Nasal blockage Flashcards
Causes of nasal blockage?
Foreign body in the nose
Viral infection - influenza, rhinovirus
Allergic rhinitis
Rhinosinusitis
Nasal polyps
Septal haematoma
Tumours
What to ask in Hx of nasal blockage?
Is problem acute (<12weeks) or chronic (>12weeks).
Is it bilateral or unilateral?
Are there associated symptoms? - this helps with diagnosis.
What does ‘nasal blockage’ encompass?
Nasal obstruction AND nasal congestion problems
Presentation of intranasal foreign body?
If an organic object e.g. food, bugs:
Unilateral
Purulent, foul smelling discharge
Nasal obstruction
Facial pain from sinusitis
If an inorganic object e.g. nails, paper, stones:
Asymptomatic usually, unless large enough to cause nasal obstruction
What intranasal foreign body needs emergency removal, and why?
Button batteries.
WHY?
- Can cause tissue necrosis through electrolysis at the negative battery pole.
- if negative pole is directed towards the septum = can get septal perforation in 4hrs.
Presentation of intranasal button battery?
Purulent discharge
Epistaxis
If have associated necrosis = black discharge, facial swelling, pain, fever.
Management of intranasal foreign object
Remove object
Examine nasal cavity
Examine other orifices
Check ears and sinuses - could have associated otitis media or sinusitis.
Presentation of nasal polyps?
Nasal obstruction
Rhinorrhea
Sneezing
Poor sense of taste and smell
Facial pain or pressure
What may be in PMH of pt with nasal polyps?
Asthma
Aspirin sensitivity
Infective sinusitis
CF
Kartagener’s syndrome
Churg-Strauss syndrome
What is Samter’s triad?
Association of aspirin sensitivity, asthma and nasal polyposis
Investigations for nasal polyps?
Anterior rhinos copy
Nasal endoscopy
CT sinuses
Biopsy
Nasal smear and culture
Differentials for nasal polyps?
Neoplasm
Foreign body
Congenital lesion
Management of nasal polyps?
Intranasal corticosteroid ( + nasal saline irrigation + doxycycline)
Surgical polypectomy
Presentation of septal haematoma?
Nasal trauma
Sensation of nasal obstruction
Pain
Rhinorrhea
O/E:
bilateral, red swelling arising from the nasal septum.
What is a septal haematoma?
Development of haematoma between the septal cartilage and the overlying perichondrium