Nasal Pathology

Question 1

Septal deviation

Answer 1

• Variant of normal
• Management:
  
  • Exclude or treat concurrent pathology (i.e. allergic rhinitis)
  • Trial of medical therapy
  • Septoplasty if symptoms match deformity

Question 2

Red flags for sinusoidal malignancy

Answer 2

• Unilateral anything
• Blood stained discharge
• Dental/orbital signs
  
  • Loose teeth
  • Proptosed eye
  • Unilateral eye movements

Question 3

Septal perforation

Answer 3

• Sensation of nasal obstruction due to altered airflow and crusting
• Investigate and treat cause
  
  • Idiopathic
  • Cocaine use
  • Rhinotillexomania
  • Iatrogenic
  • Autoimmune conditions (granulations present)
• Symptomatic treatment
  
  • Saline douching, vaseline
  • Stop causative agents
• Surgery
  
  • Septal button/flap

Question 4

Adenoids

Answer 4

• Nasal obstruction in pre-school children is likely to be due to physiological hypertrophy of the adenoids (nasopharyngeal lymphoid tissue), often associated with snoring and green rhinorrhoea.
• The adenoids usually shrink spontaneously after the age of 6 years
• Adenoidectomy may be considered if symptoms are severe
• Saline nasal douches can be helpful for milder cases