1. CASE PRESENTATION
By – Dr Pulkit Agarwal

2. Particulars
George Kurian
72 yrs
Christian
Harihar
Engineer

3. Chief Complaints
Right sided nasal obstruction since 2 months

4. 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

5. 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

6. 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.

7. Past history :
No H/O Hypertension, Bronchial Asthma, Prolonged medication
No H/O drug allergies (NSAID)

8. Personal history : Diet – Mixed Appetite – Normal
Bowel and Bladder – Normal and regular
Sleep – reduced due to nasal obstruction
No addictions

9. Family history :
No H/O similar complaints in family members

10. 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

11. 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

13. 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

14. Systemic examination :
CVS – S1S2 heard , no murmurs
R/S – Bilateral NVBS+, No added sounds
P/A – soft , no organomegaly
CNS – no focal neurological deficit

15. Provisional diagnosis :
? Antronasal polyp
? Inverted papilloma
? Mucocele Rt maxillary sinus
? Sinonasal malignancy