CASE PRESENTATION

By – Dr Pulkit Agarwal

Particulars

• George Kurian• 72 yrs• Christian• Harihar• Engineer

Chief Complaints

• Right sided nasal obstruction since 2 months

HOPI :

• Right sided, Insidious in onset, progressive, partial, no positional variation, no diurnal variation

• H/O foul smell from nose (stopped after course of antibiotic)• No H/O Nasal Discharge• No H/O chronic irritation in throat• No H/O excessive Sneezing• No H/O recurrent bleeding from nose• No H/O Headache• No H/O Ringing sensation in ear, ear pain or ear discharge• No H/O recurrent cold• No H/O reduced/altered sense of smell

• No H/O change in voice• No H/O significant loss of weight• No H/O Facial pain• No H/O trauma• No H/O loosening of tooth• No H/O double vision

Treatment History :

• Patient is a known diabetic on treatment since 14 yrs on (Metformin 750mg daily)

• Patient has taken a course of antibiotic (amoxyclav), nasal decongestant drops (xylometazoline), mucolytic for a span of one week.

Past history :

• No H/O Hypertension, Bronchial Asthma, Prolonged medication

• No H/O drug allergies (NSAID)

Personal history :

• Diet – Mixed• Appetite – Normal• Bowel and Bladder – Normal and regular• Sleep – reduced due to nasal obstruction• No addictions

Family history :

• No H/O similar complaints in family members

General physical examination

• Elderly male, moderately built and nourished, cooperative and well oriented to time, place person

• General Condition – Fair , Vitals – Stable

PallorIcterusCyanosisClubbing AbsentLymphadenopathyPedal edema

• Nose : • External Appearance – No apparent external

deformity of nose.• Cold Spatula test – decreased misting on Rt side• ARE : • Bilateral inferior turbinate visualised, left side middle

turbinate seen normally.• Rt Nasal Cavity – pinkish fleshy polypoidal mass seen

at the level of middle turbinate completely occupying the nasal cavity (middle turbinate not visualised)

• Insensitive to touch, doesn’t bleed, soft in consistency, can be probed all around except laterally

• PNS Examination :

• EA – No apparent facial deformity• No tenderness

• Throat examination :

• Oral cavity – No hard palate bulge, No loosening of teeth, no oroantral fistula

• Oropharynx – normal• PRE – normal

• Ear – normal

• Neck Examination – No lymphadenopathy• EYE – No proptosis, no diplopia

Systemic examination :

• CVS – S1S2 heard , no murmurs

• R/S – Bilateral NVBS+, No added sounds

• P/A – soft , no organomegaly

• CNS – no focal neurological deficit

Provisional diagnosis :

• ? Antronasal polyp• ? Inverted papilloma• ? Mucocele Rt maxillary sinus• ? Sinonasal malignancy