nasal discharge Flashcards
What are the common symptoms associated with nasal discharge?
Nasal obstruction
Headache and facial pain
Swelling or deformity
Disturbance of smell
Snoring
Sneezing
Itching
Burning sensation
What is the pathogenesis of nasal discharge?
Normal nasal secretion is sero-mucinous, secreted by submucosal glands and goblet cells.
Daily volume is about 1-1.5 L.
Moves backwards by the action of nasal cilia to the pharynx to be swallowed.
The normal person is unaware of nasal secretions.
When the nasal secretions change in character or increase in volume, the patient becomes aware of it.
What are the different aspects of the nature of nasal discharge?
Side: Unilateral or Bilateral
Direction: Anterior nasal discharge or Posterior nasal discharge (post-nasal dripping)
Character: Watery, Bloody, Mucoid, Muco-purulent, Purulent, Crusty, Fluid & Food
What are the causes and symptoms of cerebrospinal fluid (CSF) rhinorrhea?
Causes: Traumatic (accidental trauma, post-surgical) and Non-traumatic (high pressure leak, normal pressure leak)
Symptoms: Clear watery nasal discharge, unilateral discharge, salty taste, increase by straining or leaning forward, headache, anosmia, symptoms of the underlying cause, symptoms of complications like meningitis
What are the signs and investigations for cerebrospinal fluid (CSF) rhinorrhea?
Signs: Unilateral clear watery nasal discharge, reservoir sign, handkerchief test, halo sign
Investigations: Protein electrophoresis (B-transferrin), CT scan with metrizamide
What are the medical and surgical treatments for cerebrospinal fluid (CSF) rhinorrhea?
Medical treatment (in attempt of spontaneous healing for 10 to 14 days): Bed rest, semi-sitting position, avoid straining, diuretics, antibiotics
Surgical treatment (failure of medical treatment, chronic or recurrent leak): Closure of defect using fascia, muscle, or cartilage, endoscopic or conventional approach, treatment of the underlying cause (neoplasm excision, hydrocephalus shunt operation)
What are the causes, symptoms, signs, and treatment of allergic rhinitis?
Causes: Positive family history, exposure to certain allergens
Symptoms: Sneezing, itching of the nose and palate, bilateral watery nasal discharge, loss of smell, nasal obstruction
Signs: Bluish mucosa due to venous congestion, pale boggy mucosa due to edema, nasal polyps, watery secretion
Treatment: Avoidance of allergens, antihistamines, nasal corticosteroids, immunotherapy
What are the causes of bloody nasal discharge and their characteristics?
Causes: Idiopathic, local (traumatic, inflammatory, neoplastic, septal), general (high blood pressure, high venous blood pressure, high temperature, drugs, blood diseases)
Characteristics: Pure blood (epistaxis), blood-tinged secretions, unilateral or bilateral discharge
How does the nature of nasal discharge indicate the pathogenesis of nasal obstruction?
Nasal obstruction leads to different types of nasal discharge:
Nasal obstruction with stasis of secretions leads to mucoid nasal discharge.
Infection of stagnant nasal secretions leads to mucopurulent or purulent nasal discharge.
Unilateral obstruction results in unilateral nasal discharge.
Bilateral obstruction results in bilateral nasal discharge.
What are the causes of unilateral and bilateral nasal obstruction?
Causes of unilateral nasal obstruction: Diseases of nasal septum (septal deviation), diseases of the nasal cavity and paranasal sinuses (congenital, traumatic, neoplastic, inflammatory), diseases of the nasopharynx (adenoid hypertrophy, tumors)
Causes of bilateral nasal obstruction: Diseases of nasal septum (septal deviation, hematoma, abscess), diseases of the nasal cavity and paranasal sinuses (congenital, inflammatory, neoplastic), diseases of the nasopharynx (adenoid hypertrophy, tumors)
What are the causes of crusty nasal discharge?
Bilateral crusty nasal discharge: Septal perforation, atrophic rhinitis
Unilateral crusty nasal discharge: Unilateral atrophic rhinitis (after total inferior turbinectomy)
What are the causes and symptoms of fluid and food regurgitation through the nose?
Bilateral causes: Soft palate paralysis (e.g., bulbar palsy), cleft palate, perforated hard palate (e.g., maxillectomy)
Unilateral causes:Unilateral causes of fluid and food regurgitation through the nose include:
Nasal regurgitation: When there is a communication between the oral and nasal cavities, such as a fistula or congenital defect, it can lead to the regurgitation of fluids or food into the nose.
Palatal weakness or paralysis: Dysfunction of the soft palate muscles can result in inadequate closure of the nasopharynx during swallowing, leading to regurgitation of fluids or food into the nasal cavity on the affected side.
Palatal fistula: An abnormal connection between the oral and nasal cavities can cause regurgitation of fluids or food through the nose.
Symptoms associated with fluid and food regurgitation through the nose may include:
Nasal regurgitation: The presence of fluids or food coming out through the nose during or after swallowing.
Nasal congestion or obstruction: Due to the presence of foreign material in the nasal cavity.
Recurrent respiratory infections: Regurgitated material in the nasal cavity can increase the risk of respiratory infections.
Nasal discomfort or irritation: Irritation of the nasal mucosa caused by regurgitated material.
Treatment for fluid and food regurgitation through the nose depends on the underlying cause. Surgical repair may be necessary to close any fistulas or correct structural abnormalities. In cases of palatal weakness or paralysis, rehabilitation exercises or prosthetic devices may be employed to improve swallowing function and prevent regurgitation. It is important to consult with a healthcare professional for an accurate diagnosis and appropriate management.
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