Download MBBS Final Year ENT Miscellaneous Disorders of Nasal Cavity Notes

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GRANULOMAS OF UNSUSPECTED AETIOLOGY

WEGENER'S GRANULAMATOSIS

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AETIOLOGY

• Systemic d/o of unknown etiology
• Involves URT, Lungs, kidney, skin

CLINICAL FEATURES

• Clear or blood stained nasal d/c

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• Later become purulent
• Nasal findings: crusting
• Granulations
• Septal perforations
• Saddle nose

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• General symptoms : anaemia, fatigue, night sweats, migratory arthralgia
• Lung involvement
• Renal failure
• Biopsy done for diagnosis

TREATMENT

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Systemic steroids, cytotoxic drugs

Cyclophosphamide and azathioprine

T CELL LYMPHOMA

• Destructive lesion, starting on one side
• Involves upper lip, oral cavity, maxilla, orbit

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• Polymorphic lymphoid tissue with angiocentric & angioinvasive features
• No vasculitis
• Rapidly destructive, no systemic involvement
• Diagnosis by biopsy
• TREATMENT: radio and chemo therapy

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SARCOIDOSIS

• Unknown aetiology
• Systemic d/o ; involvement of lungs, lymph nodes, eyes, skin
• Present with submucosal nodules involving septum or inf. Turbinate with nasal obstruction, pain & epitaxis
• X ray show diffuse pulmo. Infiltrate with hilar adenopathy

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• Serum & urinary Ca elevated
• Diagnosis with biopsy

TREATMENT

• Systemic steroids
• Steroids in form of nasal spray

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RHINOLITH

• Stone formation of nasal cavity
• Usually around nucleus of small exogenous foreign body, blood clot, inspissated depositions of Ca & Mg salts
• Grows into large, irregular mass
• Cause pressure necrosis of septum & lateral wall

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• TREATMENT: removed under GA
• Most of them removed via ante. Nares
• Hard, irregular ones need late. rhinotomy

NASAL MYIASIS (Maggots in nose)

• Maggots seen to infest nose, nasopharynx, paranasal sinuses

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• Flies (genus: chrysomyia) attracted to foul smelling d/c emanating from atrophic rhinitis, syphilis, leprosy infected wounds

CLINICAL FEATURES

• First 3-4 days maggots cause irritation, sneezing, lacrimation & headache
• Thin bloodstained d/c
• Eyelids & lips become puffy

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• 3rd or 4th day maggots crawl out of nose
• Foul smell around the patient
• Cause destruction. Of nose, sinuses, soft tissue of face, palate, eyeball
• Fistula in palate or around nose
• Death occur from meningitis

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TREATMENT

• All visible maggots should be picked up with forceps
• Instillation of chloroform water & oil kills them
• Nasal douche with warm saline to remove slough, crusts, dead maggots
• Patient isolated with mosquito net

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