Title: R
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2 THE NOSE AND PARANASAL SINUSES
Reda Kamel Professor of Rhinology Cairo
University Egypt
R
- Undergraduate, The Nose, October, 2005
3 Symptoms of Nasal Diseases
Reda Kamel Professor of Rhinology Cairo
University Egypt
R
- Undergraduate, The Nose, October, 2005
4Pathology Disease Symptoms
- Main symptoms
- Obstruction
- Discharge
- Posterior nasal drip
- Headache
Reda Kamel, M.D.
5Pathology Disease Symptoms
- Epistaxis
- Bad odor
- Proptosis
- Anosmia
- Snoring
- Mouth breathing
- Nasal tone
- Sneezing
- Itching
Reda Kamel, M.D.
6Pathology Causes Etiology of symptoms
- Congenital
- Traumatic
- Inflammatory
- Neoplastic
- Others
Reda Kamel, M.D.
7Pathology Causes Etiology of symptoms
1- Congenital
Foreign body
2- Traumatic
Accident
Iatrogenic
Acute
3- Inflammatory
Chronic
Specific
Nonspecific
Benign
4- Neoplastic
Malignant
Reda Kamel, M.D.
5- Others
8Pathology CausesEtiology of symptoms
Adenoid
- Child
- Bilateral nasal obstruction
- Snoring
- Mouth breathing
- Nasal Tone
Reda Kamel, M.D.
9Pathology CausesEtiology of symptoms
Foreign Body
- Child
- Unilateral offensive nasal discharge
Reda Kamel, M.D.
10Pathology CausesEtiology of symptoms
Nasopharyngeal angiofibroma
Reda Kamel, M.D.
11Pathology CausesEtiology of symptoms
Nasopharyngeal Carcinoma
- Male
- 45 years old
- Heavy smoker
- Unilateral nasal obstruction
- Unilateral conductive deafness ET
Reda Kamel, M.D.
12Symptomatology of nasal Diseases
- Obstruction
- Discharge
- Smell disorders
- Headache
- Epistaxis
- Proptosis
Reda Kamel, M.D.
13Nasal obstruction
- Most common symptom.
- Unilateral or bilateral.
- Partial or complete.
- Associated with
- Nasal tone
- Mouth breathing
- Snoring
- Anosmia
- Facial deformity
Reda Kamel, M.D.
14Symptomatology
1- Congenital
Foreign body
2- Traumatic
Accident
Iatrogenic
Acute
3- Inflammatory
Chronic
Specific
Nonspecific
Benign
4- Neoplastic
Malignant
5- Others
15Symptomatology Bilateral Obstruction - Nasal
Bil. Choanal atresia
Deviated septum
1- Congenital
Foreign body
2- Traumatic
Accident Fracture- Haematoma
Iatrogenic Pack-Haematoma
Acute nonspecific Common cold-Abscess
3- Inflammatory
Acute specific Diphtheria
Chronic nonspecific At. - Hypertrophic
Chronic specific T.B. - Scleroma
Benign Ostioma -papilloma
4- Neoplastic
Malignant Carcinoma - Sarcoma
5- Others
Polyps
Allergy
16SymptomatologyObstruction-Nasopharyngeal
Cyst
1- Congenital
Foreign body
2- Traumatic
Accident
Iatrogenic Pack
Acute nonspecific Common cold
3- Inflammatory
Acute specific Diphtheria
Chronic nonspecific At - Hypertrophic
Chronic specific T.B. - Scleroma
Benign Angiofibroma
4- Neoplastic
Malignant Carcinoma - Sarcoma
5- Others
Adenoid
17Symptomatology Unilateral Obstruction Nasal
Uni. Choanal atresia
Deviated septum
1- Congenital
Foreign body
2- Traumatic
Accident Fracture- Haematoma
Iatrogenic Pack-Haematoma
Acute nonspecific Common cold -Abscess
3- Inflammatory
Acute specific Diphtheria
Chronic nonspecific At - Hypertrophic
Chronic specific T.B. - Scleroma
Benign Ostioma -papilloma
4- Neoplastic
Malignant Carcinoma - Sarcoma
5- Others
Antrochoanal polyp
Allergy
18SymptomatologyObstruction-Nasopharyngeal
Cyst
1- Congenital
Foreign body
2- Traumatic
Accident
Iatrogenic Pack
Acute nonspecific Common cold
3- Inflammatory
Acute specific Diphtheria
Chronic nonspecific At - Hypertrophic
Chronic specific T.B. - Scleroma
Benign Angiofibroma
4- Neoplastic
Malignant Carcinoma - Sarcoma
5- Others
Adenoid
19Symptomatology of nasal Diseases
- Obstruction
- Discharge
- Smell disorders
- Headache
- Epistaxis
- Proptosis
Reda Kamel, M.D.
20Nasal Discharge
- Second major symptom.
- Unilateral or bilateral.
- Anterior or posterior
- May be
- Mucoid
- Watery
- Purulent muco-purulent
- Sanguineous
- Crusty
- Fluid food
Reda Kamel, M.D.
21Nasal Discharge Bilateral
- Mucoid All cases of nasal obstruction.
- Purulent Acute and chronic Sinusitis and acute
rhinitis. - Watery
- Acute rhinitis
- Allergic rhinitis
- Vasomotor rhinitis
- Lacrimation
Reda Kamel, M.D.
22Nasal Discharge Bilateral
- Sanguineous Epistaxis
- Crusty
- Atrophic rhinitis
- Granuloma
- Fluid food nasal regurge
- Cleft palate
- Perforated palate
- Short soft palate
- Paralyzed soft palate
Reda Kamel, M.D.
23Nasal Discharge Unilateral
- Mucoid all causes of unilateral nasal
obstruction. - Purulent sinusitis - dental
- Watery CSF leak
- Sanguineous unilateral epistaxis.
- Crusty unilateral turbinectomy
- Fluid food Oroantral fistula
Reda Kamel, M.D.
24Nasal Discharge
- Fetor secretions
- Foreign body
- Atrophic rhinitis
- Sinusitis of dental
- Oroantral fistula
- Invasive fulminant fungal sinusitis
- Midline granuloma
- Malignant tumors
Reda Kamel, M.D.
25Symptomatology of nasal Diseases
- Obstruction
- Discharge
- Smell disorders
- Headache
- Epistaxis
- Proptosis
Reda Kamel, M.D.
26Symptomatology of nasal Diseases
- Particles
- Dissolved in mucous
- Carried to olfactory mucosa Nerve endings
- Olfactory bulb
- Olfactory nucleus, hypothalamus thalamus
Reda Kamel, M.D.
27Symptomatology Smell disorders
- Anosmia loss of sense of smell.
- Hyposmia decrease sense of smell.
- Cacosmia bad odor perceived by patient and/or
contacts. - Parosmia hallucination not existing.
- Hyperosmia increased sense of smell.
Reda Kamel, M.D.
28Symptomatology Anosmia - hyposmia
- Nasal
- Mal-direction
- Obstruction
- Atrophic rhinitis mucosa
- Neuritis
- Cranial
- Olfactory bulb
- Olfactory nerve
- Meninges
- Psychic
Reda Kamel, M.D.
29Symptomatology Cacosmia
- Foreign body
- Early Atrophic rhinitis
- Sinusitis of dental
- Oroantral fistula
- Invasive fulminant fungal sinusitis
- Midline granuloma
- Malignant tumors
Reda Kamel, M.D.
30Symptomatology Smell disorders
- Parosmia hallucination neuritis
- Post-influenza
- Hysteria
- Epilepsy
- Insanity
- Hyperosmia increased sense of smell.
- Hysteria
- Mania
Reda Kamel, M.D.
31Symptomatology of nasal Diseases
- Obstruction
- Discharge
- Smell disorders
- Headache
- Epistaxis
- Proptosis
Reda Kamel, M.D.
32Headache Facial Pain
- Definition
- Headache Pain in the head From the orbit back
to the sub-occipital region. - Facial pain Pain elsewhere in the face.
- Mechanism Traction or distention of pain
sensitive structures
Reda Kamel, M.D.
33Headache Facial Pain
- Pain sensitive structures
- Dura of skull base
- Cerebral arteries
- Venous sinuses
- Nerves
- Cranial nerves 5, 9, 10
- Cervical nerves C2,3
Reda Kamel, M.D.
34Headache Facial Pain Causes
- Extracranial
- Nasal
- Aural
- Ocular
- Dental
- TMJ
- Cervical
- Neuralgia
- Vascular
- General
- Intracranial
- Trauma head trauma
- Infection Meningitis, enchephalitis, brain
abscess - Tumour Brain tumour
Reda Kamel, M.D.
35Headache Facial Pain Causes
- Nasal
- More severe in the morning
- Increases on straining coughing
- Site depends on the affected sinus
- Infection acute chronic sinusitis
- Tumours malignant
- Aural
- Otitis externa
- Acute otitis media
- Chronic otitis media complicated
- Tumours malignant
Reda Kamel, M.D.
36Headache Facial Pain Causes
Reda Kamel, M.D.
37(No Transcript)
38Vascular Migraine
- Paroxysmal attacks of hemicranial pain preceded
by an aura flashes of light - Throbbing, episodes for 4-72 h
- Associated with nausea, vomiting, photophobia,
phonophobia - Mechanism
- Vasospasm ? aura
- Vasodilatation ? headache
- Family history Young age
- Treatment
- Acute attack Ergot Caffeine
- Prophylactic Beta blockers
Reda Kamel, M.D.
39Symptomatology of nasal Diseases
- Obstruction
- Discharge
- Smell disorders
- Headache
- Epistaxis
- Proptosis
Reda Kamel, M.D.
40Epistaxis
- Most common cause is idiopathic 90.
- Causes
- Local
- Idiopathic
- Congenital
- Traumatic
- Inflammatory
- Neoplastic Nasopharynx
- Others
- General
Sagital section
Reda Kamel, M.D.
41Epistaxis
- General
- Cardio-vascular hypertension
- Haematologic
- Platelets Thrombocytopenia
- Haemophilia coagulation
- Asprin anti-platelet
- Heparin anti-coagulant
- Leukemia Hodgkins lymphoma
- Hepatic thrombocytopenia
- Fever vasculitis
Reda Kamel, M.D.
42Epistaxis
- Most common site is Littles area anastomosis
of 4 arteries. - Greater palatine,
- Superior labial,
- Anterior ethmoid
- Sphenopalatine.
- Stop bleeding before investigations.
- CBC, BT, CT, PT, PTT mainly, biopsy.
Sagital section
Reda Kamel, M.D.
43Epistaxis
- Treatment
- Vasoconstrictor pack
- Cautery
- Anterior
- Posterior Endoscopic
- Merocel pack
- Nasal balloon
- Anterior nasal pack
- Posterior nasal pack
- Ligation of maxillary external carotid or
ethmoid arteries, rare. -
Sagital section
Reda Kamel, M.D.
44Symptomatology of nasal Diseases
- Obstruction
- Discharge
- Smell disorders
- Headache
- Epistaxis
- Proptosis
Reda Kamel, M.D.
45Proptosis
- Forward displacement of the eye ball in relation
to the skull - Direction depends on the cause
Reda Kamel, M.D.
46Proptosis
- Cause
- Paranasal sinuses
- Lacrimal gland
- Orbital
- Nasopharyngeal JAF, SCC, Chordoma
- Cavernous sinus thrombosis
- Endocrinal toxic goitre
Reda Kamel, M.D.
47Proptosis
- Paranasal sinuses
- Frontal sinus
- Downward and lateral
- Mucocele ostioma
Reda Kamel, M.D.
48Proptosis
- Paranasal sinuses
- Ethmoid sinus
- Lateral
- Mucocele, ostioma, Fungal sinusitis malignant
tumors
Reda Kamel, M.D.
49Proptosis
- Paranasal sinuses
- Ethmoid sinus
- Lateral
- Mucocele, ostioma, Fungal sinusitis malignant
tumors
Reda Kamel, M.D.
50Proptosis
- Paranasal sinuses
- Maxillary sinus
- Superior
- Malignant tumors
Reda Kamel, M.D.
51Proptosis
- 2- Lacrimal gland
- Downward and medial
- Malignant tumors
Reda Kamel, M.D.
52Proptosis
- 3- Orbit
- Forward
- Haematoma, cellulitis, abscess, Malignant tumors
Reda Kamel, M.D.
53Knowledge is power
R
Reda Kamel, M.D.