Nasalobstruction

Differential diagnosis of nasal obstruction

1. NASAL OBSTRUCTION DR RAJASHRI MANE PROF & HOD ENT D. Y. PATIL MEDICAL COLLEGE KOLHAPUR, INDIA.

2. Definition A sense of blockage/ obstruction with in the nose or difficulty breathing out from one or both nostrils.

3. NASAL OSTRUCTION I) UNILATERAL INTERMITTENT CONTINUOUS II) BILATERAL INTERMITTENT CONTINUOUS

4. Differential diagnosis of nasal obstruction Causes of unilateral nasal obstruction 1.Structural: DNS, inf.turbinate hypertrophy,concha bullosa 2.Infection: Unilateral sinusitis Polyp: Antrochoanal polyp FB Neoplasms Congenital:choanal atresia Trauma Granulomatous Dx:Rhinoscleroma Causes of Bilateral Nasal obstruction Infection: -Acute rhinitis -CRS, Atrophic rhinitis Allergy:Allergic rhinitis Non allergic,non infective: Vasomotor rhinitis 4.Adenoid hypertrophy 5.Structural: DNS 6.Trauma:Septal hematoma 7. Ethmoidal polyposis 8.Neoplasms 9.Rhinitis medicamentosa

5. UNILATERAL NASAL OBSTRUCTION CONTINUOUS 1 . DNS 2. Antrochoanal Polyp 3. FB nose, Rhinolith 4. Benign lesions of maxilla extending to nasal cavity eg . Maxillary cyst, Dental Cyst, Dentigerous Cyst, 5. Rhinosporidiosis 6.Inverted Papilloma 7. JNA 8. Malignancy 9. Choanal Atresia INTERMITTENT 1. Hypertrophy Turbinate Middle / Infeerior 2.Sinusitis

6. BILATERAL NASAL OBSTRUCTION Continuous Adenoids DNS Ethmoidal polyps Atrophic rhinitis Septal Heamatoma Septal abscess Rhinoscleroma Neoplasm Bilateral Choanal Atresia Intermittent Sinusitis, CRS Allergic Rhinitis Vasomotor Rhinitis Acute Rhinitis Rhinitis Medicamentosa

7. How to Evaluate? ENT examination External Pyramid Anterior Rhinoscopy Posterior Rhinoscopy Cold Spatula Test PNS tenderness

8. External Pyramid Root Dorsum Tip Ala Columella

9. Anterior rhinoscopy(ARS): Nasal mucosa- pale/congested/bluish Septum- deviated/straight/perforated Lateral wall- inferior and middle turbinates & meati Floor-Any growth/polyp/presence of mucopus

10. Posterior rhinoscopy(PRS): Choana ET orifice Fossa of Rosenmuller Roof of nasopharynx Soft palate

11. Paranasal sinus(PNS): Inspection- oedema/ cellulitis Palpation- tenderness of frontal/ethmoid(R/L)/maxillary(R/L )

12. COLD SPATULA TEST AIR BLAST TEST

13. INVESTIGATIONS 1.X-RAY PNS Water’s view Caldwell’s view Submentovertical view 2. x-ray Soft tissue Nasopharynx 3. Diagnostic Endoscopy 4. CT Scan PNS

14. THANK YOU.