Nose presentation for third year medical

Nose presentation for third year medical

1. Nose presentation Dr S Ganapathy Associate professor Department of ENT Kanyakumari government medical college

2. Aesthetic part of face Defines the race Often beauty of nose commented in poetry In literature nose is reference article for explaining certain mood description Nose

3. Nasal obstruction Nasal discharge/ post nasal drip Head ache/ facial pain Epistaxis Smell disturbances sneezing fever Symptoms

4. Snoring Voice change Other system like throat , ear Other symptoms

5. Obstruction

6. Duration Side / laterality Onset  progress  present stage Partial or complete Intermittant or persistent Aggravating(chill fluids, fever, climate, travel, dust) R elieving factors (systemic and local drugs, steam inhalation ) Nasal obstruction

7. Causes Unilateral DNS – C shaped and spur Turbinates hypertrophy AC polyp Rhinosporidiosis / R hinolith Forign body Synechiae Benign and malignant tumours Unilateral choanal atresia Bilateral CRS, acute rhinitis Allergic Vasomotor rhinitis S shaped DNS Septal hematoma and abscess Ethmoidal polyposis Nasophayngeal – atresia, adenoids, tumours Rh. Medicamentosa Combination of two causes

8. C or S shaped deviation Spur Dislocation(caudal deviation) Classification of septal deviation

9. Simple Obstruction Impaction Cottle‘s classification ( Sluders neuralgia)

10. MLADINA classification (valve area based)

11. Compensatory inferior turbinate hypertrophy Paradoxical obstruction Q’s in nasal obstruction

12. Nasal discharge

13. Duration Side Onset  progress  present stage Consistency - watery, mucoid , purulent, blood stained Foul smelling Aggravating /relieving factors POSTNASAL DRIP Discharge

14. Pathophysiology of discharge Qs in discharge

15. Ciliary beat is always towards the ostium Maxillary – stellate pattern Ethmoid – spiral pattern Sphenoid – spiral pattern Frontal – whorl pattern Messerklinger principle

16. Unilateral foul smelling discharge in pediatric age group? Is post nasal drip a sign of chronic sinusitis? What are the two layers of Sinus discharge? Q’s

17. Youngs syndrome Kartageners syndrome Cystic fibrosis Specific diseases

18. Duration Site / referred to site Diurnal variations if any Type – dull aching in chronic sinusitis pricking /throbbing in acute infection Association with nausea ,vomiting, photophobia and giddiness, aura Aggravating factors - on bending forward Relieving factors Head ache/ facial pain

19. Maxillary – facial heaviness rather than pain Ethmoid – behind or around eyes, more in Paediatric Frontal – called as office head ache, vacuum head ache, Sphenoid – usually referred to vertex or occipital

20. Side Number of episodes Quantity of blood h/o trauma, digital trauma h/o hypertension, drugs intake Concentrate in GE for anaemia h/o bleeding diathesis Epistaxis

21. MC cause in children – littles area bleed In adult – hypertension(brown area, wood rufff plexus) In old age – think of malignancy Torrential epistaxis in adolescent male in JNA Epistaxis

22. Causes – Spur DNS with impaction Rhinosinusitis/ other infection like rhinosporidiosis Bleeding polypus /hemangioma malignancies Q’s

23. What is trotters position?

24. Anterior nasal packing Posterior nasal packing(need General anaesthesia ) Q’s

25. Newer materials

26. Allergy Trauma Brain surgeries COVID Ethmoidal polyposis Olfactory tumours Kallman syndrome Anosmia/ Hyposmia

27. Atrophic rhinitis with greenish crusts

28. External Root Dorsum Supratip Tip Alae Nasolabial groove Examination

29. Tip elevation Vestibule Anterior end of septum vibrissae Examination

30. Anterior rhinoscopy with thudichum’s Septum Mucosa Nasal cavity Lateral wall – turbinates and meati Examination

31. Posterior rhinoscopy

32. Airway patency tests – cotton wool, cold spatula test Eliciting sinus tenderness Examination

33. Cottles line Cottles test Further definition of septal deviation

34. Cottles test signifies involvement of nasal vale area

35. Maxilla – canine fossa Ethmoid – medial to medial canthus Frontal – floor of frontal sinus / supro medial aspect of orbit Sphenoid - ? Sinus tenderness

36. In case of mass Sensation ? Probing all around possible or not (in lateral)? Bleeds on touch? Consistency? Probe test

37. Difference between AC polyp and ETH polyp Syndrome associated with polyp Why it is enlarging posteriorly in AC polyp? Q’s in polyps

38. DNE – 3 passes X ray Waters view/ caldwell view/lateral view CT PNS Blood inv. Nasal discharge for C/S Allergic tests – skin tests, RAST, PRIST, IGE assay Order of telling investigations

39. Orbital - chandler Preseptal Post septal Subperioteal Orbital abscess Cavernous sinus thrombosis Intracranial complications Potts puffy tumour – osteomyelits of frontal bone Mucocele Oroantral fistula Otological / pharyngolayngeal complications Complications of sinusitis

40. Medical Surgical Management

41. Septum – septoplasty/ SMR Sinusitis/ polyp – FESS Mass – FESS, Medial Maxillectomy Partial or Total maxillectomy ACFR Surgical

42. Septal hematoma Septal abscess Septal perforation Supra tip deformity Saddle nose deformity Floppiness of septum Columellar retraction Complication of SMR

43. Orbital Intracranial CSF rhinorrhoea Bleeding Osteomyelitis in case if done in acute condition Anosmia Lacrimal duct injury Complication of FESS

44. THANK YOU