Deviated Nasal

Septum with
Sinusitis
RAGHUNANDAN RAMANATHAN
PRE FINAL YEAR, TAGORE MEDICAL COLLEGE
Particulars

 Name: Vasanth
 Gender: Male
 Age:35
 Occupation: Teacher
 Address: Kelambakkam
 Came to Tagore MC ENT OPD
 On 8/09/2020
Chief Complaints

 Patient complains of bilateral nasal obstruction since 10

months
 Patient complains of bilateral nasal discharge since 6
months
 Patient complains of facial pain since 5 months
History Of Presenting Illness
 Patient was apparently normal 10 months back and then he
developed nasal obstruction which was initially unilateral (left side)
and then progressed to become bilateral.
 It was insidious in onset and caused partial blockage and is present
all the time.
 Aggravated with URI and slightly relieved on medication.
 Postural Variation seen. Obstruction increased on lying in supine or
left lateral position.
 Associated with mild loss of sensation of smell
 No history of mouth breathing or snoring
 Patient also complains of nasal discharge since 6 months
which is bilateral, sudden in onset and intermittent in nature.
 The discharge gradually progressed and was mucopurulent
in consistency.
 Aggravated during seasonal changes and relieved with
medication.
 Patient also complains of facial pain since 5 months which
is bilateral and intermittent in nature.
 Character – Dull aching
 Gradually progressed and was aggravated during URI.
 Diurnal variation was present and was increased at night
time.
 Relieved with medication
 Associated with throat clearing
 No history of fever
 No history of sneezing, itching or watering of eyes
 No history of ear pain or reduced hearing
 No history of sore throat
Past History
 No history of DM, TB, HTN, Syphilis, Asthma
 No history of any nasal or dental surgeries
 History of any trauma a year back.
 No history of drug allergies(aspirin)

FAMILY HISTORY
 Nothing significant
Personal History

 Diet: Adequate, Mixed

 Appetite: Normal
 Sleep: Disturbed
 Bowel and Bladder movements: Normal
 Addictive Habits : none
Summary

 Here is a case of a 35 year old male who complains of

bilateral nasal obstruction which was initially on the left
side that progressed to involve the right side. The
obstruction was associated with bilateral mucopurulent
nasal discharge and facial pain.
General Physical Examination

 Patient’s consent was taken

 Patient was oriented to time, space and person
 Examination was done under adequate exposure to light
 Patient was of moderate built
 BMI :- 23
Vitals
RR: 16 breaths/min Temp: 98˚ F
Pulse: 77 beats per minute, regular rhythm, normal in volume and
character, no radio- radio delay, other pulses felt and are normal
BP: 120/90 mm of hg in right arm, sitting position
 Pallor: not seen, Icterus: not seen, Clubbing: not seen, Cyanosis: Not
seen, Lymphadenopathy: not present, Edema: Not present

Systemic Examination
 CVS: S1 and S2 heard, no murmurs
 RS: Normal Vesicular Breath Sounds, no added sounds
 Abd : soft, non tender, no organomegaly
 CNS: no focal neurological deficit
Local Examination - Nose

 External nose : -normal

 Vestibule: - Normal
 Cold Spatula Test: - reduced fogging on both the sides.
More marked on the left side.
 Anterior Rhinoscopy:-
Nasal passage: Narrow (septal deviation to left side and
hypertrophy of turbinates on right side
Septum: Deviation to the left side and caudal dislocation to
the right side
 floor of nose : normal
lateral wall-
mucosa :- congested
turbinates:- hypertrophied on right side
purulent discharge present in middle meatus
No Crust, Mass, Maggots

 Cottle test: positive on left side

Examination of Paranasal Sinuses
 Swelling and Redness over the area of skin overlying maxillary
sinus.
 Maxillary tenderness present in right and left side
 Frontal tenderness - absent
 Ethmoidal tenderness - absent

Sinus Right Left

Maxillary Tenderness Positive Positive

Frontal Tenderness Negative Negative

Ethmoidal Tenderness Negative Negative

 Posterior rhinoscopy:
Choana free
hypertrophied posterior ends of turbinates on the right side
Purulent discharge in middle meatus
Examination of Ear
Right Left
Pinna normal normal
Pre-auricular area normal normal

Post-auricular area normal normal

Tragal Tenderness absent absent

Mastoid Tenderness absent absent

External Auditory Canal normal normal

Tympanic Membrane Normal Normal

 Right Left

Rinne’s test positive positive

Weber’s test Equally heard on both sides

Absolute Bone Conduction Not reduced Not reduced

Test
Facial Nerve test

Able to close eyes tightly yes yes

Able to blow cheeks yes yes

Able to raise eyebrows yes yes

Able to stretch neck yes yes

Fistula Test negative negative

Examination of Oral Cavity

Right Left

Lips Normal Normal

Buccal Mucosa Normal Normal

Gums and Teeth Normal Normal

Hard Palate Normal Normal

Ant. 2/3rds of tongue Normal Normal

Floor of mouth Normal Normal

Retromolar trigone Normal Normal

 EXAMINATION OF OROPHARYNX
Right Left
Post. 1/3rd of tongue and vallecula Normal Normal
Anterior Pillar Normal Normal
Tonsil Normal Normal
Posterior Pillar Normal Normal
Soft palate and uvula Normal Normal
Post. Pharyngeal Wall Normal Normal

EXAMINATION OF NECK
 Inspection -Skin is normal

-No swellings seen

 Palpation – No palpable lymph nodes
Diagnosis
 Case of left sided C- shaped Deviated Nasal Septum with
chronic Maxillary sinusitis
Investigation
 X ray nose and paranasal sinus(water’s view).
 Diagnostic Nasal Endoscopy
 CT scan – Coronal (3mm cut), Sagittal

MANAGEMENT
 Medical management for chronic sinusitis
 Septoplasty
 Septo-turbinoplasty with Functional Endoscopic Sinus Surgery
Thank You