1. CASE HISTORY
A 25 year old female, homemaker, resident of Kalaburagi, presented with complaints of nasal obstuction in left side since 2 years, mouth breathing since 6 months on 28th April 2017.

2. HISTORY
Patient was apparently well 2 years back, then she developed left nasal obstruction which was insidious in onset, gradually progressive in nature, initially it was partial but now there is total left side nasal obstruction, improves on nasal drops instillation and aggrevates on episodes of cold.

3. Associated with nasal discharge which is mucoid and yellowish in colour. Also has post nasal dripping.
Patient developed mouth breathing since 6 months, insidious in onset, gradually progressive and associated with snoring. She also complains of awakening in night.
No history of nasal bleed, headache.

4. FAMILY HISTORY:- Not significant.
PAST HISTORY:-
Patient had similar complaints of left sided nasal obstruction 4 years back for which she was operated (no documentation available) and was symptom free for 2 years.
Not on any medication currently.
No history of trauma.
No history of nasal allergy.
FAMILY HISTORY:- Not significant.

5. PERSONAL HISTORY:- Not a known case of diabetes mellitus, hypertension, pulmonary tuberculosis, and bronchial asthma.

6. GENERAL PHYSICAL EXAMINATION:-
The patient is moderately built and nourished, conscious and co-operative, well oriented to time, place and person .No Pallor, icterus, cyanosis, generalized lymphadenopathy and edema.
Vital signs-
Pulse – 84 beats/minute, regular and good volume.
Respiratory rate – 14 breaths/minute.
BP – 118/72 mmHg.
Temperature- Afebrile

7. EXAMINATION OF NOSE:-
1) External appearance- external framework of nose appears normal.
2) Examination of nasal cavity
(a)Anterior rhinoscopy(per speculum)-
Solitary, smooth, pale, glistening, pedunculated mass occupying the left middle meatus area is seen.

8. The mass is cystic in consistency, insensitive on probing which could be probed all around except the lateral side without any bleeding.Nasal septum and turbinates appears normal.
Right nasal cavity is normal.

9. (b)Posterior rhinoscopy-
solitary, smooth, pale, glistening mass occupying both the choana is seen.
3) Sinus tenderness – left maxillary sinus tenderness is present.
4) Smell identification test- Reduced on left side.
5) Cold spatula test- No fogging on left side. Adequate fogging on right.
6) Cotton wool test- No movements noticed on left side.

10. EXAMINATION OF ORAL CAVITY AND OROPHARYNX
Post nasal dripping seen. Rest all findings are normal.
EXAMINATION OF EAR: Clinically normal.

11. SYSTEMIC EXAMINATION :-
CNS- Higher mental functions are normal.
RS- Normal vesicular breath sounds heard without any adventitious sounds.
CVS-normal S1, S2 heard and no added sounds.
Per Abdomen-Not suggestive of organomegaly.

12. PROVISIONAL DIAGNOSIS Left sided unilateral antrochoanal polyp with nasopharynx obstruction.

13. DIFFERENTIAL DIAGNOSIS Blob of mucus Angiofibroma Malignancy pediatric masses-glioma and encephalocele hypertrophied MiDDLE TURBINATE.

14. INVESTIGATIONS:- TLC- 7800 cells/cumm. DLC- Within normal range.
Hb% gm%.
Platelet count lakh/cumm.
Blood group- O positive.
RBS- 85 mg/dl.
HIV- non reactive.
HBsAg- negative.

15. DIAGNOSTIC NASAL ENDOSCOPY
Rhinoscopic findings confirmed
On 1st pass endoscopy – Polyp is seen between
nasal septum and left inferior turbinate.
s= Nasal septum
*=Antrochoanal polyp
t= Left inferior turbinate

16. DIAGNOSTIC NASAL ENDOSCOPY…..
On 2nd pass endoscopy - polyp is seen coming out from accessory ostium.
n.o=Natural ostium
a.o=Accessory ostium
*=Antrochoanal polyp

17. CT FINDINGS *=Antrochoanal polyp
A soft tissue density occupying left maxillary sinus
extending into nasal cavity via widened ostium.
*=Antrochoanal polyp

18. CT FINDINGS…. *=Antrochoanal polyp
A soft tissue density occupying the left choana.
*=Antrochoanal polyp

19. CT FINDINGS…… *=Antrochoanal polyp
A soft globular mass density extending into the
nasopharynx seen above the soft palate.
*=Antrochoanal polyp

20. CLINICAL DIAGNOSIS Left sided antrochoanal polyp with nasopharynx obstruction.

21. Treatment
Diagnostic Nasal Endoscopy was done on 2nd May 2017 and complete resection of polyp was performed.
It was sent for histopathological examination and reports are being awaited for.
She has been advised for regular follow-up .

22. SUMMARY
A 25 year old female presented with long standing left sided unilateral nasal obstruction, was evaluated clinically, endoscopically and radiologically. A diagnosis of left sided antrochoanal polyp (Recurrent) was made. surgical management was done on 2nd may which involved polypectomy,wide antrostomy and clearence of inflamed sinus mucosa to prevent recurrence.