Nasal polyps
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Nasal polyps are non-cancerous growths that can develop in the nasal cavity or sinuses. There are two main types - antrochoanal polyps which typically affect children and adolescents, originating in the maxillary sinus, and ethmoid polyps which commonly affect adults and are linked to allergy. Clinical presentation depends on the type but may include nasal obstruction, discharge, and sinus issues. Diagnosis involves endoscopy and imaging tests. Treatment involves antibiotics, steroids, and surgery to remove the polyps and widen sinus openings to prevent recurrence.
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NASAL SEPTAL DISEASES
DISEASES AND DEFECTS OF NASAL SEPTUM
FRACTURE OF NASAL SEPTUM
DNS
NASAL HEMATOMA
NASAL ABCESS
NASAL SYNECHIA
SEPTAL PERFORATION
Septal hemotoma
Septal hematoma is a collection of blood between the nasal septum and cartilage caused by trauma. It can lead to necrosis of the cartilage if not drained urgently. Symptoms include nasal swelling, pain, and congestion. Treatment involves incision and drainage of the hematoma within hours, along with nasal packing and antibiotics. Complications may include saddle nose deformity from infected cartilage necrosis if not properly treated.
Rhinosinusitis
This document provides information about rhinosinusitis, including definitions, classifications, signs, symptoms, investigations and treatment. It defines acute and chronic rhinosinusitis based on duration of symptoms. Common causes include viral and bacterial infections. Chronic rhinosinusitis is classified as with or without nasal polyps. Diagnosis involves symptoms and endoscopy or CT scan findings. Treatment aims to reduce inflammation, bacterial load and improve mucociliary clearance using medications, sinus irrigation and surgery.
Malignant Otitis Externa
Malignant otitis externa is an aggressive infection of the external ear and skull base that commonly affects older diabetics. It is caused mainly by Pseudomonas aeruginosa bacteria invading the external ear canal and spreading through fissures in the bone. Symptoms include severe ear pain, discharge, and potentially cranial nerve palsies. Diagnosis involves culture, imaging like CT showing bone destruction, and ruling out other causes. Treatment requires long-term antibiotics like ciprofloxacin, tight blood sugar control, and sometimes hyperbaric oxygen or surgery. Prognosis has improved but mortality remains high if the infection spreads intracranially or causes multiple cranial neuropathies.
Nasal endoscopy
1) Nasal endoscopy is used to examine the nasal passages and paranasal sinuses using specialized equipment like rigid or flexible endoscopes and a light source.
2) The examination involves inserting the endoscope into the nasal cavity to visually inspect different areas like the inferior meatus, nasopharynx, sphenoethmoidal recess, and middle meatus.
3) Nasal endoscopy is useful for evaluating and treating inflammatory diseases of the sinuses, detecting tumors, locating the source of epistaxis, and assisting with other procedures like sinus surgery or skull base repairs. It provides information that CT scans cannot by allowing direct visualization of mucosal changes.
Complications of sinusitis
1) Sinusitis complications arise when infection spreads beyond the sinus mucosa into surrounding areas like the orbit or skull. Common local complications include mucoceles/pyocles, osteomyelitis of the frontal bone or maxilla, and orbital issues like preseptal cellulitis, subperiosteal abscesses, or orbital cellulitis.
2) Intracranial complications from sinusitis spreading can cause meningitis, extradural or subdural abscesses, brain abscesses, or cavernous sinus thrombosis. Descending infections from sinus discharge can also lead to otitis media, pharyngitis, or laryngitis.
3) Orbital cell
Cortical mastoidectomy
1) The document discusses the surgical approach and procedure for cortical mastoidectomy. Key steps include raising skin and periosteal flaps, drilling along anatomical landmarks like the sigmoid sinus and facial nerve to identify structures, and widening the aditus and performing a posterior tympanotomy to access the mesotympanum.
2) Post-operative care involves drain removal within 48 hours and dry dressing of the ear. Potential complications discussed are persistent deafness, facial nerve injury, CSF leak, hemorrhage and infection.
3) The patient is advised restricted activity for 3 weeks followed by a gradual return to normal activity over 4 weeks, and to keep the operation site dry.
Diseases of external ear
This document discusses diseases of the external ear. It begins by describing the anatomy of the external ear canal. It then categorizes conditions affecting the external ear into congenital, inflammatory, reactive, traumatic, and tumors. Under congenital conditions it discusses preauricular sinus, congenital ear swellings, fistulas and anomalies. It provides details on preauricular sinus including embryology, clinical features, management and associated syndromes. It also discusses other congenital conditions such as ear swellings, fistulas and atresia. The document further describes inflammatory conditions including erysipelas, perichondritis and malignant otitis externa. It also covers reactive, traumatic, and neoplastic conditions of the external
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NASAL SEPTAL DISEASES
DISEASES AND DEFECTS OF NASAL SEPTUM
FRACTURE OF NASAL SEPTUM
DNS
NASAL HEMATOMA
NASAL ABCESS
NASAL SYNECHIA
SEPTAL PERFORATION
Septal hemotoma
Septal hematoma is a collection of blood between the nasal septum and cartilage caused by trauma. It can lead to necrosis of the cartilage if not drained urgently. Symptoms include nasal swelling, pain, and congestion. Treatment involves incision and drainage of the hematoma within hours, along with nasal packing and antibiotics. Complications may include saddle nose deformity from infected cartilage necrosis if not properly treated.
Rhinosinusitis
This document provides information about rhinosinusitis, including definitions, classifications, signs, symptoms, investigations and treatment. It defines acute and chronic rhinosinusitis based on duration of symptoms. Common causes include viral and bacterial infections. Chronic rhinosinusitis is classified as with or without nasal polyps. Diagnosis involves symptoms and endoscopy or CT scan findings. Treatment aims to reduce inflammation, bacterial load and improve mucociliary clearance using medications, sinus irrigation and surgery.
Malignant Otitis Externa
Malignant otitis externa is an aggressive infection of the external ear and skull base that commonly affects older diabetics. It is caused mainly by Pseudomonas aeruginosa bacteria invading the external ear canal and spreading through fissures in the bone. Symptoms include severe ear pain, discharge, and potentially cranial nerve palsies. Diagnosis involves culture, imaging like CT showing bone destruction, and ruling out other causes. Treatment requires long-term antibiotics like ciprofloxacin, tight blood sugar control, and sometimes hyperbaric oxygen or surgery. Prognosis has improved but mortality remains high if the infection spreads intracranially or causes multiple cranial neuropathies.
Nasal endoscopy
1) Nasal endoscopy is used to examine the nasal passages and paranasal sinuses using specialized equipment like rigid or flexible endoscopes and a light source.
2) The examination involves inserting the endoscope into the nasal cavity to visually inspect different areas like the inferior meatus, nasopharynx, sphenoethmoidal recess, and middle meatus.
3) Nasal endoscopy is useful for evaluating and treating inflammatory diseases of the sinuses, detecting tumors, locating the source of epistaxis, and assisting with other procedures like sinus surgery or skull base repairs. It provides information that CT scans cannot by allowing direct visualization of mucosal changes.
Complications of sinusitis
1) Sinusitis complications arise when infection spreads beyond the sinus mucosa into surrounding areas like the orbit or skull. Common local complications include mucoceles/pyocles, osteomyelitis of the frontal bone or maxilla, and orbital issues like preseptal cellulitis, subperiosteal abscesses, or orbital cellulitis.
2) Intracranial complications from sinusitis spreading can cause meningitis, extradural or subdural abscesses, brain abscesses, or cavernous sinus thrombosis. Descending infections from sinus discharge can also lead to otitis media, pharyngitis, or laryngitis.
3) Orbital cell
Cortical mastoidectomy
1) The document discusses the surgical approach and procedure for cortical mastoidectomy. Key steps include raising skin and periosteal flaps, drilling along anatomical landmarks like the sigmoid sinus and facial nerve to identify structures, and widening the aditus and performing a posterior tympanotomy to access the mesotympanum.
2) Post-operative care involves drain removal within 48 hours and dry dressing of the ear. Potential complications discussed are persistent deafness, facial nerve injury, CSF leak, hemorrhage and infection.
3) The patient is advised restricted activity for 3 weeks followed by a gradual return to normal activity over 4 weeks, and to keep the operation site dry.
Diseases of external ear
This document discusses diseases of the external ear. It begins by describing the anatomy of the external ear canal. It then categorizes conditions affecting the external ear into congenital, inflammatory, reactive, traumatic, and tumors. Under congenital conditions it discusses preauricular sinus, congenital ear swellings, fistulas and anomalies. It provides details on preauricular sinus including embryology, clinical features, management and associated syndromes. It also discusses other congenital conditions such as ear swellings, fistulas and atresia. The document further describes inflammatory conditions including erysipelas, perichondritis and malignant otitis externa. It also covers reactive, traumatic, and neoplastic conditions of the external
NASAL POLYPS
This document discusses nasal polyposis, including its definition, epidemiology, etiology, pathogenesis, pathology, symptoms, signs, diagnosis and treatment. Some key points include:
- Nasal polyps are soft, non-cancerous growths that develop in the nasal cavity or sinuses. The two main types are ethmoidal polyps and antrochoanal polyps.
- Ethmoidal polyps are more common in adults and often associated with chronic rhinosinusitis, asthma or allergies. Antrochoanal polyps usually present in adolescents and originate in the maxillary sinus.
- Symptoms include nasal obstruction, loss of smell, discharge and headaches. Diagnosis involves
Nasal polyps
Nasal polyps can be either antrochoanal polyps, typically seen in children, or ethmoid polyps, more common in adults. Antrochoanal polyps originate in the maxillary sinus and extend backwards towards the nasopharynx, while ethmoid polyps originate in the ethmoid sinuses and grow forwards, often bilaterally. Treatment involves surgical removal of antrochoanal polyps and may require postoperative antibiotics to prevent recurrence, whereas ethmoid polyps are usually first treated medically with steroids and antihistamines and only require surgery if medical treatment fails or for large polyps.
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The document discusses inflammatory diseases of the nose and paranasal sinuses. It begins by describing the anatomy of the nasal cavities and paranasal sinuses. It then discusses common inflammatory conditions like rhinitis, sinusitis, and nasal polyps. Rhinitis can be acute or chronic, allergic or non-allergic. Sinusitis can be acute, chronic, subacute or recurrent. Common symptoms and treatments are provided for each condition.
Nasal septum and its diseases
1) The nasal septum consists of three parts - the columellar septum, membranous septum, and septum proper. The septum proper contains cartilage and bones that provide support to the nose.
2) Deviations, fractures, and injuries to the nasal septum can cause problems like nasal obstruction, epistaxis, and deformities. Surgical procedures like submucous resection (SMR) and septoplasty are used to correct septal abnormalities.
3) Complications of nasal septum diseases and their surgeries include bleeding, septal hematoma, infection, and saddle nose deformity. Accurate diagnosis and treatment of septal fractures or deviations is
Allergic fungal rhinosinusitis
Allergic fungal rhinosinusitis (AFRS) is a type of non-invasive fungal rhinosinusitis seen in young, atopic patients presenting with chronic rhinosinusitis and nasal polyps. It is characterized by eosinophilic mucin containing fungal hyphae and positive fungal cultures. Diagnosis involves CT scans showing sinus opacification and bone erosion along with endoscopic examination of allergic mucin. Treatment involves functional endoscopic sinus surgery along with post-operative steroids to reduce the high recurrence rate associated with AFRS. Long-term follow up is needed given the risk of recurrence requiring repeat surgery.
Atrophic rhinitis.pptx
Atrophic rhinitis, also known as ozaena, is a chronic inflammation of the nasal mucosa that results in atrophy, squamous metaplasia, and crust formation. It is characterized by the atrophy of the nasal mucosa and turbinates, scanty viscid secretions, loss of ciliated columnar epithelium, and crust formation. The pathophysiology involves periarteritis and endarteritis of the nasal mucosa, decreasing blood supply and resulting in atrophy of mucous glands, epithelium, and metaplasia of the ciliated columnar epithelium. Treatment involves antibiotics, estrogen therapy, surgical procedures to narrow the nasal cavity and increase lubrication, and sal
Nasal Septum and its Diseases
The nasal septum has 3 parts - the columellar septum, membranous septum, and septum proper. The septum proper contains cartilage and provides structural support to the nose. Deviations or fractures of the septum can cause nasal obstruction. Common causes of septal deviations include trauma and abnormal intrauterine positions. Symptoms include nasal obstruction and crusting. Septoplasty and submucous resection (SMR) are surgical procedures used to correct deviations. Indications for surgery include significant obstruction while risks include bleeding, perforation and infection.
Fess complications
This document discusses avoiding complications during endoscopic sinus surgery (ESS). It outlines common complications like injury to the orbit, optic nerve, great vessels, and nasolacrimal duct. Factors that help avoid complications include using nasal endoscopes, precise instruments, imaging guidance, and thorough knowledge of anatomy. Complications are more common during revision surgery, surgery for polyps, and in patients with complex anatomy. Careful attention to anatomical landmarks can help reduce risks.
Nasalobstruction
This document discusses nasal obstruction, including its definition, types, causes, evaluation, and investigations. Nasal obstruction can be unilateral or bilateral, and intermittent or continuous. Common causes include structural abnormalities, infections, allergies, and tumors. Evaluation involves examination of the external nose and nasal cavity, as well as palpation of the sinuses. Diagnostic tests may include x-rays of the sinuses and nasal cavity, as well as endoscopy and CT scans to further evaluate the source of nasal obstruction.
Septplasty
This document discusses septoplasty and submucous resection of the nasal septum (SMR) procedures. It defines key terms like septum, deviated septum, and provides an overview of the causes and symptoms of a deviated septum. The document outlines the steps of SMR and septoplasty, including anesthesia, incisions, cartilage/bone removal, and packing. Potential complications are also summarized.
Atrophic rhinitis
This document discusses three chronic nasal diseases: atrophic rhinitis, rhinosporidiosis, and rhinoscleroma. Atrophic rhinitis causes nasal atrophy and foul odors. It can be primary from infection or nutritional factors, or secondary from other conditions like sinusitis. Rhinosporidiosis is caused by Rhinosporidium seeberi and presents as red nasal lesions. Rhinoscleroma is caused by Klebsiella rhinoscleromatis and presents in stages from rhinitis to fibrosis, commonly affecting the nose and spreading to other areas. Treatment involves antibiotics, surgery, or other measures depending on the specific condition.
Granulomatous lesions of nose
1. Granulomatous lesions of the nose can be caused by infections, inflammation, or neoplasms. Common infectious causes include tuberculosis, leprosy, rhinoscleroma, and fungal infections like aspergillosis.
2. Sarcoidosis is a common inflammatory cause of nasal granulomas. It is a systemic condition of unknown etiology characterized by non-caseating granulomas. Nasal manifestations include crusting, bleeding, and septal perforation.
3. Wegener's granulomatosis is a necrotizing vasculitis that causes granulomatous inflammation in the respiratory tract and kidneys. In the nose it can cause septal destruction
Complications of sinusitis
This document discusses various local and orbital complications that can arise from sinusitis as well as potential intracranial complications. Local complications include mucoceles of the paranasal sinuses, mucus retention cysts, and osteomyelitis of the maxilla or frontal bone. Orbital complications range from preseptal inflammatory edema to subperiosteal abscesses, orbital cellulitis, and orbital apex syndrome. Sinus infections can also potentially spread and cause meningitis, encephalitis, or brain abscesses. Descending infections from sinusitis may lead to otitis media, pharyngitis, laryngitis or tracheobronchitis.
Nasopharynx and its diseases
1) Adenoids are lymphoid tissue located in the nasopharynx that develop in utero and enlarge between ages 3-5 before involuting at puberty.
2) Acute and chronic nasopharyngitis can be caused by viral or bacterial infections and cause symptoms like nasal obstruction, discharge, and ear complaints.
3) Rare tumors of the nasopharynx include juvenile nasopharyngeal angiofibroma, which is a benign but locally invasive tumor seen in adolescent males.
Epistaxis
This document discusses epistaxis (nosebleeds). It provides details on:
- Causes of epistaxis including local factors, medications, and underlying medical conditions
- The vascular anatomy of the nasal cavity and common bleeding sites
- Differences in epistaxis between children and adults
- Evaluation of epistaxis including history and physical exam
- Management approaches including cauterization, nasal packing, ligation of vessels, and newer endoscopic techniques
- Potential complications of different treatment methods
Rhinitis
Rhinitis is inflammation of the nasal mucosa that can be acute or chronic. It is classified based on etiology into infectious and non-infectious types. Common infectious causes are viral infections like the common cold, while non-infectious causes include allergies. Clinical features vary depending on type but may include nasal obstruction, rhinorrhea, sneezing, and loss of smell. Treatment involves managing symptoms, treating underlying causes, and antibiotics for secondary bacterial infections. Complications can include sinusitis if left untreated.
Steroids ent
Corticosteroids readily diffuse into cells and bind to receptor proteins, forming complexes that reduce inflammation by decreasing cytokine production and cellular responses. This process takes approximately 3 hours to have a clinical effect. Intravenous steroids are used for emergencies to gain an hour over oral administration, while oral steroids are preferred for long-term use. Intramuscular depot injections last 3 weeks, intranasal steroids treat local nasal issues with low systemic exposure, and topical ear drops treat external ear conditions. Systemic steroids through various routes of administration treat various inflammatory and allergic conditions.
Epistaxis ent
Epistaxis, or nosebleed, is bleeding from inside the nose. The nasal cavity has a rich blood supply from branches of the internal and external carotid arteries. The most common site of epistaxis is Little's area, located on the anterior nasal septum. Other vascular areas prone to bleeding include the retrocolumellar vein and Woodruff's area on the inferior turbinate. Anterior epistaxis is more common and usually mild, while posterior epistaxis is rarer but more severe. The leading cause of epistaxis is local trauma from nose picking, but it can also arise from systemic issues like hypertension or medications like aspirin. Proper management depends on identifying the source and
Vasomotor rhinitis & nares
Vasomotor rhinitis is a chronic non-allergic rhinitis caused by an imbalance of the autonomic nervous system leading to hyperactivity of the nasal mucosa. Symptoms include recurrent sneezing, rhinorrhea, and nasal obstruction. The exact cause is unknown but it involves overactivity of the parasympathetic nervous system causing vasodilation and secretion from the nasal glands. Treatment focuses on avoiding triggers, using oral or topical decongestants and steroids, and in severe cases, short term systemic steroids or surgical procedures like turbinate reduction.
Nasal polyps
Nasal Polyps are defined as pale, polypoidal, pedunculated , prolapsed sinus mucosa into the nose.
They cause nasal obstruction. Nasal allergy and infecions are proposed to be the most common etiological factors for nasal polyps.
This presentation explains in detail about every aspect of nasal polyps.
Nasal polyps Dr Krishna Koirala
Nasal polyps are common occurrences in ENT Practice.
Here I am going to describe the ethmoidal and antrochoanal polyps in details.
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NASAL POLYPS
This document discusses nasal polyposis, including its definition, epidemiology, etiology, pathogenesis, pathology, symptoms, signs, diagnosis and treatment. Some key points include:
- Nasal polyps are soft, non-cancerous growths that develop in the nasal cavity or sinuses. The two main types are ethmoidal polyps and antrochoanal polyps.
- Ethmoidal polyps are more common in adults and often associated with chronic rhinosinusitis, asthma or allergies. Antrochoanal polyps usually present in adolescents and originate in the maxillary sinus.
- Symptoms include nasal obstruction, loss of smell, discharge and headaches. Diagnosis involves
Nasal polyps
Nasal polyps can be either antrochoanal polyps, typically seen in children, or ethmoid polyps, more common in adults. Antrochoanal polyps originate in the maxillary sinus and extend backwards towards the nasopharynx, while ethmoid polyps originate in the ethmoid sinuses and grow forwards, often bilaterally. Treatment involves surgical removal of antrochoanal polyps and may require postoperative antibiotics to prevent recurrence, whereas ethmoid polyps are usually first treated medically with steroids and antihistamines and only require surgery if medical treatment fails or for large polyps.
Nasal and Para nasal inflammatory disease PPT
The document discusses inflammatory diseases of the nose and paranasal sinuses. It begins by describing the anatomy of the nasal cavities and paranasal sinuses. It then discusses common inflammatory conditions like rhinitis, sinusitis, and nasal polyps. Rhinitis can be acute or chronic, allergic or non-allergic. Sinusitis can be acute, chronic, subacute or recurrent. Common symptoms and treatments are provided for each condition.
Nasal septum and its diseases
1) The nasal septum consists of three parts - the columellar septum, membranous septum, and septum proper. The septum proper contains cartilage and bones that provide support to the nose.
2) Deviations, fractures, and injuries to the nasal septum can cause problems like nasal obstruction, epistaxis, and deformities. Surgical procedures like submucous resection (SMR) and septoplasty are used to correct septal abnormalities.
3) Complications of nasal septum diseases and their surgeries include bleeding, septal hematoma, infection, and saddle nose deformity. Accurate diagnosis and treatment of septal fractures or deviations is
Allergic fungal rhinosinusitis
Allergic fungal rhinosinusitis (AFRS) is a type of non-invasive fungal rhinosinusitis seen in young, atopic patients presenting with chronic rhinosinusitis and nasal polyps. It is characterized by eosinophilic mucin containing fungal hyphae and positive fungal cultures. Diagnosis involves CT scans showing sinus opacification and bone erosion along with endoscopic examination of allergic mucin. Treatment involves functional endoscopic sinus surgery along with post-operative steroids to reduce the high recurrence rate associated with AFRS. Long-term follow up is needed given the risk of recurrence requiring repeat surgery.
Atrophic rhinitis.pptx
Atrophic rhinitis, also known as ozaena, is a chronic inflammation of the nasal mucosa that results in atrophy, squamous metaplasia, and crust formation. It is characterized by the atrophy of the nasal mucosa and turbinates, scanty viscid secretions, loss of ciliated columnar epithelium, and crust formation. The pathophysiology involves periarteritis and endarteritis of the nasal mucosa, decreasing blood supply and resulting in atrophy of mucous glands, epithelium, and metaplasia of the ciliated columnar epithelium. Treatment involves antibiotics, estrogen therapy, surgical procedures to narrow the nasal cavity and increase lubrication, and sal
Nasal Septum and its Diseases
The nasal septum has 3 parts - the columellar septum, membranous septum, and septum proper. The septum proper contains cartilage and provides structural support to the nose. Deviations or fractures of the septum can cause nasal obstruction. Common causes of septal deviations include trauma and abnormal intrauterine positions. Symptoms include nasal obstruction and crusting. Septoplasty and submucous resection (SMR) are surgical procedures used to correct deviations. Indications for surgery include significant obstruction while risks include bleeding, perforation and infection.
Fess complications
This document discusses avoiding complications during endoscopic sinus surgery (ESS). It outlines common complications like injury to the orbit, optic nerve, great vessels, and nasolacrimal duct. Factors that help avoid complications include using nasal endoscopes, precise instruments, imaging guidance, and thorough knowledge of anatomy. Complications are more common during revision surgery, surgery for polyps, and in patients with complex anatomy. Careful attention to anatomical landmarks can help reduce risks.
Nasalobstruction
This document discusses nasal obstruction, including its definition, types, causes, evaluation, and investigations. Nasal obstruction can be unilateral or bilateral, and intermittent or continuous. Common causes include structural abnormalities, infections, allergies, and tumors. Evaluation involves examination of the external nose and nasal cavity, as well as palpation of the sinuses. Diagnostic tests may include x-rays of the sinuses and nasal cavity, as well as endoscopy and CT scans to further evaluate the source of nasal obstruction.
Septplasty
This document discusses septoplasty and submucous resection of the nasal septum (SMR) procedures. It defines key terms like septum, deviated septum, and provides an overview of the causes and symptoms of a deviated septum. The document outlines the steps of SMR and septoplasty, including anesthesia, incisions, cartilage/bone removal, and packing. Potential complications are also summarized.
Atrophic rhinitis
This document discusses three chronic nasal diseases: atrophic rhinitis, rhinosporidiosis, and rhinoscleroma. Atrophic rhinitis causes nasal atrophy and foul odors. It can be primary from infection or nutritional factors, or secondary from other conditions like sinusitis. Rhinosporidiosis is caused by Rhinosporidium seeberi and presents as red nasal lesions. Rhinoscleroma is caused by Klebsiella rhinoscleromatis and presents in stages from rhinitis to fibrosis, commonly affecting the nose and spreading to other areas. Treatment involves antibiotics, surgery, or other measures depending on the specific condition.
Granulomatous lesions of nose
1. Granulomatous lesions of the nose can be caused by infections, inflammation, or neoplasms. Common infectious causes include tuberculosis, leprosy, rhinoscleroma, and fungal infections like aspergillosis.
2. Sarcoidosis is a common inflammatory cause of nasal granulomas. It is a systemic condition of unknown etiology characterized by non-caseating granulomas. Nasal manifestations include crusting, bleeding, and septal perforation.
3. Wegener's granulomatosis is a necrotizing vasculitis that causes granulomatous inflammation in the respiratory tract and kidneys. In the nose it can cause septal destruction
Complications of sinusitis
This document discusses various local and orbital complications that can arise from sinusitis as well as potential intracranial complications. Local complications include mucoceles of the paranasal sinuses, mucus retention cysts, and osteomyelitis of the maxilla or frontal bone. Orbital complications range from preseptal inflammatory edema to subperiosteal abscesses, orbital cellulitis, and orbital apex syndrome. Sinus infections can also potentially spread and cause meningitis, encephalitis, or brain abscesses. Descending infections from sinusitis may lead to otitis media, pharyngitis, laryngitis or tracheobronchitis.
Nasopharynx and its diseases
1) Adenoids are lymphoid tissue located in the nasopharynx that develop in utero and enlarge between ages 3-5 before involuting at puberty.
2) Acute and chronic nasopharyngitis can be caused by viral or bacterial infections and cause symptoms like nasal obstruction, discharge, and ear complaints.
3) Rare tumors of the nasopharynx include juvenile nasopharyngeal angiofibroma, which is a benign but locally invasive tumor seen in adolescent males.
Epistaxis
This document discusses epistaxis (nosebleeds). It provides details on:
- Causes of epistaxis including local factors, medications, and underlying medical conditions
- The vascular anatomy of the nasal cavity and common bleeding sites
- Differences in epistaxis between children and adults
- Evaluation of epistaxis including history and physical exam
- Management approaches including cauterization, nasal packing, ligation of vessels, and newer endoscopic techniques
- Potential complications of different treatment methods
Rhinitis
Rhinitis is inflammation of the nasal mucosa that can be acute or chronic. It is classified based on etiology into infectious and non-infectious types. Common infectious causes are viral infections like the common cold, while non-infectious causes include allergies. Clinical features vary depending on type but may include nasal obstruction, rhinorrhea, sneezing, and loss of smell. Treatment involves managing symptoms, treating underlying causes, and antibiotics for secondary bacterial infections. Complications can include sinusitis if left untreated.
Steroids ent
Corticosteroids readily diffuse into cells and bind to receptor proteins, forming complexes that reduce inflammation by decreasing cytokine production and cellular responses. This process takes approximately 3 hours to have a clinical effect. Intravenous steroids are used for emergencies to gain an hour over oral administration, while oral steroids are preferred for long-term use. Intramuscular depot injections last 3 weeks, intranasal steroids treat local nasal issues with low systemic exposure, and topical ear drops treat external ear conditions. Systemic steroids through various routes of administration treat various inflammatory and allergic conditions.
Epistaxis ent
Epistaxis, or nosebleed, is bleeding from inside the nose. The nasal cavity has a rich blood supply from branches of the internal and external carotid arteries. The most common site of epistaxis is Little's area, located on the anterior nasal septum. Other vascular areas prone to bleeding include the retrocolumellar vein and Woodruff's area on the inferior turbinate. Anterior epistaxis is more common and usually mild, while posterior epistaxis is rarer but more severe. The leading cause of epistaxis is local trauma from nose picking, but it can also arise from systemic issues like hypertension or medications like aspirin. Proper management depends on identifying the source and
Vasomotor rhinitis & nares
Vasomotor rhinitis is a chronic non-allergic rhinitis caused by an imbalance of the autonomic nervous system leading to hyperactivity of the nasal mucosa. Symptoms include recurrent sneezing, rhinorrhea, and nasal obstruction. The exact cause is unknown but it involves overactivity of the parasympathetic nervous system causing vasodilation and secretion from the nasal glands. Treatment focuses on avoiding triggers, using oral or topical decongestants and steroids, and in severe cases, short term systemic steroids or surgical procedures like turbinate reduction.
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Nasal polyps
Nasal Polyps are defined as pale, polypoidal, pedunculated , prolapsed sinus mucosa into the nose.
They cause nasal obstruction. Nasal allergy and infecions are proposed to be the most common etiological factors for nasal polyps.
This presentation explains in detail about every aspect of nasal polyps.
Nasal polyps Dr Krishna Koirala
Nasal polyps are common occurrences in ENT Practice.
Here I am going to describe the ethmoidal and antrochoanal polyps in details.
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This document discusses nasal polyps and antrochoanal polyps. It defines nasal polyps as non-neoplastic masses of edematous nasal or sinus tissue. The main types are bilateral ethmoidal polyp and antrochoanal polyp. Nasal polyps are commonly caused by inflammatory conditions like rhinosinusitis or disorders of ciliary motility. Antrochoanal polyps originate in the maxillary sinus near its ostium. Symptoms include nasal obstruction, loss of smell, and discharge. Treatment involves polypectomy, intranasal ethmoidectomy, or endoscopic sinus surgery depending on the type and location of polyp.
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Nasal polyps are non-cancerous masses of swollen nasal or sinus mucosa. There are two main types: bilateral ethmoidal polyps and antrochoanal polyps. Bilateral ethmoidal polyps commonly arise from inflammatory conditions like rhinosinusitis or disorders of ciliary motility. Antrochoanal polyps originate from the maxillary sinus near its opening and grow into the nasal cavity and nasopharynx. Symptoms include nasal obstruction, loss of smell, headache and discharge. Signs include pale grape-like masses seen on nasal examination. Treatment involves polypectomy or endoscopic sinus surgery. Recurrence is less common for antrochoanal polyps if completely removed from their
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Otosclerosis is a disease affecting the bone of the middle ear that causes conductive or mixed hearing loss. It involves abnormal bone remodeling in the inner ear capsule, most commonly at the stapes footplate, causing stapes fixation and hearing loss. Symptoms include progressive hearing loss beginning in young adults. Diagnosis is made through audiometry showing air-bone gaps and absent acoustic reflexes. Treatment involves stapedectomy or stapedotomy surgery to remove the stapes and replace it with a prosthesis to reestablish sound conduction.
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This document provides information about nasal polyps through three parts. Part 1 discusses the anatomy of the nasal cavity and its relationship to polyps. It describes the structures of the nasal septum and lateral walls. Part 2 defines nasal polyps and classifies them according to location. It also discusses their etiology, pathogenesis, symptoms, signs, diagnosis and treatment options. Part 3 presents two case studies of patients presenting with nasal polyps - one involving an antrochoanal polyp and the other involving bilateral ethmoid polyps. Both cases discuss the relevant history, examination findings, investigations, diagnoses and treatment plans.
nasalpolyps.pptx
Nasal polyps are non-cancerous swellings that develop in the nasal cavity or sinuses. There are two main types - ethmoidal polyps which originate in the ethmoid sinuses, and antrochoanal polyps which arise from the maxillary sinus near its opening. Nasal polyps are caused by inflammatory sinus conditions like rhinosinusitis, or disorders like cystic fibrosis. Symptoms include nasal congestion, loss of smell, headaches and sneezing. Treatment involves medications to reduce swelling, or surgical procedures to remove the polyps. Antrochoanal polyps differ in that they usually affect one side, originate in the maxillary sinus, and can grow backwards into the throat causing
nasalpolyp
Nasal polyps are non-cancerous swellings that develop in the nasal cavity or sinuses. There are two main types - ethmoidal polyps which originate in the ethmoid sinuses, and antrochoanal polyps which arise from the maxillary sinus near its opening. Nasal polyps are caused by inflammatory sinus conditions like rhinosinusitis, or disorders of mucus and cilia function. Common symptoms include nasal congestion, loss of smell, headaches and sneezing. Treatment involves medications to reduce swelling, or surgical polypectomy/sinus surgery to remove the polyps. Antrochoanal polyps differ in that they present as a single swelling growing from the maxillary sinus
nasalpolyps-151224095805.pptx
Nasal polyps are non-cancerous swellings that develop in the nasal cavity or sinuses. There are two main types - ethmoidal polyps which originate in the ethmoid sinuses, and antrochoanal polyps which arise from the maxillary sinus near its opening. Nasal polyps are caused by inflammatory sinus conditions like rhinosinusitis, or disorders like cystic fibrosis. Symptoms include nasal congestion, loss of smell, headaches and sneezing. Treatment involves medications to reduce swelling, or surgical procedures to remove the polyps. Recurrence is more common for ethmoidal polyps compared to antrochoanal polyps, which rarely reoccur if completely removed.
Complications of sinusitis
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal, for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Rhinosinusitis- Definition, Clinical features, Diagnosis.pptx
Rhino-sinusitis: inflammation of lining mucosa of nose & paranasal sinuses
Acute: infection lasting < 4 weeks
Sub acute: infection lasting 4 to 12 weeks
Chronic: infection lasting > 12 weeks
Recurrent acute (RARS): > 4 episodes in a year, each episode lasting for 7-10 days, without persistent symptoms in between
Etiology:
Rhinogenic: commonest (85%), following any form of rhinitis
Dental: root abscess, dental procedures (maxillary sinusitis)
Trauma:
Accidental: R.T.A., swimming, diving, F.B., barotrauma
Iatrogenic: nasal packing, septal surgery
Hematogenous : rare
Symptoms
Nasal discharge : mucoid / purulent / blood-stained
Nasal obstruction with hyposmia / anosmia
Headache and facial pain
Cheek / eyelid congestion and swelling
Hawking, sore throat, dry irritating cough
Earache: associated Eustachian tube dysfunction
Constitutional: fever, malaise, body ache
Rhinosinusitis Task Force Criteria (RI 2004)
Location of facial pain in sinusitis
Maxillary sinusitis
Cheek, upper jaw, forehead that increases on bending forward
Frontal sinusitis
Pain over the forehead that increases during morning and decreases by late afternoon (office headache)
Anterior Ethmoid : nasal bridge and peri-orbital, more on eye movement
Posterior Ethmoid : deep seated retro-orbital
Sphenoid : vertex, occipital, retro-orbital pain
Palpation to elicit paranasal sinus tenderness
Maxillary: over the canine fossa
Anterior ethmoid: medial to medial canthus
Frontal: Floor of sinus at the superomedial aspect of the orbit or tap over its anterior wall on the forehead
Postural tests for rhinosinusitis
Performed in acute sinusitis (active nasal discharge)
Pus cleaned in supine position & patient sits upright
Pus appears : frontal or ethmoid sinusitis
Pus appears on stooping forwards: sphenoid sinusitis
No discharge patient lies in lateral position with affected side up
Pus appears: maxillary sinusitis
Plain x ray of Paranasal Sinuses
Water’s view (Occipito -mental) maxillary sinus
Caldwell’s view (Occipito -frontal) and lateral view frontal
Rhese’s view (lateral oblique) and laterai view ethmoids
Base skull view (Submento - vertical) and Pierre’s view (Occipito -mental with mouth open) sphenoid
Air-fluid level seen in acute sinusitis
Mucosal thickening seen in chronic sinusitis
CT scan of nose and PNS
Most reliable imaging modality for sinusitis at present
Plain axial, coronal and sagittal cuts of 3 mm (contrast for suspected vascular, neoplastic, inflammatory lesions)
Helps to delineate the extent of disease, define anatomical variants and study the relationship of sinuses with surrounding structures
Indications:
Recurrent acute/chronic sinusitis not responding to medical treatment
Before endoscopic sinus surgery
Impending complications of sinusitis
Complications of sinusitis
This document discusses complications that can arise from sinusitis, including orbital complications like pre-septal cellulitis, orbital cellulitis, and intraorbital abscesses. Intracranial complications such as meningitis, brain abscesses, and cavernous sinus thrombosis are also described. Chronic complications include mucocoeles, pyoceles, osteomyelitis which can lead to Pott's puffy tumor, oroantral fistulas, and rarely toxic shock syndrome. Medical and surgical treatment options are provided for managing these complications.
Diseases of Pharynx.pptx
This document discusses diseases of the pharynx, including its anatomy and functions. It describes inflammatory conditions like adenoiditis and tonsillitis, as well as tumors. Adenoiditis is usually caused by viral or bacterial infections and can cause nasal obstruction. Tonsillitis can be acute or chronic, with group A streptococcus being a common cause of acute tonsillitis. Obstructive sleep apnea is also discussed, with enlarged adenoids and tonsils being a common cause. Deep neck space infections are an important complication, with odontogenic infections being a frequent source. Management involves airway protection, antibiotics, and sometimes surgical drainage.
Clinical features and diagnosis of rhinosinusitis
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Clinical features and diagnosis of rhinosinusitis
Plain C.T. scan and M.R.I. are useful imaging modalities for evaluating sinusitis and its complications. C.T. scan is most reliable for delineating the extent of disease and defining anatomical variants. M.R.I. helps assess intracranial extension and orbital complications.
Acute and Chronic Sinusitis.pptx
This document discusses sinusitis, including the anatomy and physiology of the paranasal sinuses, causes of sinusitis, clinical presentation, diagnosis and treatment. It covers acute and chronic sinusitis, as well as complications involving nearby structures like the orbit and brain. Acute sinusitis is usually caused by viral or bacterial infection, while chronic sinusitis results from long-term inflammation and obstruction. Diagnosis involves imaging like x-rays or CT scans. Treatment includes antibiotics, nasal saline washes, and surgery in refractory cases.
CHRONIC SUPPURATIVE OTITIS MEDIA (TUBOTYMPANIC)
This document provides information on chronic suppurative otitis media (CSOM), a long-standing middle ear infection characterized by ear discharge and a permanent perforation of the tympanic membrane. It discusses the definition, causes, clinical features, types (tubotympanic and atticoantral), microbiology, and treatment options including medical management with topical antibiotics and antiseptics as well as surgical procedures like myringoplasty to repair perforations using grafts such as temporalis fascia. The goal of treatment is to eliminate infection and control ear discharge.
L6_TONSILLITIS.-ADENOIDS.-TONSILLAR-HYPERTROPHY-LECTURE.pdf
1. The document discusses the anatomy, function, clinical evaluation, classification, complications, and treatment of tonsillitis and adenoid disease.
2. Tonsillitis can be acute, chronic, or present as peritonsillar abscess. Treatment involves antibiotics or tonsillectomy based on severity and frequency of infections.
3. Adenoid disease includes acute or chronic adenoiditis and obstructive hyperplasia. Adenoidectomy criteria include recurrent or persistent infections and airway obstruction.
Nasalpolyps
Includes :
-Definition
-Types
-Brief discussion about the types of nasal polyps along with management and treatment
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Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal, for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Complications of sinusitis
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal, for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Complications of sinusitis
Sinusitis can lead to serious complications if left untreated. Orbital complications are the most common and include pre-septal cellulitis, orbital cellulitis, and orbital abscesses which can further progress to involve the cavernous sinus. Intracranial complications involve spread of infection to the brain and include meningitis, brain abscesses, and cerebral venous sinus thrombosis. Other complications include osteomyelitis of the bones around the sinuses, dental infections, and distant infections like toxic shock syndrome. Treatment involves high dose antibiotics, surgical drainage of abscesses, and sinus surgery to address the underlying cause.
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Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
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Epistaxis is one of the commonly encountered problem in day to day life by the otolaryngologists. Most of the times, it is mild , but sometimes, it is very difficult to manage and there may be mortality, too.
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Nasal polyps
- 1. Nasal Polyps Dr. Krishna Koirala MBBS, MS ENT-HNS Associate professor MCOMS, Pokhara, Nepal29-06-2020
- 2. Definition • Hypertrophied, edematous, pedunculated mucosa prolapsing out of the nose or paranasal sinus • Classification – Antrochoanal Polyp – Ethmoidal polyps • Properties of Nasal Polyps – Pale /grey in color, glistening, pedunculated, smooth surface, mobile, insensitive to touch, do not bleed on probing
- 3. Antro - choanal Polyp ( Killian’s Polyp)
- 4. • Etiology: – Infection – Proetz Theory (anomaly of maxillary sinus ostium) – Bernoulli’s phenomenon ( pressure drop next to constriction) • Origin: – Arises from maxillary sinus mucosa and exits via its natural or accessory ostium and extends to choana
- 5. Why does AC polyp prefer to extend towards the choana? 1. Maxillary ostium is directed posteriorly 2. Cilia beat posteriorly 3. Air current flows posteriorly in a greater force 4. Nasal floor slopes posteriorly 5. Posterior nasal cavity is larger 6. Negative oropharyngeal pressure while swallowing
- 6. Parts of Killian’s Antrochoanal polyp • Antral: globular • Choanal: globular • Nasal: flattened transversely • Neck : present at maxillary ostium
- 7. Clinical presentation • Common in children and adolescent age • Unilateral nasal obstruction • Unilateral nasal discharge • Occasionally nasal mass seen on anterior rhinoscopy • Mass bulging in the choana / oropharynx, seen on posterior rhinoscopy
- 8. Examination of nasal mass • Inspection : side, size, number, color, surface, pedunculated or sessile, origin, attachment • Probing : consistency, sensitivity to touch, bleeding on touch, can be passed all around • Shrinkage with decongestant drops
- 9. Probe test Antrochoanal polyp Hypertrophied turbinate Insensitive to pain Sensitive Probe can be passed all around Cannot be passed Mobile Not mobile
- 10. Differential Diagnosis • Hypertrophied inferior turbinate • Blob of mucous • Inverted papilloma • Rhinosporidiosis / rhinoscleroma • Angiofibroma • Meningocoele • Malignancy
- 11. Investigations • Diagnostic Nasal Endoscopy • Plain X-ray of nose and PNS (Waters view) • X-ray nasopharynx lateral view: presence of air between skull base and polyp • CT scan nose and PNS (coronal and axial cuts)
- 13. Plain X-ray Nose and Paranasal Sinuses C.T. scan of nose and Paranasal Sinuses
- 14. Treatment • Antibiotics (pre & post operatively) • Avulsion polypectomy with middle meatal antrostomy • F.E.S.S. • Caldwell – Luc operation (for recurrence)
- 16. Caldwell – Luc Operation
- 17. How to prevent recurrence ? • Complete removal of all parts ( Nasal , Antral , Choanal) • Wide middle meatal antrostomy (widening of maxillary sinus ostium) • Post-operative antibiotics
- 18. Ethmoidal Polyps
- 19. Clinical Presentation Adult patient • Bilateral nasal obstruction • Bilateral watery nasal discharge • Excessive, paroxysmal sneezing • H/o previous nasal surgery
- 20. Etiology of ethmoid polyp 1. Allergy 2. Infection 3. Vasomotor imbalance 4. Bernoulli phenomenon 5. Poly-saccharide changes
- 21. Associated diseases • Samter’s triad – Aspirin intolerance , bronchial asthma, ethmoid polyps • Cystic fibrosis • Allergic fungal sinusitis • Kartagener’s syndrome (ciliary dyskinesia) − Situs inversus, chronic sinusitis, and bronchiectasis • Young’s syndrome (hyperviscous mucous) − Bronchiectasis, chronic rhinosinusitis and infertility
- 22. Investigations • Diagnostic Nasal Endoscopy (D.N.E.) • X-ray PNS (Rhese lateral oblique view) • C.T. scan P.N.S. (coronal cuts) • Tests for allergy
- 23. CT Scan Paranasal Sinus
- 24. Non-surgical Treatment • For small polyps – Avoid allergens – Oral antihistamines (1-3 months) – Corticosteroid nasal sprays (3-6 months) – Oral prednisolone (1 mg/kg/day for 2 weeks )
- 25. Pre - steroid vs. Post- steroid
- 26. Surgical Treatment 1. Intra-nasal avulsion polypectomy 2. Extra-nasal external ethmoidectomy 3. Trans-antral ethmoidectomy 4. Functional Endoscopic Sinus Surgery • Conventional • Micro - debrider • Laser
- 27. F.E.S.S.
- 29. Micro-debrider
- 30. How to prevent recurrence? 1. Complete removal of all polyps 2. Avoid allergens 3. Post-operative course of: − Oral antihistamines (1-3 months) − Corticosteroid nasal sprays (3-6 months)
- 32. Post FESS CT scan
- 33. Antrochoanal polyp Ethmoid polyps Seen in adolescents & children Adult Etiology is infection Allergic Single Multiple Unilateral Bilateral Shape is tri-lobed (dumb-bell) Grape like Grows backward Forward Treatment is surgical Medical + Surgical Recurrence is uncommon Common