Head and Neck Conditions

Nasal polyp

This is a benign, inflammatory proliferation of the lining of the nose, which usually occurs after recurrent colds (infective sinusitis).

Associations

Eosinophilic granulomatosis with polyangiitis

Conditions causing poor cilia motility, e.g., cystic fibrosis and primary ciliary dyskinesia (previously known as Kartagener’s syndrome)

Samter’s triad – nasal polyps and asthma in conjunction with aspirin sensitivity

Symptoms

Nasal congestion

Rhinorrhoea

Changes to taste (ageusia) and smell (anosmia)

Management

Steroid spray to reduce size of polyp

If remains persistent, refer to ENT for examination and removal

Nasopharyngeal Carcinoma

This is a malignant squamous cell tumour of the nasopharynx.

It is rare in most parts of the world, except in southern China, and is associated with the Epstein-Barr virus (EBV).

Symptoms

Nasal obstruction, discharge and epistaxis

Cervical lymphadenopathy

Spread into the ears leads to otalgia and unilateral serous otitis media

Visual changes (secondary to spread to the brain which can compress CN V and VI particularly)

Key tests

Nasal endoscopy with biopsy for histological analysis.

CT/MRI for staging

Management

Radiotherapy and chemotherapy

Vocal Cord Nodule

This refers to a nodule growing on the true vocal cords, which causes hoarseness of voice and a reduced vocal range.

It is usually due to excessive use of the vocal cords (e.g., singing).

Key tests

Laryngeal endoscopy is the diagnostic test

Management

1st line is resting the voice, if unresolving may require surgery

Laryngeal Carcinoma

This is a squamous cell cancer of the cells which form the larynx.

It is associated with smoking and chronic alcohol use.

Risk Factors

Smoking

Chronic alcohol use

Symptoms

Hoarse voice

Sore throat

Neck lump

Key tests

For laryngeal masses, larynx is observed by indirect laryngoscopy

A tissue biopsy will be undertaken to obtain a sample of tissue

Management

Surgery with adjuvant chemo/radiotherapy

Epistaxis

This refers to nosebleeds which can be split into anterior and posterior bleeds.

Anterior bleed 

This occurs due to trauma to the blood vessels that form Kiesselbach’s plexus.

Bleeding occurs out of the front of the nose and is visible.

Posterior bleed

These are more profuse, originating from Woodruff’s plexus.

They occur more frequently in older patients, leading to higher risk of aspiration.

Management

If hemodynamically stable, ask the patient to sit forward with their mouth open and pinch soft area of nose for 15 minutes

Then use topical antiseptic (e.g., naseptin) to reduce crusting and risk of vestibulitis

If bleeding does not stop after 15 minutes, use cautery if source of bleed is visible

Otherwise, use nasal packing and admit to hospital for observation and ENT review

If patient is hemodynamically unstable, will need fluid resuscitation +/- surgery