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 Pallor Icterus Cyanosis Clubbing Lymphadenopathy Pedal edema Absent • 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