PART 8 — NOSE & PARANASAL SINUSES

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Study use: Rapid revision of nasal and paranasal-sinus anatomy, epistaxis, septal trauma, rhinitis, rhinosinusitis, fungal disease, nasal polyps, vascular and malignant masses, CSF leaks, congenital obstruction, and destructive nasal disorders. Management points are intentionally concise and should be interpreted with the clinical context.

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Priority Guide: 🔴 Core / Must Know | 🟠 Important | 🟡 Additional

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🎯 High-Yield Overview

• Posterior ethmoid → superior meatus; sphenoid → sphenoethmoidal recess; frontal/maxillary/anterior ethmoid → middle meatus; nasolacrimal duct → inferior meatus.
• Little/Kiesselbach area is the classic common anterior epistaxis site; major posterior arterial bleeding commonly involves sphenopalatine branches.
• Nasal trauma + fluctuant septal swelling → septal hematoma → urgent drainage to prevent cartilage necrosis/saddle nose.
• Allergic rhinitis: sneezing + itching + watery rhinorrhea + pale boggy mucosa; prolonged topical decongestant use → rhinitis medicamentosa.
• Acute bacterial rhinosinusitis is suggested by ≥10 days without improvement or double worsening; chronic rhinosinusitis lasts ≥12 weeks.
• Polyps + heterogeneous hyperattenuating/double-density sinus material → allergic fungal rhinosinusitis; diabetes/DKA + black necrotic tissue → mucormycosis.
• Multiple bilateral pale polyps → ethmoidal polyps; single unilateral maxillary-to-choana lesion → antrochoanal polyp.
• Adolescent male + recurrent profuse epistaxis + unilateral obstruction + Holman-Miller sign → JNA; avoid routine biopsy.
• Trauma/surgery + unilateral clear watery rhinorrhea → CSF leak; confirm with β2-transferrin.
• Newborn with cyclic cyanosis relieved by crying → bilateral choanal atresia; adult unilateral OME/neck node → consider nasopharyngeal carcinoma.

1. NASAL & PARANASAL-SINUS ANATOMY

2. EPISTAXIS, SEPTUM & NASAL TRAUMA

3. RHINITIS

4. RHINOSINUSITIS, FESS & COMPLICATIONS

5. FUNGAL RHINOSINUSITIS

6. NASAL POLYPS