Proforma: DNS/Polyp

Name
Age
Sex
Address
Occupation
Education

Chief complaint: B/L nasal obstruction X ______m

Associated nasal discharge X _______m

HOPI:
Apparently asymptomatic ________ years back when he developed
Bilateral nasal obstruction which was
1. insidious in onset
2. complete/partial Muottham irukka/konjam irukka
3. static
move avadha
4. intermittent/continuous
5. aggravated on URTI/​lying on a side Orupakka
padhikanaaka
6. relieved on medication
adhikama
7. no history of trauma/URI awadha/jasti awadha

Nasal discharge was

1. insidious in onset
2. gradually progressing
3. moderate in quantity
4. intermittent in nature
5. mucoid
6. odorless
7. non blood stained
8. not associated with fever
9. no history of trauma
10. aggrevated on URTI
11. relieved on medication
12.No h/o PND Sali-expectorant
irumbal-cough

History of anosmia present

History of epistaxis present (amount/aggrevating factors)
wardha-aa raaha hai
Rule out adenoids:
1. Snoring
2. Noisy breathing Muchi
3. Mouth breathing idukkarambodha
saddam wardha
4. Voice change
5. School performance vailendha muchi
idukkaringla
Rule out spur: Headache
Asai marcha?
Rule out allergic sinusitis: School la eppadi
padhikarengla
 1. Sneezing (number and times and aggravating factors) Thhumba irukka
2. itching kannalendha thanni
3. watering of eyes wardha

Rule out sinusitis:

1. headache
2. PND
3. Purulent nasal discharge
4. Anosmia
Ask for Ear/Throat complaints

Past history
History of trauma/fracture
Type of delivery (?)
MEDICAL: DM/Htn/TB/​asthma/allergy/systemic disorder
SURGICAL: No prev ENT surgeries (esp failed ​septoplasty​)

Personal
Appetite
Addictions
Sleep-wake cycle
Allergy to drugs
Bowel and bladder movements

Menstrual history

Family history
History of DNS
No overcrowding
No pneumonia/TB/asthma in family members

Treatment history

Examination:

General Physical Examination:

1. consent was taken
2. patient was conscious, oriented
3. moderately built, moderately nourished
4. No P/I/C/C/L/E
5. Pulse, BP, Temp, RR
Examination of NOSE

1. External osseocartilagenous framework: Normal

2. Vestibule: No furuncle/vestibulitis
3. Anterior rhinoscopy

DNS
Draw.

R L
Nasal passage – narrow Nasal passage – narrow
Septum – C-shaped deviation to R
Floor – mucoid discharge seen Floor – mucoid discharge
seen
Roof – not seen Roof – not seen
Lateral wall – inferior and middle turbinate Lateral wall – inferior
normal turbinate hypertrophy seen
Mucosa not congested Mucosa not congested

Polyp
Draw.

Antrochoanal polyp

R L
Nasal passage – Nasal passage –
Septum – C-shaped deviation to R Septum -
Floor – Floor –
Roof – Roof –
Lateral wall – single, unilateral, globular Lateral wall –
polyp with smooth surface covered with
discharge

Ethmoidal polyp

R L
Nasal passage – Nasal passage –
Septum – C-shaped deviation to R Septum -
Floor – Floor –
Roof – Roof –
Lateral wall - multiple, pale, grape-like Lateral wall – multiple, pale,
polyps with smooth surface, covered with grape-like polyps with smooth
discharge surface, covered with discharge
PROBE TEST

Polyp:
1. insensitive to touch
2. cannot/can be probed all around
3. does not bleed on touch
4. soft in consistency
5. mobile

4. cottle’s test: improved nasal patency on R side

5. cold spatula test : reduced fogging on L side
6. cotton wool test: reduced movement of cotton wool on L side
7. test for olfaction: not done
8. Posterior Rhinoscopy – attempted but patient not cooperative
9. Paranasal sinus examination – no tenderness

Examination of EAR
Examination of THROAT

Systemic examination
CVS
RS
GIT
CNS

Provisional diagnosis
1. DNS to R with compensatory hypertrophy of L inferior turbinate
2. Antrochoanal polyp on R side
3. B/L ethmoidal polyp