Nasal blockage

Question 1

Causes of nasal blockage?

Answer 1

Foreign body in the nose
Viral infection - influenza, rhinovirus
Allergic rhinitis
Rhinosinusitis
Nasal polyps
Septal haematoma
Tumours

Question 2

What to ask in Hx of nasal blockage?

Answer 2

Is problem acute (<12weeks) or chronic (>12weeks).
Is it bilateral or unilateral?
Are there associated symptoms? - this helps with diagnosis.

Question 3

What does ‘nasal blockage’ encompass?

Answer 3

Nasal obstruction AND nasal congestion problems

Question 4

Presentation of intranasal foreign body?

Answer 4

If an organic object e.g. food, bugs:
Unilateral
Purulent, foul smelling discharge
Nasal obstruction
Facial pain from sinusitis

If an inorganic object e.g. nails, paper, stones:
Asymptomatic usually, unless large enough to cause nasal obstruction

Question 5

What intranasal foreign body needs emergency removal, and why?

Answer 5

Button batteries.

WHY?
- Can cause tissue necrosis through electrolysis at the negative battery pole.
- if negative pole is directed towards the septum = can get septal perforation in 4hrs.

Question 6

Presentation of intranasal button battery?

Answer 6

Purulent discharge
Epistaxis
If have associated necrosis = black discharge, facial swelling, pain, fever.

Question 7

Management of intranasal foreign object

Answer 7

Remove object
Examine nasal cavity
Examine other orifices
Check ears and sinuses - could have associated otitis media or sinusitis.

Question 8

Presentation of nasal polyps?

Answer 8

Nasal obstruction
Rhinorrhea
Sneezing
Poor sense of taste and smell
Facial pain or pressure

Question 9

What may be in PMH of pt with nasal polyps?

Answer 9

Asthma
Aspirin sensitivity
Infective sinusitis
CF
Kartagener’s syndrome
Churg-Strauss syndrome

Question 10

What is Samter’s triad?

Answer 10

Association of aspirin sensitivity, asthma and nasal polyposis

Question 11

Investigations for nasal polyps?

Answer 11

Anterior rhinos copy
Nasal endoscopy
CT sinuses
Biopsy
Nasal smear and culture

Question 12

Differentials for nasal polyps?

Answer 12

Neoplasm
Foreign body
Congenital lesion

Question 13

Management of nasal polyps?

Answer 13

Intranasal corticosteroid ( + nasal saline irrigation + doxycycline)
Surgical polypectomy

Question 14

Presentation of septal haematoma?

Answer 14

Nasal trauma
Sensation of nasal obstruction
Pain
Rhinorrhea

O/E:
bilateral, red swelling arising from the nasal septum.

Question 15

What is a septal haematoma?

Answer 15

Development of haematoma between the septal cartilage and the overlying perichondrium

Question 16

How is nasal septal haematoma managed?

Answer 16

Emergency incision and drainage
IV abx

Question 17

Complication of nasal septal haematoma?

Answer 17

Irreversible septal perforation
Necrosis —> saddle nose deformity

Question 18

Investigation for nasal septal haematoma?

Answer 18

Anterior rhinoscopy - see bilateral cherry-red swelling.

Question 19

Presentation of nasal or sinus cancer compared to nasal polyps?

Answer 19

Unilateral
Epistaxis
Vision loss/diplopia
Watering eye
Pain/pressure in one ear
Lump in face, nose, or roof of mouth.

Question 20

Investigations for nasal or sinus cancer?

Answer 20

Nasal endoscopy
Biopsy
Fine needle aspiration
Imaging - CT, MRI, PET, USS

Question 21

Risk factors for nasal and sinus cancer?

Answer 21

Prolonged exposure to certain substances - wood dust, leather dust, nickel, formaldehyde

Smoking

HPV

Question 22

Management for nasal and sinus cancers?

Answer 22

Surgical removal of tumour
Radiotherapy
Chemotherapy
Smoking cessation