R

1
? ?? ?????? ?? ????? ??? ?????
??? ???? ????? ????? ????? ? ?????? ??????? ????
???? - ????? ???????
R
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

4
Pathology Disease Symptoms

• Main symptoms
• Obstruction
• Discharge
• Posterior nasal drip
• Headache

Reda Kamel, M.D.
5
Pathology Disease Symptoms

• Epistaxis
• Bad odor
• Proptosis
• Anosmia
• Snoring
• Mouth breathing
• Nasal tone
• Sneezing
• Itching

Reda Kamel, M.D.
6
Pathology Causes Etiology of symptoms

• Congenital
• Traumatic
• Inflammatory
• Neoplastic
• Others

Reda Kamel, M.D.
7
Pathology 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
8
Pathology CausesEtiology of symptoms
Adenoid

• Child
• Bilateral nasal obstruction
• Snoring
• Mouth breathing
• Nasal Tone

Reda Kamel, M.D.
9
Pathology CausesEtiology of symptoms
Foreign Body

• Child
• Unilateral offensive nasal discharge

Reda Kamel, M.D.
10
Pathology CausesEtiology of symptoms
Nasopharyngeal angiofibroma

• Male
• Teen age
• Epistaxis

Reda Kamel, M.D.
11
Pathology CausesEtiology of symptoms
Nasopharyngeal Carcinoma

• Male
• 45 years old
• Heavy smoker
• Unilateral nasal obstruction
• Unilateral conductive deafness ET

Reda Kamel, M.D.
12
Symptomatology of nasal Diseases

• Obstruction
• Discharge
• Smell disorders
• Headache
• Epistaxis
• Proptosis

Reda Kamel, M.D.
13
Nasal obstruction

• Most common symptom.
• Unilateral or bilateral.
• Partial or complete.
• Associated with
• Nasal tone
• Mouth breathing
• Snoring
• Anosmia
• Facial deformity

Reda Kamel, M.D.
14
Symptomatology
1- Congenital

Foreign body
2- Traumatic
Accident
Iatrogenic

Acute
3- Inflammatory
Chronic
Specific
Nonspecific
Benign
4- Neoplastic
Malignant
5- Others
15
Symptomatology 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
16
SymptomatologyObstruction-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
17
Symptomatology 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
18
SymptomatologyObstruction-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
19
Symptomatology of nasal Diseases

• Obstruction
• Discharge
• Smell disorders
• Headache
• Epistaxis
• Proptosis

Reda Kamel, M.D.
20
Nasal 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.
21
Nasal 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.
22
Nasal 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.
23
Nasal 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.
24
Nasal Discharge

• Fetor secretions
• Foreign body
• Atrophic rhinitis
• Sinusitis of dental
• Oroantral fistula
• Invasive fulminant fungal sinusitis
• Midline granuloma
• Malignant tumors

Reda Kamel, M.D.
25
Symptomatology of nasal Diseases

• Obstruction
• Discharge
• Smell disorders
• Headache
• Epistaxis
• Proptosis

Reda Kamel, M.D.
26
Symptomatology of nasal Diseases

• Particles
• Dissolved in mucous
• Carried to olfactory mucosa Nerve endings
• Olfactory bulb
• Olfactory nucleus, hypothalamus thalamus

Reda Kamel, M.D.
27
Symptomatology 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.
28
Symptomatology Anosmia - hyposmia

• Nasal
• Mal-direction
• Obstruction
• Atrophic rhinitis mucosa
• Neuritis
• Cranial
• Olfactory bulb
• Olfactory nerve
• Meninges
• Psychic

Reda Kamel, M.D.
29
Symptomatology Cacosmia

• Foreign body
• Early Atrophic rhinitis
• Sinusitis of dental
• Oroantral fistula
• Invasive fulminant fungal sinusitis
• Midline granuloma
• Malignant tumors

Reda Kamel, M.D.
30
Symptomatology Smell disorders

• Parosmia hallucination neuritis
• Post-influenza
• Hysteria
• Epilepsy
• Insanity
• Hyperosmia increased sense of smell.
• Hysteria
• Mania

Reda Kamel, M.D.
31
Symptomatology of nasal Diseases

• Obstruction
• Discharge
• Smell disorders
• Headache
• Epistaxis
• Proptosis

Reda Kamel, M.D.
32
Headache 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.
33
Headache 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.
34
Headache 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.
35
Headache 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.
36
Headache Facial Pain Causes
Reda Kamel, M.D.
37
(No Transcript)
38
Vascular 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.
39
Symptomatology of nasal Diseases

• Obstruction
• Discharge
• Smell disorders
• Headache
• Epistaxis
• Proptosis

Reda Kamel, M.D.
40
Epistaxis

• Most common cause is idiopathic 90.
• Causes
• Local
• Idiopathic
• Congenital
• Traumatic
• Inflammatory
• Neoplastic Nasopharynx
• Others
• General

Sagital section
Reda Kamel, M.D.
41
Epistaxis

• 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.
42
Epistaxis

• 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.
43
Epistaxis

• 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.
44
Symptomatology of nasal Diseases

• Obstruction
• Discharge
• Smell disorders
• Headache
• Epistaxis
• Proptosis

Reda Kamel, M.D.
45
Proptosis

• Forward displacement of the eye ball in relation
  to the skull
• Direction depends on the cause

Reda Kamel, M.D.
46
Proptosis

• Cause
• Paranasal sinuses
• Lacrimal gland
• Orbital
• Nasopharyngeal JAF, SCC, Chordoma
• Cavernous sinus thrombosis
• Endocrinal toxic goitre

Reda Kamel, M.D.
47
Proptosis

• Paranasal sinuses
• Frontal sinus
• Downward and lateral
• Mucocele ostioma

Reda Kamel, M.D.
48
Proptosis

• Paranasal sinuses
• Ethmoid sinus
• Lateral
• Mucocele, ostioma, Fungal sinusitis malignant
  tumors

Reda Kamel, M.D.
49
Proptosis

• Paranasal sinuses
• Ethmoid sinus
• Lateral
• Mucocele, ostioma, Fungal sinusitis malignant
  tumors

Reda Kamel, M.D.
50
Proptosis

• Paranasal sinuses
• Maxillary sinus
• Superior
• Malignant tumors

Reda Kamel, M.D.
51
Proptosis

• 2- Lacrimal gland
• Downward and medial
• Malignant tumors

Reda Kamel, M.D.
52
Proptosis

• 3- Orbit
• Forward
• Haematoma, cellulitis, abscess, Malignant tumors

Reda Kamel, M.D.
53
Knowledge is power
R

Reda Kamel, M.D.