Disorders of Nose and Paranasal Sinus - NEET PG ENT

Disorders of the nose and paranasal sinuses are an important topic for NEET PG because they are common and can have a significant impact on a person's quality of life. 

Therefore, it is essential for medical professionals to have a good understanding of the anatomy and physiology of the nose and sinuses, as well as the diagnosis and management of the various disorders that can affect these structures.

In this blog, we have covered this important ENT topic from the NEET PG exam point of view. Read on and get a quick overview and enhance your NEET PG Exam Preparation.

Rhinosinusitis   

1. Acute Rhinosinusitis
   • Mc causative agent: Rhinovirus, self-limiting disease 
   • In 10-20% cases it was caused by corona viruses
   • Novel corona virus not only cause acute rhinosinusitis, it also severe Acute Respiratory Distress Syndrome 
   • Discharge: mucoid (colourless) discharge
   • Treatment: Symptomatic 
2. Acute Bacterial Rhinosinusitis
   • M/c: Streptococcus pneumoniae
   • Discharge:Mucopurulent (Yellowish/Green)
   • Treatment: Symptomatic + Antibiotics
3. Chronic Rhinosinusitis
   • >12 weeks: Chronic Rhinosinusitis 
   • Mc causative organism: Staph Aureus
   • Treatment: Culture/sensitivity directed Antibiotics + Nasal Decongestants (Rx of choice)

↓not responding 

FESS (Functional endoscopic Sinus Surgery) – reserved treatment 

• 4. Vasomotor Rhinosinusitis
  • Due to increase parasympathetic discharge 
  • There is non allergic, non infective, perineal rhinosinusitis (NANIPER) 
  • More common in emotional female
  • Rx anticholinergic drugs / anticholinergic spray e.g Ipratropium Bromide 
•   Gold standard Treatment: Vidian Neurectomy
• 5.Rhinitis Medicamentosa
  • Excess usage of Nasal decongestants for long period of duration which leads to Rebound congestion because of that hypertrophy occurs & congestion of nasal mucosa leads to nasal obstruction 
  • Rx: Intra nasal corticosteroid spray (DOC)

• 6. Allergic Rhinosinusitis                             

• M/c allergen: Carpet dust mites/ House dust mite 
• Symptoms:
  • Intermittent Symptoms (< 4 days/ week or < 4 weeks)
    • Mild
    • Moderate - Severe
• Persistent Symptoms (> days/week &> 4 weeks)  OR   
• Mild symptoms – not causing day to day problems, life style is not affected 
• Moderate – Severe – lifestyle is affected, patient is not able to concentrate is school or office, day time lethargicness present

Also Read : How to prepare ENT for Medical PG Entrance Exams ?

Also Read: Anatomy of Middle ear

On Examination

• Signs 
  • Allergic or Atopic facies- mouth breathing
    • Allergic Shiner (Dark circles around eyes) and Dennie morgan lines 
    • Allergic salute:  Nasal Crease – transverse crease created on Dorsum of nose 
  • On examination - Pale bluish hypertrophic mucosa 
  • Confirmed by Skin Prick Test: IOC 
  • Nasal Allergen challenge/ Provocation test/inhalation test (Gold Standard)
    • Not clinically done 
• Rx 
  • Mild – Intermittent: 2^nd generation non sedative Antihistamine 
  • Moderate to severe/ Persistent: Intranasal steroid spray is given and if not responds to pharmacotherapy, then immunotherapy is given 
  • Desensitization is done where increasing dosage of allergens is given for 3-5 years to decrease hypersensitivity (Type II) in patient 

Important Information Immunotherapy is the only curative therapy for chronic allergic Rhinosinusitis Only given in severe persistent patients

Nasal Polyps                

Antro-choanal Polyp (AC Polyp)	Ethmoidal Polyp
Starts from Maxillary antrum and goes to choana	starts from ethmoidal air cells and terms out from Anterior Nares
Single, Lange, Unilateral	Small, multiple, bilateral
Grows posteriorly towards choana	Comes out Anteriorly
d/t infection	d/t allergy
Seen in children	Seen in Adults

• M/c site of obstruction: Middle meatus
• Gold standard investigation: CT scan
• Rx:  FESS

Polyps with Syndrome

• Samter's Triad: Asthma + Aspirin intolerance + Polyps 
• Kartagener Syndrome: Situs Inversus + Bronchiectasis + Polyps
• Young Syndrome: Azoospermia + Bronchiectasis + Polyps 
• Churg Strauss Syndrome: Eosinophilic granulomatosis with Polyangiitis 
• NARES: Non-Allergic Rhinitis with Eosinophilia also has Polyps
• Allergic fungal Rhinosinusitis (AFRS): also has Nasal Polyps, 10% cases are associated with nasal polyps

Atrophic Rhinosinusitis (OZAENA)

• Causative agents: Klebsiella Ozaenae (Perez bacillus)
• Young Females of poor socio-economic status with
  • Iron deficiency 
  • Multi Vitamin (Vitamin D) deficiency
• Pseudo stratified Ciliated columnar epithelium is converted to Stratified Squamous epithelium
• Mc complaint: B/L Nasal obstruction  
  • Foul smell (Ozaena)
  • Anaemia: Merciful Anosmia
• Rx
  • Alkaline Nasal Douching :  Crust softens Klebsiella does not grow
  • 25% Glucose in Glycerine (Hygroscopic effect)

↓

Nourishes the columnar cells 

• Antibiotics
• Multivitamins (Vitamin D), Fe supplements
• Estrogen Spray
• Surgery
  • Young's Operations:  Alternative closure of each nasal cavity for 6 months
  • Modified Young's Operations:  partially closing both Nasal cavities.

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