1. Nose and Nasal Passage

Question 1

Diseases of the nose and nasal passage

Answer 1

1. Inflammatory conditions:
   a. Rhinitis
   - Infective Rhinitis (Common Cold)
   - Allergic Rhinitis (Hay Fever)
   - Chronic Rhinitis
   b. Nasal Polyps
   c. Necrotising lesions
   - Acute fungal infections
   - Granulomatous inflammation
   d. Sinusitis
2. Neoplasms:
   a. Benign
   - Haemangioma (most common)
   - Squamous cell papilloma
   - Transitional cell papilloma
   - Inverted papilloma
   b. Malignant
   - Squamous cell carcinoma (most common)
   - Adenocarcinoma
   - Transitional cell carcinoma
   - Anaplastic carcinoma
   - Olfactory neuroblastoma

Question 2

Types of rhinitis

Answer 2

1. Infective rhinitis
2. Allergic rhinitis
3. Chronic rhinitis

Question 3

Infective rhinitis

Answer 3

1. Usually caused by viral infections (rhinovirus, adenovirus, echovirus)
2. Results in necrosis of epithelial cells with exudation of fluid and submucosal edema
3. Secondary bacterial infection enhances the inflammatory reaction, producing a mucopurulent exudate

Question 4

Allergic rhinitis

Answer 4

Type I hypersensitivity response (IgE mediated immune reaction) to inhaled allergens (e.g. pollen) causing exudation & edema

Question 5

Chronic rhinitis

Answer 5

Sequel to recurrent acute rhinitis (either infective or allergic) with eventual development of superimposed bacterial infection

Question 6

Rhinitis can lead on to the development of?

Answer 6

1. Nasal polyps

2. Acute sinusitis

Question 7

Nasal polyps

Answer 7

1. Focal outward protrusions of nasal mucosa
2. May be allergic or non-allergic polyps
3. Caused by long-standing, recurrent bouts of rhinitis
4. Histologically composed of edematous mucosa with inflammatory cells (eosinophils in allergic polyps)

Question 8

Types of necrotizing lesions

Answer 8

1. Acute fungal infections
   - Mucormycosis (particularly in immunocompromised & diabetic patients)
2. Granulomatous inflammations
   - Mycobacterial (tuberculosis, leprosy)
   - Sarcoidosis
   - Wegener granulomatosis

Question 9

Definition of sinusitis

Answer 9

Inflammation of the paranasal sinuses (maxillary, ethmoidal, frontal), may be acute or chronic

Question 10

Causes of acute sinusitis

Answer 10

1. Usually, extension of acute or chronic rhinitis
2. Direct extension of infection of bony boundaries of
   the sinuses

Question 11

Causes of chronic sinusitis

Answer 11

1. Sequel of acute sinusitis (with block in drainage)
2. Fungal infections (mucormycosis)
3. Kartagener syndrome

Question 12

Complications of sinusitis

Answer 12

1. Obstruction of drainage by mucosal edema, resulting
   in formation of mucocele (accumulation of mucus without direct bacterial invasion) or empyema of the sinus (accumulation of pus)
2. Osteomyelitis with potential spread into the cranial vault (causing septic thrombophlebitis of dural venous sinuses) or orbit

Question 13

Benign neoplasms of the nose and nasal passages

Answer 13

1. Haemangioma (most common)
   - Commonly causes epistaxis (nose bleeds)
2. Squamous cell papilloma
   - Occurs in the nasal vestibule
3. Transitional cell papilloma
4. Inverted papilloma
   - Occurs on the lateral wall
   - Papillomatous proliferation of squamous cells which extend into the mucosa (inverted growth) instead of outwards (exophytic growth)
   - Histologically benign but locally aggressive (able to
   erode underlying bone with invasion into the cranial
   vault or orbit) & has a high rate of recurrence

Question 14

Malignant neoplasms of the nose and nasal passages

Answer 14

1. Squamous cell carcinoma (most common)
2. Adenocarcinoma
3. Transitional cell carcinoma
4. Anaplastic carcinoma
5. Olfactory neuroblastoma (Esthesioneuroblastoma)
   - Arises from neuroendocrine cells of olfactory mucosa
   - Composed of small round cells which form lobular nests surround by vascularised connective tissue