From: Subject: Name of speciality Date: Fri, 1 Sep 2006 12:35:12 +0530 MIME-Version: 1.0 Content-Type: text/html; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable Content-Location: file://C:\WINNT\Profiles\Administrator\Desktop\1sep\ent\nasalpolyp.htm X-MimeOLE: Produced By Microsoft MimeOLE V5.00.2314.1300 Name of = speciality

Name of speciality           =20 :           =20 ENT

Name of case=20            =20 :           =20 Nasal Polyp

Name of expert :           =20 Prof. A. Ravikumar

Name of Hospital : Sri Ramchandra Medical College = &=20 Research

Institute (Deemed University), = Porur,=20

Chennai - = 6000116

 

 

1.    = History

 

Onset of = symptoms

           =20            =20 Sudden

           =20            =20 Insidious

 

Chief = complaints

 

Progression of = symptoms

           =20            =20 Rapid

           =20            =20 Gradual

           =20            =20 Intermittent

Functional deficits at=20 present

           =20            =20 eg. effort intolerance

           =20            =20      =20 Loss of smell etc.

History of = allergy

           =20            =20 Especially dust, Aspirin

           =20            =20 Drug allergy

Associated = disease

           =20            =20 Bronchial Asthma

           =20            =20 Hypertension

           =20            =20 Skin Allergies

Addictions

           =20            =20 H/o Smoking, snuff, tobacco use

           =20            =20 Alcohol / drug use

Treatment History         =20

           =20            =20 Medications / Surgical procedures

2.    = Clinical = Examination

 

General = Examination:

           =20            =20 Pallor, Cyanosis, Clubbing, Vital Parameters

 

Local Examination(Nose, PNS & = Throat)

           =20            =20 External nose

           =20            =20 Anterior Rhinoscopy

Posterior=20 Rhinoscopy

Probe=20 test

Tests for=20 olfaction

Signs of=20 Paranasal Sinus Disease

Throat =96=20 Pharyngitis, Post Nasal Drip

 

 

3.    = Investigations

Nasal=20 smear(of discharge) =96 for Eosinophils

Routine=20 Hematology including Absolute Eosoniphil count

X-Ray =96=20 Paranasal Sinuses(PNS)

CT Scan =96=20 PNS

Diagnostic=20 Nasal Endoscopy(DNE)

Allergy Skin=20 Prick tests

 

4.    = Differential = Diagnosis

Etmoidal=20 polypi

Antro choanal=20 Polyp

Hypertrophied=20 Turbinate

Rhinosporidiosis

Juvenile=20 Nasopharyngeal Angiofibroma(in young males)

Inverted=20 Papilloma

Meningocele:=20 Meningo myelocele(in child)

Aesthesio=20 neuroblastoma

Malignant=20 tumors of PNS presenting in inose

Granulomatous=20 diseases of nose and PNS including

Fungal=20 granulomas

 

5.    = Non-Surgical = Management

Antihistamines,=20 Decongestants

Mucolytics

Antibiotics

Topical=20 steroid nasal sprays

Topical=20 anti-histamine sprays

Topical=20 Ipratropium sprays

Topical nasal=20 drops

Systemic=20 steroids =96 oral, parental

Leukotrine=20 antagonists

 

6.    = Surgical = Management

Polypectomy(Trans-Nasal)

Caldwell =96=20 Luc operation

Functional=20 Endoscopic Sinus Surgery(FESS) + Polypectomy

Microdebrider=20 / Laser assisted Polypectomy

External=20 Ethmoidectomy

 

7.    = Any other

Radio Allegro=20 Sorbent Test(RAST) =96 its importance

Kartagener=92s=20 Syndrome

Young=92s=20 Syndrome

Samter=92s=20 Triad =96 Nasal Polyposis, Asthma & Aspirin Intolerance

Merits &=20 Demerits of FESS including complications and long term Management