Return: Clerkship Objectives and Exam Topics Review

Note: last updated before 2018

Symptoms

• Obstruction leads to inflammation, infection, sinusitis, headaches and obstructive sleep apnea. 

Anatomic Deformities

• Septal/External nasal deviation 
  • Anatomic displacement of the nasal septum affecting the majority of the population to varying degrees. 
  • Severe deviation can cause obstruction leading to chronic/recurrent sinusitis or obstructive sleep apnea. 
  • Correction will not cure sleep apnea, but will improve airflow and often increases CPAP tolerance/compliance 
• Nasal valve compromise
  • The narrowest area of the nasal passage is referred to as the nasal valve. Alterations to the architecture of the nasal valve can result in increased resistance to airflow leading to obstruction. 
• Turbinate hypertrophy
  • Chronic inflammation due to allergies or a deviated septum can cause the nasal turbinates to increase in size which may contribute to nasal obstruction
• Nasal polyps
  • Localized edematous nasal/sinus mucosa
  • 50% of patients also have allergies.
  • Treatment: systemic steroids followed by intranasal steroids. Surgery if recurrent or resistant to treatment.
  • Other considerations for polyps:
    • Asthma-Exacerbated Respiratory Disease (AERD)Samter’s Triad (asthma triad): asthma, sensitivity to aspirin/NSAIDs and recurrent nasal polyposis.
      • Particularly bad form of nasal polyps and asthma. 
      • Treatment includes avoidance of NSAIDS or NSAID desensitization. 
    • Unilateral polyps --> work-up for neoplasm.
    • Polyps in kid --> work-up for Cystic Fibrosis.

Other nasal masses 

• Pyogenic granuloma (misnomer: caused by inflammation/irritation also increased incidence in pregnant women)
• Wegner’s granulomatosis 
• Sarcoidosis
• Inverting papilloma (HPV) 
• Juvenile nasopharyngel angiofibroma
• Esthesioneuroblastoma
• Sinonasal undifferentiated carcinoma
• Adenocarcinoma

Surgical treatments for Nasal Obstruction

• Septoplasty
• Turbinate Reduction 
• Adenoidectomy 

References/Recommended Reading

American Academy of Otolaryngology–Head and Neck Surgery Foundation. (2011). Primary Care Otolaryngology, Third Edition. Retrieved from: www.entnet.org. 

Nasal Aerodynamics. Samuel J Lin. Medscape Retrieved 12/19/17. https://emedicine.medscape.com/article/874822-overview#a1