1.
CASE PRESENTATION
DR. UTKAL MISHRA

2.
BIODATA
NAME- Harekrushna Dharua
AGE- 42
SEX- Male
RELIGION- Hindu
ADDRESS- Bolangir
ADMITTED ON – 08/05/2016

3.
CHIEF COMPLAINTS -
Discharge from Right Nostril – 2 mon.
Nasal obstruction both nostril – 1 mon.
Headache – last 10 days

4.
HISTORY OF PRESENT ILLNESS
Patient was apparently alright 2 mon. back to start with he developed discharge
from right nostril which was clear, thin, watery, occasionally blood stained, not foul smelling &
can’t be sniffed back. The discharge was more in morning hours while waking up from sleep &
aggravated by coughing or head bending.
1 mon back he developed nasal obstruction of right nostril first which was gradual
in onset, mild to moderate & subsequently progressed to complete obstruction with mild
obstruction of left nostril.
For last 10 days he have headache which was continuous dull aching type
predominantly right sided not associated with fever, nausea, vomiting, photophobia or neck
tenderness.
There is no H/O fever, blurring of vision, lacrimation.
There is no H/O trauma or any operative procedure of nose.

5.
No H/O similar illness in past.
Not a K/C/O – TB, DM, HTN, SCD
No H/O previous hospitalization or Blood
transfusion.
HISTORY OF PAST ILLNESS

6.
PERSONAL HISTORY
He is married with 1 son & 2 daughters.
By occupation he is a Labourer
Educated upto 8th class.
Low Socioeconomic status.
He is habituated to regular pond bath.
He is addicted to alcohol for last 20 yrs.
There is loss of weight but sleep appetite bladder &
bowel habit normal.

7.
No H/O similar illness in any of the family members.
FAMILY HISTORY

8.
TREATMENT HISTORY
He is treated by various local physicians but
symptoms doesn’t subside with regular medication.
No H/O any drug allergy

9.
GENERAL EXAMINATION
Patient is Conscious, alert, Co-operative, well oriented to
time place person.
Average body built, Well nourished
Pallor +ve , No icterus, clubbing, cyanosis, koilonychia,
edema.
Neck veins are neither engorged nor pulsatile
No Lymph node enlargement in cervical region
No palpable thyroid swelling

10.
GENERAL EXAMINATION
Pulse rate is 82/min, regular, good volume
BP is 100/70 mm Hg
Respiration is 14/min regular
Temperature is normal.
Gait is normal
Right Handed.

11.
SYSTEMIC EXAMINATION
CVS → S1 S2 normal, No murmur
Chest → B/L NVBS, No added sounds
P/A → Soft, Nontender, No organomegaly
Cranial Nerve Examination shows no deficit, paresis or delay.

12.
EXAMINATION OF NOSE
1. External Appearance → Broadening of right side of
dorsum of nose.
2. Vestibule → Normal
3. Anterior Rhinoscopy →
Right Left
1. Nasal Passage Blocked by mass Narrow
2. Septum Deviated to Left touching Infr. turbinate
3. Mass Greyish white, firm, nontender mass
extremely sensitive to touch filling whole
Right nasal cavity & pushing the septum to left.
Don’t bleed on touch.
Non pulsatile, Non reducible, No cough impulse
With every attempt to touch there is reflex
cough.
Attachment couldn’t be found due to obvious
reasons

13.
EXAMINATION NOSE
4. Posterior Rhinoscopy →
Postr. Part of septum
Choanae
Nasopharynx NORMAL
E.T. opening
Fossa of Rosenmuller
5. Nasal Patency →
6. Sense of smell → Absent in both nostril
Right Left
Cold Spatula Test Negative Reduced fogging
Cotton Wool Test Negative Positive

14.
EXAMINATION OF PNS
INSPECTION –
No redness, swelling over paranasal sinuses.
No lid edema, conjuctival congestion or proptosis.
No limitation of eyeball movement .
PALPATION –
Tenderness over Right frontal, ethmoid & maxillary
sinus.

15.
EXAMINATION OF EAR
RIGHT LEFT
1. Pinna Normal Normal
2. Pre, post, supra, infra
auricular region
Normal Normal
3. Tragal tenderness &
mastoid tenderness
Absent Absent
4. EAM Normal
No Discharge
Normal
No Discharge
5. Tympanic Membrane Subtotal perforation with
inverted margins
MEM – edematous
No granulation, mass or polyp.
Subtotal perforation with
inverted margins
MEM – edematous
No granulation, mass or polyp.
6. Facial Nerve Intact Intact
7. Rinnie’s Test Negative Negative
8. Weber Test Not lateralized
9. Fistula Test Negative Negative

16.
EXAMINATION OF ORAL CAVITY
TEETH → Exposed roots of Left lower incisors & canine
GUM
CHEEK
RETROMOLAR TRIGONE
FLOOR OF MOUTH
TONSILLAR PILLAR
TONSIL
POSTR. PH. WALL
NORMAL

17.
EXAMINATION OF LARYNX
BASE OF TONGUE
VALLECULA
EPIGLOTTIS
AE FOLD NORMAL
INTER ARYTENOID AREA
PYRIFORM FOSSA
VOCAL CORD
1. Laryngeal Suprastructure → normal
2. Moves normally with degluttition.
3. Laryngeal crepitus present
4. IDL →

18.
PROVISIONAL DIAGNOSIS
Esthesioneuroblastoma of Right Nasal cavity