NASAL CYCLE

1. At given time one side of nose tends to be more blocked than other
2. This alternating pattern is called nasal cycle
3. 4-12 hours
4. Physiological
5. Anxious patient

NASAL OBSTRUCTION

UNILATERAL

1. DNS
2. Unilateral rhinosinusitis
3. AC polyp
4. Foreign body
5. Neoplasm: Angiofibroma, Olfactory neuroblastoma, Nasopharyngeal Ca
6. Choanal Atresia

BILATERAL

1. Acute Rhinosinusitis
2. Allergic rhinosinusitis
3. Adenoid enlargement
4. Vasomotor rhinosinusitis
5. DNS
6. Choanal Atresia

HISTORY

1. Onset
2. Duration
3. Unilateral /Bilateral
4. Complete/Incomplete

SHORT DURATION

•       Acute Rhinosinusitis

•       Foreign body

LONGER DURATION:

1.     DNS

2.     Allergic Rhinosinusitis

3.     Vasomotor Rhinosinusitis

4.     Rhinitis due to environmental factor e.g. pollution, fumes     

5.     Adenoid hyperplasia

LATERALITY:

1.     Unilateral: DNS, FB,  AC polyp

2.     Bilateral: Nasal allergy, Septal hematoma, Ethmoid polyp

LATENCY:

1.     Constant: Nasal mass

2.     Intermittent : Allergic Rhinosinusitis

SEVERITY:

1.     Severe: Noticeable enough to prevent routine work of

2.     patient

PROGRESSIVE:

1.     Polyp or Malignancy

FOREIGN BODY NOSE

Common:

1.  Children 2-6 yrs
2.  Adults especially those with mental retardation or psychiatric illness
3. Children habit of  exploring  new object

Common object :

1.Piece of paper

2.     Sponge

3.     Eraser

4.     Beads

5.     Vegetable seed

Inorganic

1.     Plastic or metal;

2.     beads,

3.     eraser and

4.     small parts from toys.

5.     Often asymptomatic and may be discovered incidentally

Organic

a.     Food, wood and sponge

b.     More irritating to the nasal mucosa and thus may produce earlier symptoms

DANGERS

1. Injury from clumsy attempts at removal by unskilled persons.
2. Local spread of infection- sinusitis or meningitis.
3. Inhalation of foreign bodies leading to lung collapse and infection.
4. All foreign bodies harbor the potential for swallowing or airway obstruction if they are displaced posteriorly. 

CLINICAL FEATURE:

1. Unilateral, usually
2. No symptoms: not uncommon initially
3. Nasal obstruction: if large
4. If children: patient are not aware
5. Long term:

a.     Unilateral foul smelling purulent discharge

b.     Sinusitis

c.     Granulation surrounding FB

If a child presents with unilateral, foul-smelling nasal discharge, foreign body must be excluded

TREATMENT

1. Sort of medical emergency: as chance of going further
2. Most FB removed without anaesthesia by FB hook, forceps
3. GA in uncooperative pt
4. If long term may be associated with rhinosinusitis so antibiotics
5. Vasoconstriction if bleeding

RHINOLITH

1. Rare
2. Resemble stone in nasal cavity
3. Small FB , mucous , blood clot—nucleus for concretion & those get coated with calcium & magnesium phosphate--- rhinolith
4. White/ brown or grey in color
5. Irregular surface , hard
6. Brittle and portion may break off while manipulating
7. Radio-opaque
8. May fill up entire nasal cavity: obstruction
9. Unilateral nasal obstruction & foul smelling

    discharge commonly blood stained  

Treatment

1. Removal under GA