behind the soft palate.

Clinical picture:
1-Unilateral then bilateral nasal obstruction.
2-Endoscopic examination will reveal the polyp.

Investigation: CT scan will reveal the condition.

Treatment:
Endoscopic excision but recurrence may occur at which radical antrum may be needed.