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 Absent Lymphadenopathy Pedal edema

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 : Throat examination : Ear – normal 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