RUNNY, STUFFED UP NOSE

• Inflammation – extremely common cause of the runny nose. Causes include 1.) allergies; 2.) infections (bacteria (rhinosinusitis), viruses (flu, colds), fungal (allergic, noninvasive, invasive), other (parasites)); 3.) polyps; 4.) immune deficiency – IgA, IgG subclasses; 5.) CF, even in adults!

• Structural –1.) septal deviation – midline of nose

2.) valve collapse – a valve is a triangular junction of the septum w/ soft alar tissue & inferior turbinate below; if pulling skin to the side makes it better, this is higher on the DDx.

3.) CSF leak – rhinnorhea (nose)

• Systemic – WG (systemic, necrotizing granulomatosis vasculitis potentially affecting the kidney, lung, ear, nose, throat, or larynx), sarcoidosis (non-caseating granulomatosis potentially affecting the lungs, larynx, nose, and skin), TB (caseating granulomas), SLE, syphilis

• Neoplastic – 1.) inverted papilloma - 10% will have cancer; most common benign nose/sinus neoplasm, comes with a high risk of recurrence.

2.) Cancers – SCC – most common head and neck cancer; adenocarcinoma; “small blue cell tumors” – lymphoma, sarcoma, melanoma.

3.) Dental – dentigerous cysts, ameloblastoma.

Category: ENT Notes