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Neurology: cranial nerves
Published in Shahed Yousaf, Medical Examination Made Memorable (MEMM), 2018
Inspect nasal passages with a torch for obstructions, deviated septum. Occlude one nostril with your finger and check the other one with essence bottles of scent such as coffee, ask them to identify it with their eyes closed. Usually not tested.
The nose and nasopharynx
Published in Rogan J Corbridge, Essential ENT, 2011
This is a cosmetic operation that aims to improve the aesthetic appearance of the nose. Septorhinoplasty will also attempt to improve the nasal airway by repositioning a deviated septum. Both the patient and the surgeon must be aware of the surgical priority: airway or appearance. Details of rhinoplasty are beyond the scope of this book, but we shall outline the most common negative features of the nose that rhinoplasty can improve: An overly large nose can be made smaller with a reduction rhinoplasty.Deviation of the nasal bones and/or deviation of the cartilaginous septum may be straightened with a septorhinoplasty.A broad nasal bridge may be narrowed.Nasal hump is a common feature after a nasal injury and may be removed.Dorsal saddling results from inadequate support for the dorsum of the nose, usually as a result of destruction of the dorsal cartilaginous septum. This may be augmented using cartilage, bone or a silastic prosthesis.Over- or under-rotation of the nasal tip can be corrected.
Example of the Integrated Management of a Disease: Acute and Chronic Sinusitis
Published in W. John Diamond, The Clinical Practice of Complementary, Alternative, and Western Medicine, 2017
Etiology and risk factors — The majority of cases are chronic with acute exacerbations. The predisposing and etiological factors include, in order of importance: Allergic diathesis — usually food or environmental allergies. Food allergies include dairy, wheat, corn, sugar, yeast, and soybeans. Environmental allergies include pollens of trees, grasses, weeds, and some bushes. Dust, animal fur and epithelium, smoke, perfumes, and mold fill out the remainder.Infections — viral, bacterial, and fungal infections. Look for rhinovirus, enterovirus, Coxsackie A and B, Coronavirus, Echovirus, Respiratory Syncytial Virus (RSV), influenza, and parainfluenza viruses. Bacteria include Streptococcus pneumoniae, H. Influenzae, and Branhamella catarrhalis. Anaerobes are rarely found. Fungal cultures will be positive in 30 to 40% of recalcitrant cases — mainly Candida species, Mucor and Aspergillus.Bowel dysbiosis — large bowel symptoms including chronic constipation, diarrhea, irritable bowel, or even chronic colitis in almost all cases of chronic sinusitis. Most have a yeast overgrowth dependent on multiple antibiotic usage, birth control pills, or excessive sugar and carbohydrate ingestion.Physical issues — deviated septum, foreign body, small osteomeatal complex, and large nasal polyps. These must be ruled out with appropriate investigations.
Angioleiomyoma of the nasolacrimal duct: case report and literature review
Published in Orbit, 2022
Ariel M. Azhdam, Yao Wang, Raymond S. Douglas, Elena E. Chang, Arthur W. Wu
A 65-year-old female presented to a tertiary-care Otolaryngology – Head and Neck Surgery clinic for a nasolacrimal duct lesion found incidentally when receiving dental implants recently prior to presentation. She reported a history of chronic lower right eyelid edema, epiphora, and frequent styes. Computed tomography of the orbits without contrast revealed a well-defined mass in the right nasolacrimal duct, suggestive of a low-grade neoplasm or polyp. Magnetic resonance imaging of the head demonstrated a mass expanding the right nasolacrimal canal, suggestive of a dacryocystocele (Figure 1a,b). Endoscopy was also performed, which visualized a right deviated septum. She was subsequently referred to an oculoplastics surgeon who confirmed nasolacrimal duct obstruction with lacrimal irrigation. The patient subsequently underwent endoscopic excision of the right nasolacrimal duct lesion, medial maxillectomy, septoplasty, and dacryocystorhinostomy with both otolaryngology and oculoplastics. An intraoperative biopsy of the lesion determined that it was not cystic and that it was a solid tumor (Figure 1c). Consistent with imaging, the walls of the lesion were smooth with no evidence of bony invasion or aggressive features. In frozen section pathology, it was noted to be a benign vascular tumor and final pathology revealed an angioleiomyoma. The procedure was completed without surgical complication and the patient did well postoperatively with the resolution of her epiphora.
Identification of bleeding sites and microwave thermal ablation of posterior epistaxis
Published in Acta Oto-Laryngologica, 2019
Zhengcai Lou, Hong Wei, Zihan Lou
Blood in the nasal cavity was removed by suction under general anesthesia. A 0° rigid endoscope was used to determine whether the bleeding point was in Kiesselbach’s area. Then the patients were examined for the presence or absence of a deviated nasal septum, and to determine whether the bleeding originated from the convex or concave side of the deviated septum or from septal spurs. The presence of intranasal tumors or polyps was also investigated. If the bleeding site could not be identified, a more detailed examination was performed using using different diameter and angle endoscope, to include the anterior nasal septum, olfactory cleft, middle meatus, middle nasal septum, inferior meatus, the lateral wall of inferior nasal concha, PNA septum, Woodruff’s plexus, and the floor of the nasal cavity, in that order. The bleeding point was determined after the identification of the bleeding site. Retained blood was removed and the bleeding point was sought following a preliminary estimation of the bleeding site, using a small-diameter suction tip. Pulsating or jet-like bleeding was observed in the bleeding site if the mucosa was scraped using a suction tip, the bleeding point should be confirmed based on the miliary or punctate bulge or papillary hyperplasia in the nasal mucosa.
Disease-related expenditures and revision rates in chronic rhinosinusitis patients after endoscopic sinus surgery
Published in Journal of Medical Economics, 2018
Tina D. Hunter, Adam S. DeConde, R. Peter Manes
In addition to the impact of NP on revision rates, other factors were found to be influential. While we observed lower revision rates for patients with a diagnosis of deviated septum, Rudmik et al.16 reported a similar result based on concurrent septoplasty, which was highly correlated with the diagnosis in our population. Another study reported a similar correlation between the presence of septal deviation accompanied by septoplasty and improvement in patient reported outcomes after ESS (p = .004)21. We also found that females had an increased likelihood (p < .0001, HR = 1.2) of revision, which is consistent with the results of a logistic regression model (OR =1.20, p < .001) reported by Stein et al.13. Finally, several studies have reported significant differences in revision rates based on geography, with higher differences seen between individual US states and between regions within Alberta, Canada than we saw in this study, based on the larger and more diverse US Census Regions22,23.