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Nasal obstruction :pig_nose: (:globe_with_meridians:Causes (SidesâĶ
Nasal obstruction
:pig_nose:
Def
: Breathing difficulty thru nose, mouth breathing (āļŦāļēāļĒāđāļāļāļēāļāļāļēāļ)
mayb 1 side or Both sides
:globe_with_meridians:
Causes
Physiologic causes
Anatomical causes
Infections
Inflammations
Trauma
Foreign body
Tumor
Systemic diseases
External causes
Sides
Uni
lateral
Bi
lateral
Hx
āļāļēāļāļēāļĢ
āļāļąāļāļāļĄāļđāļ
āļāļēāļāļēāļĢāļāļēāļāļāļĄāļđāļāļāļ·āđāļāđ
āļāļēāļāļēāļĢāļĢāđāļ§āļĄāļāļ·āđāļāđ
Personal Hx
PE
Complete ENT exam
+/- Flexible or Rigid endoscopy
Inx
D/C C/S (if Rx āđāļĨāđāļ§āđāļĄāđāļāļĩāļāđāļāļĒāļŠāđāļ)
Nasal smear cytology
Skin prick test/Specific
IgE
(allergy)
Plain film/CT PNS
Rhinomanometry
Check
āļāđāļāļ&āļŦāļĨāļąāļ
uses nasospray(oxymethazoline),
then
compare
graph(resistance&windpressure) āļāđāļāļ&āļŦāļĨāļąāļāļāđāļ âĻ
Graph
same
âĻ
Structural
lesion
Graph
Better
/ :arrow_down:resistance âĻ
Mucosal
lesion
Acoustic rhinometry
Check resistance âĻfind obstruction point
Blood test
:stars:
Common causes
Physiologic causes
Nasal cycle
: q 1-4 hr
āļāļāđāļĢāļēāļāļąāļāļāļĄāļđāļāļŠāļĨāļąāļāļāđāļēāļāđāļāđ
Recumbency rhinitis
āļāļąāļāļāļĄāļđāļāļāļēāļĄāļāđāļēāļāļāļĩāđāļāļāļ (āļāļ°āđāļāļāļāđāļēāļĒāļāđāļāļąāļāļāļĄāļđāļāļāđāļēāļĒ)
Anatomical causes
Choanal atresia
Unilateral
Bilateral (
ernergency
)
Deviated nasal septum
Turbinate hypertrophy
(turbinate āđāļāļĩāļĒāļāļāļąāļ nasal septum āļāļāļĢāļ°āļŦāļ§āđāļēāļāļĄāļąāļāļāļąāđāļāļŠāļāļāđāļāļāļĄāļēāļ)
Concha bullosa
Bullosa = Air-filled cavity within turbinate/concha
Def: pneumatized (air) cavity within concha
Infection
Allergic rhinitis
4 Symptoms āļāļĩāđāļāļāļāđāļāļĒ: āļāļąāļ āļāļēāļĄ āļāđāļģāļĄāļđāļāđāļŦāļĨ āļāļąāļāļāļĄāļđāļ
Atrophic rhinitis
Disruption of mucosal lining âĻ Mucociliary system āļāļāļāļąāļāđāļĨāđāļ§cilia āđāļŠāļĩāļĒ func âĻ Crust, secretion âĻNasal obstruction
Sinusitis
:star: obstruction of sinus drainage
Rhinitis medicamentosa
aka Rebound rhinitis
Hx uses Nasal spray (eg Oxymetazoline) for
long time
for months-years
Rx
āđāļŦāđPt āļŦāļĒāļļāļāļĒāļē
Advice:
donât use for over 1 wk
, uses q 12 hr for 1 wk then stop
Trauma
Fracture of nose
Septal hematoma
Rx: drain blood, nasal packing & ATBs
Foreign body
Tumor/Mass
Adenoid
hypertrophy
Adenoid = Lymphatic Tissue just like tonsils
Usu. found in children tho adult may also find
Symptoms
āļāļāļāļāļĢāļ
āļŠāļĄāļēāļāļīāļŠāļąāđāļ
Delayed development
Apnea at night
āļŠāļ°āļāļļāđāļāļāļāļ·āđāļat night
Rx
Adrenotonsillectomy
dramatic Response āļāļąāļāļāļĩ
Nasal
polyp
Mass characteristics
āđāļŦāļĨāļ·āļāļāđāļŠ
Smooth surface
Translucent (light can pass thru)
Antrochoanal
polyp
Causes
unilateral sinusitis
Rx
Sx via Olympus cam is definite Dx
Inverted papilloma
Mass characteristics
Ugly
Rough surface (āļāļĢāļļāļāļĢāļ°)
Dark color
Juvenile angiofibroma
Benign tumor of vss (believe to be of Sphenopalatine aâ
largest artery of nose)
Usu found in Teenage boy :male_sign:
Symptoms
Unilateral nasal obstruction
Off & On Epistaxis
Vascular mass at posterior layer
near nasopharynx
SCCA
Looks like necrosis (black)
CA Nasopharynx
At Rossenmuller fossa
Rx by Concurrent chemoRT
Malignant melanoma
CC: black mass in nose
NK T cell lymphoma
:star:nasal mass
must Bx for definite Dx
:!: aware that
āļāđāļāļāđāļāļ·āđāļāđāļāđ âĻ can Bx at OPD
vascular tumor âĻ
canât
Bx at OPD āđāļāļĩāđāļĒāļ§ bleed âĻ Do CT scan
Inflammation
Rhinoscleroma
Chronic inflammation of Nose & Other structure of URT
Etio: Klebsiella rhinoscleromatis (G - bacilli)
Usually found in Egypt, America