[Link] is Bernoulli’s phenomenon?

When gas or liquid passes through a narrow constricted area at a high velocity, negative pressure develops in the vicinity so
that mucosa is sucked out along with occurrence of edema and extravasation of fluid.
[Link] are the types of nasal polyp?
Antrochoanal polyp and Ethmoidal polyposis
[Link] are the causes for development of nasal polyposis?
Allergy
Infection
Bernoulli’s phenomenon
Vasomotor instability
Cystic fibrosis
Non allergic rhinitis with eosinophilia
Allergic fungal sinusitis
Associated with Karatagener’s syndrome, Young’s syndrome, cystic fibrosis and Sampter’s triad
[Link] antrochoanal polyp goes posteriorly?
Because it comes out thru’ the accessory ostium which is directed posteriorly
The normal anatomical contour of the nasopharynx is sloping downwards and backwards
The mucociliary clearance is directed posteriorly
Due to the effect of gravity
[Link] between AC polyp and ethmoidal polyposis?

ETHMOIDAL POLYP AC POLYP

Multiple-bilateral Single-unilateral
Affects adolescents and middle age Affects children and younger individuals
Site of origin;ethmoidal labyrinth Maxillary antrum
Aetiology:allergy and infection Aetiology is not known allergy may play a
role
Anterior rhinoscopy-multiple polypi in middle Posterior rhinoscopy-single polypus in
meatus choana
X ray paranasal sinuses haziness in ethmoidal Haziness in affected antrum
labyrinth and often antra
Recurrences are common Recurrences are less common
 6. DD for nasal polyp
Hypertrophied inferior turbinate JNA
Inverted papilloma Rhinosporidiosis
Encephalocoele/ meningoencephalocoele in children
[Link] will you differentiate between an AC polyp and a mass arising from the roof of the
nasopharynx?
X-ray lateral view of the nasopharynx will show a curvilinear or crescentic air shadow between the
mass and roof of nasopharynx in an antrochoanal polyp
[Link] are the structures you see on post nasal examination?
Posterior end of nasal septum
Choanae
Posterior ends of the middle and inferior turbinates
Nasopharyngeal end of the Eustachian tube
Torus tubaris or tubal elevation
Fossa of Rosenmuller
[Link] is Cottle’s test,line and areas?
TEST: When the cheek is drawn laterally if there is improvement of airway on the affected side it
indicates abnormality of the vestibular component of nasal valve
LINE: A line drawn from the nasal spine of the frontal bone to the anterior nasal spine of the
maxilla
For any deviation anterior to the line septoplasty is done
For posterior deviations SMR is done
AREA : Vestibular, attic, valvular, turbinal and choanal
[Link] is Little’s area?
An area of arterial anastamosis between the branches of the external and internal carotid arteries
situated in the antero inferior part of the nasal septum
Major site of bleeding
[Link] are the arteries taking part in the formation of Kiesselbach’s plexus?
Anterior Ethmoidal artery
Sphenopalatine artery
Greater palatine artery
Superior labial artery
[Link] is olfactory area?
Situated in the roof of the nasal cavity , above the superior turbinate and corresponding area of
the nasal septum
[Link] is paradoxical nasal obstruction?
A patient with a deviated nasal septum to one side complains of nasal obstruction on the opposite
side due to the compensatory hypertrophy of the inferior turbinate on the opposite side
[Link] is compensatory hypertrophy?
Hypertrophy of the inferior turbinate on the concave side of septal deviation to take over the
humidification and warming functions.
[Link] are the reasons for headache in deviated nasal septum?
Deviated nasal septum can lead to obstruction of sinus ostia leading to sinusitis and headache
Pressure on the anterior ethmoidal nerve due to impaction of septum on the middle
turbinate leading to headache
Vacuum headache
[Link] is Sluder’s neuralgia?
Pressure on the anterior ethmoidal nerve due to impaction of septum on the middle
turbinate
[Link] are the types of septal deviation?
C shaped,S shaped,septal spur and caudal septal dislocation
[Link] are the indications for SMR?
DNS with nasal obstruction
Deviation causing Sluder’s neuralgia
To close septal perforation
Other indications
An approach to sphenoidal sinus, pituitary gland
Transeptal vidian neurectomy
To obtain cartilage graft
Transeptal repair of CSF rhinorrhea
19. What are the indications for septoplasty?
a) Nowadays it is preferred in the majority of cases of nasal septal deflections
b) In children(All septal surgery should if possible be left until facial growth is complete)
c) In anterior deflections of septum where S.M.R is contraindicated.
d) In caudal dislocations
e) Approach route for trans-sphenoidal surgery

[Link] are the differences between septoplasty and SMR?

S.M.R SEPTOPLASTY

1 Usually indicated for deflections posterior to Indicated for anterior segment deflections and
the vertical line passing between the nasal dislocations
processes of the frontal and maxillary bones.

2 Killian’s incision is used. Oblique incision Usually Freer’s hemitransfixation incision.

about 5mm behind the mucocutaneous
 junction

3 Mucoperichondrium and periosteum is Mucoperichondrium is elevated on one or both

elevated on both sides sides.

4 Obstructing cartilage and bone are removed Septal cartilage is freed from all its
leaving only the dorsal and caudal struts of attachments and maintained in its new position
cartilage. by sutures after suitable scoring.

5 Complications include perforation, supra tip Complications are rare

saddling,retraction of the columella and
septal hematoma.

[Link] are the complications of septal surgery?

Hemorrhage Septal Hematoma
Septal abscess Septal perforation
Columellar retraction Flapping of the septum
Saddle nose Tip collapse
Synechiae formation
22. What are the causes for septal perforation?
Traumatic – due to septal surgery, fracture, nose picking,cautery
Infective – syphilis (bony), leprosy (bony and cartilaginous), TB
Malignancy
Chemicals – cocaine, chromic acid
23. What are the constituents of nasal septum?
Quadrangular septal cartilage, perpendicular plate of the ethmoid, vomer with contributions from
the crest of the nasal bones, nasal spine of frontal bone, rostrum of sphenoid, crest of palatine
bones, maxillary crest and anterior nasal spine of maxilla
[Link] ethmoidal polyp is bilateral and multiple?
Because the ethmoidal labyrinth is a single midline unit
There are 15 -20 air cells with multiple ostia
[Link] is Frog face?
Broadening of the nose. May be seen in extensive ethmoidal polyposis and JNA
[Link] is hypertelorism?
Widening of the inter canthal distance
[Link] polyp.
Macroscopically Polyp is a soft,smooth, cystic swelling of mucosa usually translucent may be opaque or
pale due to exposure to air currents or trauma
Microscopically it consists of hypertrophied edematous mucosa usually lined by ciliated columnar
 epithelium,may be transitional or squamous due to exposure to air currents, consisting of fibrillar
stroma with intercellular fluid spaces with lymphocytes, polymorphs and eosinophils
[Link] polyp is insensitive to touch?
Because of scarcity of nerve endings
[Link] polyp does not bleed on touch?
Because it is avascular
[Link] a polyp bleeds what will you suspect?
Metaplasia to transitional or squamous epithelium due to exposure to air currents
Underlying malignancy in an elderly patient
31.A child with a unilateral nasal obstruction with foul smelling nasal discharge and bleeding,what
will you suspect?
Ignored Foreign body
[Link] is atrophic rhinitis?
Non-specific chronic inflammatory condition of the nasal cavity characterized by progressive
Atrophy of the nasal mucosa with underlying turbinates resulting in abnormal patency with
yellowish-green crust formation and usually associated with ozaena
[Link] is cacosmia?
Perception of bad odour
[Link] is merciful anosmia?
Patient with atrophic rhinitis has hyposmia or anosmia but foul odour is detected from the patient
by others due to presence of foul smelling crusts
[Link] are the organisms present in atrophic rhinitis?
Coccobacillus, Bacillus mucosus, Coccobacilus foetidus ozenae, Klebsiella and Diphtheroids
[Link] are the causes of Atrophic rhinitis?
Primary – cause is not known, may be due to hormonal, hereditary, autoimmune response of
Mucosa, zinc,iron and Vitamin A deficiency and a variant of Reflex Sympathetic Dystrophy
syndrome
Secondary – may be due to trauma, extensive nasal surgery and inflammatory due to
Tuberculosis, syphilis
[Link] are the types of Atrophic rhinitis?
Type I – Terminal arterioles show endarteritis and periarteritis
Type II –Capillary proliferation and dilatation
[Link] are the conventional methods of polypectomy?
Intranasal polypectomy(avulsion) – removal of polyp with uncapping of the bony ostium
Intranasal ethmoidectomy
External ethmoidectomy
Transantral ethmoidectomy
FESS
[Link] are the indications for Caldwell- Luc surgery?
Chronic maxillary sinusitis unresponsive to medical treatment and minor surgical procedures like
antral lavage
Recurrent antrochoanal polyp
Trans antral ethmoidectomy
Suspected antral malignancy for doing a biopsy
Removal of foreign bodies in the antrum (most common FB is tooth)
Blow out fractures of the orbit
Repair of oro antral fistula
Transantral ligation of maxillary artery in the pterygopalatine fossa
Transantral vidian neurectomy
40. Which is the indication as well as complication for Caldwell- Luc surgery?
Oro-antral fistula
41. How will you treat atrophic rhinitis medically?
Alkaline douche with soda bicarbonate,sodium biborate and sodium chloride in the
ratio of 1:1:2 1 tsp dissolved in 280 ml of water
Application of 25% glucose in glycerine will inhibit proteolytic organisms and keep the mucosa
moist
Oestradiol in arachis oil [Not used in Type II – tendency to produce bleeding]
Injection of placentrex – biological product which has got biogenic action
Kemicetine antiozaena solution – chlormycetin,estradiol and vitamin D2
[Link] is the surgery you do for atrophic rhinitis?
Aim is to narrow the nasal cavity and give rest to the nasal mucosa
Young’s operation /Modified Young’s operation
Lautenslager’s operation : Medialisation of lateral wall
Transpositioning of the Stensen’s duct into the maxillary antrum to moisten the nasal cavity
[Link] are the functions of the nose?
Respiration
Air conditioning of inspired air
Filtration
Protection of lower airway
Vocal resonance
Olfaction
[Link] is the nerve supply of nose?
Anterior Ethmoidal nerve
Branches of sphenopalatine ganglion
Branches of infraorbital nerve
[Link] are the clinical findings in sinusitis?
 Presence of mucopurulent or purulent discharge in the meati
Sinus tenderness
Post nasal drip
[Link] are the investigations you will do for a patient with DNS and sinusitis?
Diagnostic nasal endoscopy
X ray para nasal sinuses – Water’s view
CT scan of the paranasal sinuses
[Link] will you look for in the X ray?
Anterior group of sinuses will be visualized
Sphenoid sinus is seen if mouth is opened
Compare the sinuses on both sides
Look for haziness, thickening of mucosa and fluid level
Scalloped appearance of the frontal sinus
[Link] are the findings in x-ray of PNS suggestive of malignancy?
Haziness or opacity
Enlargement of corresponding antrum
Thinning of outline
Discontinuity of outline due to erosion
[Link] will you palpate for sinus tenderness?
Maxillary sinus – Canine fossa
Frontal sinus - Floor of the frontal sinus
Ethmoidal sinus – Just medial to the medial canthus
[Link] is transillumination test?
It is done by placing a torch inside the oral cavity and observing the infra-orbital crescentric glowing of light in a dark
room. When there is pus in the maxillary antrum the crescent is absent. For the frontal sinus it is done thru the floor of the
frontal sinus
[Link] is antral lavage?
It is a minor surgical procedure done through the inferior meatus and puncturing of the lateral wall
to enter the maxillary antrum
Diagnostic - aspirate can be sent for culture and sensitivity
Therapeutic - antral wash can be done for chronic sinusitis
A Tilley-Lichtwitz trocar and cannula is used
55. Where do the sinuses drain?
Maxillary sinus drains in the posterior part of the infundibulum into the middle meatus
Frontal sinus drains into the middle meatus thru the frontal recess
Anterior ethmoid group drains into the middle meatus
Posterior ethmoid group drains into the superior meatus
Sphenoid sinus drains into the sphenoethmoidal recess
56. Which perforation produces whistling sound?
Small septal perforation
57. What is rhinolalia clausa?
Any mass or growth occluding the nasopharyngeal space producing hyponasal voice e.g. adenoids
antrochoanal polyp

[Link] is rhinolalia aperta?

Abnormal nasopharyngeal space or incompatability of the soft palate which fails to approximate
the nasopharyngeal isthmus e.g., cleft palate, palatal paralysis
[Link] do you get epistaxis in DNS?
Mucosa over the deviated part of septum is exposed to the drying effects of air currents leading to
formation of crusts which when removed can cause bleeding
Stretching of mucosa over the nasal spur
[Link] do you get anosmia in DNS?
Failure of inspired air reaching the olfactory area
[Link] is avulsion of nasal polyp?
Removal of polyp along with its ostia [uncapping of ostia]
[Link] is the dangerous area of face?
It includes upper lip,nasal tip and its surrounding area. Infection in this area can spread to cavernous sinus
through anterior facial or angular veins or Ophthalmic veins- all valveless veins.
[Link] is office headache or vacuum headache?
Headache in frontal sinusitis shows a characteristic periodicity. It comes on waking up in the
morning,gradually increases,reaches its peak in the midday and then starts subsiding.
[Link] are the regions where headache occurs in sinusitis?
Maxillary sinus -– Alveolus Infraorbital pain
Frontal sinus – Supraorbital pain
Ethmoid sinus – Pain over the bridge of the nose and between the eyes,may be referred to parietal region,more
intense at night
Sphenoid sinus – Occipital,vertical or retro orbital pain
[Link] is the dangerous area of nose?
Olfactory area because infection can spread from the nose intracranially through the pia-arachnoid
sheath of the olfactory nerve through the cribriform plate of the ethmoid
[Link] is septal spur?
Sharp angulation occurring at the junction of septal cartilage with the ethmoid or vomer
[Link] is Rhinophyma?
Also known as potato nose, caused by the hypertrophy of sebaceous glands
[Link] is Sampter’s triad?
 Asthma,aspirin sensitivity along with nasal polyposis
69. What is Kartagener’s syndrome?
Bronchiectasis,sinusitis,situs inversus and ciliary dyskinesia
[Link] is Young’s syndrome?
Nasal polyposis,bronchiectasis,sinusitis and azoospermia
[Link] do you get altered perception of smell in atrophic rhinitis?
Crusts may be present in the olfactory area preventing the perception of smell
Atrophy of the mucosa
Damage to the nerve endings
72. How will you differentiate a polyp from a hypertrophied turbinate
Turbinate is sensitive to touch,firm in concictency,cannot be probed all around
Polyp is insensitive to touch,soft in consistency and can be probed all around
73. What are the boundaries of choana?
Medially : Post end of septum(vomer)
Above by : Basi sphenoid supported by ala of vomer and vaginal process of medial pterygoid plate
Laterally : Medial Pterygoid plate
Below : Palatine bone
74. What is FESS?
Functional endoscopic sinus surgery
Purpose of the surgery is to remove the disease with widening of the ostium so that it facilitates adequate
drainage and ventilation thereby restoring the mucociliary functions of the nose
75. What are the compications of FESS?
Orbital – injury to the lamina papyracea leads to prolapsed of the orbital pad of fat, medial rectus muscle injury,
orbital cellulitis
Posterior ethmoidal and sphenoidal sinus surgery – injury to the optic nerve can lead to blindness
Injury to the cribriform plate – CSF rhinorrhea