Книга_4440_Библиотеки_им_академика_М_И_Перельмана

Добавил:

Sekretar kiopkiopkiop18@yandex.ru t.me/Prokururor I Вовсе не секретарь, но почту проверяю Опубликованный материал нарушает ваши авторские права? Сообщите нам.

Вуз:

Ростовский Государственный Медицинский Университет

Предмет:

Медицина общая

Файл:

Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_4440_Библиотеки_им_академика_М_И_Перельмана.pdf

Скачиваний:

Добавлен:

30.08.2026

Размер:

51 Мб

Скачать

☆

<<< < Предыдущая 6 7 8 9 10 11 12 13 14 15 16 1718 / 5018 19 20 21 22 23 24 25 26 27 28 29 30 > Следующая >>>

158

3 History andExamination ofEar

3.4 Colour Atlas ofCommon Ear Disease (Fig.3.87)

e f

h i

Fig. 3.87 Clinical picture of common disease of ear. (a) Ear polyp; (b) perichondritis; (c) constricted ear; (d–i) perforations of ear; (j–l) retraction of ear; (m) acute otitis

k l

media; (n, o) granulation; (p, q) serous otitis media; (r) bullous myringitis; (s, t) otomycosis; (u) foreign body in ear; (v) purulent discharge ear; and (w) tympanosclerosis

3.4 Colour Atlas of Common Ear Disease

m n o

p q r

159

v w

Fig. 3.87 (continued)

t u

History andExamination ofNose andPara Nasal Sinuses

4.1 Presentation/History/ Symptoms ofNasal andPNS Disorders

1. History/Presentation/Chief Complaints of

Nasal diseases—Patients with nasal and paranasal sinus diseases/tumours/trauma present with various chief complaints.

Nasal discharge Nasal obstruction Alteration in sense of smell Nasal mass Epistaxis Nasal swelling Nasal pain Headache Facial swelling Diplopia Altered vision Watering from eye Orbital swelling Telecanthus Deformities of nose

(a) Nasal discharge (rhinorrhoea): This

condition, commonly known as a runny nose, occurs relatively frequently. It is a common symptom of allergies (hay fever)

or certain viral infections, such as the

common cold, cerebrospinal uid (CSF)

rhinorrhoea, foreign body (FB) in the nose and sinusitis, and it also can be a side effect of crying, exposure to cold temperatures and cocaine abuse. In history, nasal discharges can be described under various subheadings, like type, colour, amount, etc.

• Type of discharge—There are various types of discharge from the nose with which the patient can be presented (Table4.1).

• Amount of discharge

– Copious—Acute rhinitis, allergic

rhinitis, acute rhinosinusitis, pansinusitis

– Moderate—Bacterial sinusitis,

spontaneous CSF rhinorrhoea

– Scanty—Atrophic rhinitis, rhinitis

sicca, rhinitis caseosa

• Colour of discharge (Fig.4.1)

– White—Allergic rhinitis, fungal

infection

– Black—Fungal infection (fungal

rhinosinusitis), mucormycosis

– Colourless—Acute rhinorrhoea,

CSF rhinorrhoea, allergic rhinitis – Yellow—Bacterial sinusitis – Redish—Carcinoma, inverted pap-

illoma, granuloma

© The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2025 S. K. Kashyap, S. Sagar, Clinical Methods of Otorhinolaryngology, Skull Base & Head Neck Surgery, https://doi.org/10.1007/978-981-96-1765-4_4

161

162

Table 4.1 The denition and D/D of different types of nasal discharge

Types of discharge Denition Causes Watery/serous It is a colourless, thin in consistency,

non-foul smelling and may be sticky or not

Mucoid It is a sticky, ropy discharge, thick in

consistency and whitish in colour

Mucopurulent It is yellowish in colour, mixed with

mucous and thick in consistency

Purulent It is pus, thick in consistency and yellow,

greenish in colour

Serosanguinous/blood mixed/blood

Fig. 4.1 Different colours of nasal discharge

It is blood-mixed discharge or blood (epistaxis)

4 History andExamination ofNose andPara Nasal Sinuses

CSF rhinorrhoea, acute rhinitis, allergic rhinitis, viral rhinitis

Allergic rhinitis, viral rhinitis

Bacterial rhinosinusitis involving any sinus, FB in the nose, rhinolith

Bacterial rhinosinusitis, furunculosis, septal abscess, sinusitis

Trauma, bleeding disorder, rhinosporidiosis, JNA, SCC, hypertension

Colourless

Black/Gray

Red/BrownYellow

– Red (blood)—JNA, microaneu-

rysm, rhinosporidiosis

– Green—Infection

• Odour of discharge—It can be foul smelling or non-foul smelling.

– Foul smelling—FB, non-aerobic

bacterial infection, atrophic rhinitis, rhinolith

– Non-foul smelling—Aerobic bac-

terial rhinosinusitis, allergic rhinitis, NARES, viral rhinitis

• Consistency of discharge—The nasal discharge can be thin or thick in consistency.

– Thin—Acute rhinorrhoea, allergic

rhinitis, CSF rhinorrhoea

– Thick—Allergic rhinitis,

Kartagener syndrome, rhinosinusitis, fungal rhinosinusitis

• Mode of Onset

– Sudden—CSF rhinorrhoea, bleeding,

acute rhinitis, acute rhinosinusitis

– Gradual/insidious—Acute exacer-

bation of chronic rhinosinusitis, FB in nose, allergic rhinitis

Green

White

• Associated symptoms/history—The leading questions should be asked about the associated history like nasal obstruction, anosmia, head trauma, fever, facial pain, facial swelling, facial trauma, h/o FB insertion and nasal trauma.

– Nasal discharge + nasal obstruc-

tion—Chronic rhinosinusitis, allergic rhinitis with hypertrophied inferior turbinate (HIT), allergic rhinitis with DNS, nasal polyp

– Nasal discharge + head trauma/

nasal trauma—CSF rhinorrhoea

– Nasal discharge + fever—Acute

rhinosinusitis

– U/L nasal discharge + H/o BF

insertion—FB in nose, rhinolith

– Nasal discharge+ facial swelling/

nasal swelling—Furunculosis nose

(b) Nasal obstruction: It is dened as a

blockage of the nose or difculty in breathing through nose. It may be unilateral or bilateral and is caused by a wide variety of diseases. Examiners or students should enquire about:

4.1 Presentation/History/Symptoms ofNasal andPNS Disorders

163

• Onset of nasal obstruction—The nasal obstruction can develop suddenly or gradually.

– Sudden onset (nasal obstruction

develops within a short span of time)—FB, acute rhinitis, trauma

– Gradual onset (nasal obstruction

develops over a long span of time and slowly)—DNS with HIT, nasal polyp, nasal mass, rhinosporidiosis, nasal tumours, HIT, concha bullosa

• Side of nasal obstruction—It may be unilateral or bilateral. It can be caused by various disease processes involving vestibule, nasal cavity proper and nasopharynx.

– Causes of unilateral nasal obstruc-

tion (Table4.2)

– Causes of bilateral nasal obstruc-

tion (Table4.3)

• Periodicity of nasal obstruction—Any diurnal variation noted

• Duration

– Acute—If nasal obstruction is less

than 3months, caused by FB inser-

tion, furunculosis nose, acute rhinosinusitis or trauma to nose.

– Chronic—If nasal obstruction is

more than 3months. It is caused by HIT, DNS, nasal polyp, nasal mass, chronic rhinosinusitis, growth in nose, encephalocele and tumour of nose.

• Nature of nasal obstruction – Recurrent—Seasonal allergic rhini-

tis, acute rhinosinusitis

– Persistent—DNS, nasal growth/

tumour, HIT, concha bullosa, AC polyp

• Associated symptoms—Nasal

obstruction can be presented as isolated symptoms or along with other symptoms (Table4.4).

It is dened as inability or decreased ability to smell. There are various types of altered smell.

• Type of altered smell – Hyposmia—It is dened as partial

loss of smell or decreased sense of

Table 4.2 Causes of unilateral nasal obstruction

Vestibule Nasal cavity proper Nasopharynx Furunculosis, vestibulitis

Stenosis of nares Nasoalveolar cyst Papilloma SCC

Table 4.3 Causes of bilateral nasal obstruction

Vestibule Nasal cavity Nasopharynx Bilateral vestibulitis

Collapsing nasal alae Stenosis nares Congenital atresia of nares

Deviated nasal septum Unilateral HIT, concha bullosa Synechia in nasal cavity Bleeding polyp of septum Rhinolith, FB AC polyp, rhinosporidiosis inverted papilloma, tumour of nose, olfactory neuroblastoma

Acute/chronic rhinitis Rhinitis medicamentosa Allergic rhinitis Hypertrophic inferior turbinate DNS with HIT Atrophic rhinitis Septal haematoma Septal abscess Rhinitis sicca Ethmoidal polyp huge JNA

Choanal atresia Adenoid Nasopharyngeal carcinoma Juvenile nasopharyngeal angiobroma

Adenoid hypertrophy AC polyp Thornwaldt’s cyst Nasopharyngeal carcinoma Juvenile nasopharyngeal angiobroma

164

Table 4.4 Associated symptoms with nasal obstruction and its D/D

Associated symptoms with nasal obstruction Diagnosis Nasal discharge Acute rhinitis, allergic rhinitis, rhinosinusitis Nasal/facial pain Acute sinusitis, septal spur, concha bullosa Anosmia/hyposmia Allergic rhinitis, ethmoidal polyp, nasal mass, growth Headache Sluder’s neuralgia Nasal discharge+headache Maxillary sinusitis Snoring Adenoid, nasal mass, HIT Loss of vision/decreased vision Clival chordoma

4 History andExamination ofNose andPara Nasal Sinuses

smell and may be caused by allergy, infection, DNS, smokers, hormonal imbalance or ageing.

– Anosmia—It is dened as total

loss of smell and may be congenital, idiopathic or neurological.

– Hypersomnia—It is dened as

heightened sense of smell. It sometimes happens on its own but can also occur as part of another condition, including autoimmune disease, Lyme disease and pregnancy.

– Dysosmia (phantom smell or

olfactory hallucination)—Any smell alteration

– Parosmia—It is dened as dis-

torted perception of smells either pleasant, unpleasant or change in intensity of odour.

– Phantosmia—It is dened as per-

ception of smell without an odour present or the smell of something that is not actually present.

– Agnosia—Inability to classify or

contrast odours although able to detect odour.

• Onset of altered or difculty of sense of smell—It may be sudden or gradual

– Sudden—Head injury, infection,

medication like antidepressant, loratadine

– Gradual—Allergies, polyp, devi-

ated nasal septum, chronic sinusitis, hormonal, smoking, radiation

• Side of altered or difculty of sense of smell—Unilateral or bilateral

– Unilateral—Antrochoanal polyp,

sinusitis, nasal mass, esthesioneuroblastoma, DNS, dental problem

– Bilateral—Ethmoidal polyp, aller-

gies, medication like antidepressant, loratadine, hormonal imbalance, viral infection

• Duration of altered sense of smell – Acute—Viral infection, head

trauma

– Chronic—Chronic sinusitis, DNS,

smoking, nasal mass, allergies, drugs, radiotherapy

• Progression of altered sense of smell – Progressive—Allergies, smoking,

drug induced

– Non-progressive—DNS, radiother-

apy treatment

• Time of onset – Congenital—Patients who have

congenital olfactory dysfunction usually have no memory associations of avour or smell perception throughout their life. It is caused by Kallman’s syndrome or hypogonadotropic hypogonadism, congenital olfactory dysfunction or familial anosmia.

– Acquired—Acquired smell loss

through things like an infection, smoking, nasal growth or a brain injury is more common.

• Associated symptoms with altered

sense of smell (Table 4.5)

• Past history—Alzheimer’s disease,

brain tumours, multiple sclerosis, Parkinson’s disease, schizophrenia,

4.1 Presentation/History/Symptoms ofNasal andPNS Disorders

Table 4.5 Associated symptoms with altered sense of smell with D/D

Symptoms Differential diagnosis Neurological Alzheimer’s disease, Parkinson’s disease, schizophrenia, epilepsy, brain or head injury, brain

surgery Nasal Esthesioneuroblastoma, nasal tumours, nasal polyp, DNS, concha bullosa, allergic rhinitis Bleeding Nasal carcinoma Headache Skull base tumour Fever Viral infection Others Idiopathic, malnutrition, vitamin deciencies, hypothyroidism

Table 4.6 Associated symptoms with nasal pain with D/D

Associated symptoms with nasal pain Diagnosis Nasal discharge Acute rhinitis, acute sinusitis, furunculosis, trauma Itching in eyes, nose Allergic rhinitis Nasal obstruction Septal spur, concha bullosa, septal haematoma, septal abscess,

rhinolith Facial pain Acute sinusitis Swelling around the cheek, eyes and forehead Furunculosis nose, trauma Reduced sense of smell Trauma Morning cough Sinusitis Earache URI with acute otitis media (AOM) Sore throat URI Bleeding from nose Trauma Watery discharge Traumatic CSF rhinorrhoea

165

epilepsy, brain or head injury, brain

surgery, diabetes mellitus chemical burn, nasal or neuro-surgery, radiation therapy, long-term alcoholism, stroke, treatment/medication (some antibiotics and high blood pressure medications)

• Site of pain – Dorsum of nose—Fractured nose,

cellulitis, furunculosis

– Interior of nose—Furunculosis,

fractured nose, fractured septum, rhinolith, septal haematoma, septal abscess

– Medial to medial canthus of eye—

Ethmoid sinusitis

– Tip of nose—Vestibulitis,

furunculosis

• Onset of pain – Sudden—Trauma, furunculosis

– Gradual/insidious—Rhinolith,

sinusitis, rhinolith

• Severity of pain – Mild—Rhinolith – Moderate—Fractured nose, eth-

moidal sinusitis, cellulitis, septal haematoma

– Severe—Vestibulitis, furunculosis,

septal abscess

• Associate symptoms/history—

Symptoms of nasal cavity dysfunction that can result in nose pain (Table4.6).

(e) Headache: Headache is one of the most

common health problems experienced by most people at some time. There are various causes of headaches like emotional (stress, depression or anxiety), medical (migraine, high blood pressure), physical (such as an injury) and environmental (weather). It can be primary or secondary.

166

Primary headache Secondary headache Primary tension headaches that are episodic

Primary tension headaches that are chronic Primary muscle contraction headaches Primary migraine headaches with auraPrimary migraine headaches without aura Primary cluster headache Primary paroxysmal hemicrania (a type of cluster headache) Primary cough headache Primary stabbing headache Primary headache associated with sexual intercourse Primary thunderclap headache Hypnic headache (headaches that awaken a person from sleep) Hemicrania continua (headaches that are persistently on one side only) New daily persistent headache (NDPH) (a type of chronic headache) Headache from exertion Trigeminal neuralgia and other cranial nerve inammation

4 History andExamination ofNose andPara Nasal Sinuses

Trauma

Disorders Infection Structural problems with the bones of the face, teeth, eyes, ears, nose, sinuses or other structures Substance abuse or withdrawal

• Site of headache—The differential diagnosis can be predicted by the site of headache (Table4.7 and Fig.4.2).

• Types of headaches

– Types of frontal headache

(Table 4.8)—The types of frontal headache help clinicians to reach a proper diagnosis.

Table 4.7 Sites of headache with differential diagnosis

Frontal headache Occipital headache Retro-orbital headache Hemicranium headache Whole head Tension headache

Maxillary sinusitis Frontal sinusitis Refractory error Schluder’s neuralgia

Sinus Headache

Sphenoidal sinusitis Tension headache Migraine Occipital neuralgia Arthritis in the upper spine Myalgia Cerebellar stroke

Tension headache

Ethmoid sinusitis Gradenigo’s syndrome Cluster headache Eye infection Migraine Occipital neuralgia

Cluster headache

– Types of occipital headache—

This is a type of headache, which starts in the upper neck or back of the head and radiates behind the eyes and over the scalp. It can be piercing, throbbing or electricshock- like pain present in upper part of back of neck, back of head,

Migraine Unilateral Pansinusitis Hemicrania continua Aneurysm

B/L Pansinusitis Tension headache Migraine

Migraine

Headache

Fig. 4.2 Sites of headache and their causes

4.1 Presentation/History/Symptoms ofNasal andPNS Disorders

Table 4.8 Specic features of frontal headache and differential diagnosis

Specic features of frontal headache Diagnosis Frontal headache which increases on bending forward or/and may be

associated with recurrent URI and facial pain Frontal headache which is more in the morning and relieved in the

evening. This is also known as an ofce headache It is a frontal headache which is more in the evening and relieved on

taking rest Frontal headache which is dull and boring type with problem in vision Refractory error Ipsilateral frontal headache, which is associated with facial or nasal pain

and relieved by anaesthetizing the nose

Table 4.9 Specic features of occipital headache and its DD

Specic features of occipital headache Name Diagnosis Throbbing type of pain may be present in back of neck,

occipital region, vertex or retro-orbital area This is dened as sudden, severe, throbbing, intense,

piercing, stabbing and sharp pain. Each episode of intense pain may only last for a few seconds or minutes. It may present at the top of neck, back of head, behind the ear and behind the eye. This increases by turning the head to one side, laying the head down on pillow and brushing the hair

Occipital neuralgia (Arnold neuralgia)

Maxillary sinusitis

Frontal sinusitis

Tension headache

Schluder’s neuralgia (anterior ethmoidal nerve syndrome)

Sphenoid sinusitis

Upper cervical spine osteoarthritis Gout, infection Blood vessel inammation Whiplash injury Muscle spasm

167

behind the ear and behind the eye and it increases on turning the head to one side, laying the head down on pillow and brushing the hair (Table4.9).

– Types of retro-orbital pain—It is

dened as pressure dagger feelings or ice-pick feeling, brief, severe, behind the eyes, with or without blurred vision. It can also be associated with temperomandibular joint disorder (TMD); patients with limited mouth opening often experience these kinds of symptoms. The spasm of sphenomandibularis muscle can cause strain and torque of the sphenoid bone and contribute to the above- mentioned symptoms. The sphenomandibularis muscle (an internal muscle behind the eyes) runs from the mandible (internal lower jaw) and inserts into the sphenoid bone just behind the eyes (Table4.10).

– Types of pain in one side of the

head (hemicranial headache)—It is dened as pain in one side of the head that may or may not involve the face. It may arise from both intracranial and extracranial structures such as cranium, neck, vessels, eyes, ears, nose, sinuses, teeth, mouth and neck. Two-thirds of patients with hemicranial headaches have primary headaches, and the remaining one-third have either secondary headaches or neuralgias. Many of these patients with hemicranial pain syndromes have overlapping presentations and may present to a variety of clinicians, including neurologists, dentists, otolaryngologists, ophthalmologists, psychiatrists and physiotherapists. Unfortunately, there is no uniform approach for such patients, and diagnostic ambiguity is frequently encountered in clinical practice (Table4.11 and Fig.4.3).

168

Table 4.10 Specic features and D/D of retro-orbital pain

Specic features of retro- orbital pain Diagnosis It is characterized as a brief but severe retro- or periorbital pain with tearing and

redness around the eye, facial swelling and blocked or runny nose. Each cluster usually lasts between 15min and 3h and may occur 1–8 times per day. It is one of the most painful headaches, often awakening the patient in the middle of the night

This type of pain is present between the eyes with tenderness when touching the bridge of your nose

It is a rare disorder characterized by unilateral severe periorbital headaches, along with decreased and painful eye movements (ophthalmoplegia)

It is dened as a dagger or ice pick, feeling behind the eye Sphenomandibularis

Table 4.11 D/D of hemicranial headache syndrome

Specic features of hemicranial headache Different diagnosis Side locked unilateral pain Cluster headache (histamine headache),

Side shifting unilateral pain Cluster headache, migraine, trigeminal

Unilateral alternating with bilateral Migraine Always bilateral Tension headache, B/L sinusitis, B/L

Bilateral more on one side U/l pansinusitis with DNS on the other side Moderate to severe pain, unilateral, side locking or B/L, it is

throbbing and pulsating It causes constant pain in one side of the face and head. It does not

have the trigger factors It presents with episodic severe throbbing, claw-like or boring U/L

pain, 30–40 episodes/day, redness, tearing of eye, runny or stuffy nose and sweating on face

It is short extremely intense headache that lasts for seconds Primary stabbing (ice-pick headache) Dull or throbbing U/L or B/L headache, wake-up episodes,

sensitivity to light and sound, runny nose and eye It presents as U/L, headache, facial pain, tearing eye and nasal

congestion

4 History andExamination ofNose andPara Nasal Sinuses

Cluster headache

Ethmoid sinusitis

Tolosa-Hunt syndrome

Muscle spasm TM joint dysfunction

migraine

autonomic cephalgia, hemicrania continua

refractory error

Migraine

Hemicrania continua

Paroxysmal hemicrania

Hypnic headache

Trigeminal autonomic cephalgia

Denitions of different types of headaches (Table 4.12)

– Pain in full head

B/L pansinusitis, migraine, hangover, physical exertion, fatigue, lack of sleep, poor posture, hypertension

• Onset of headache—It may be sudden or gradual

– Sudden—Acute sinusitis, tension

headache, acute attack of migraine, hypertension

– Gradual—Chr. sinusitis, migraine,

tension headache, polyp

• Duration of headache – Acute—It is a pain or discomfort

that may start suddenly and get worse quickly, like an episodic CH

– Chronic—Chronic CH

• Severity of headache – Mild—Refractory error – Moderate—Tension headache,

uncomplicated sinusitis, Schluder’s neuralgia

– Severe—Migraine, CH, occipital

neuralgia

<<< < Предыдущая 6 7 8 9 10 11 12 13 14 15 16 1718 / 5018 19 20 21 22 23 24 25 26 27 28 29 30 > Следующая >>>

Соседние файлы в папке Библиотека им академика М.И. Перельмана

#
30.08.202658 Мб0Книга_4434_Библиотеки_им_академика_М_И_Перельмана.pdf
#
30.08.202655 Мб0Книга_4436_Библиотеки_им_академика_М_И_Перельмана.pdf
#
30.08.202655 Мб0Книга_4437_Библиотеки_им_академика_М_И_Перельмана.pdf
#
30.08.202653 Мб0Книга_4438_Библиотеки_им_академика_М_И_Перельмана.djvu
#
30.08.202652 Мб0Книга_4439_Библиотеки_им_академика_М_И_Перельмана.pdf
#
30.08.202651 Мб0Книга_4440_Библиотеки_им_академика_М_И_Перельмана.pdf
#
30.08.202650 Мб0Книга_4442_Библиотеки_им_академика_М_И_Перельмана.pdf
#
30.08.202649 Мб0Книга_4443_Библиотеки_им_академика_М_И_Перельмана.pdf
#
30.08.202649 Мб0Книга_4444_Библиотеки_им_академика_М_И_Перельмана.pdf
#
30.08.202649 Мб0Книга_4445_Библиотеки_им_академика_М_И_Перельмана.pdf
#
30.08.202649 Мб0Книга_4446_Библиотеки_им_академика_М_И_Перельмана.pdf