Snoring is vibration of the respiratory structures and the resulting sound that results from obstructed air movement during sleeping
The site of snoring varies from person to person
The same person can have different sites of snoring at different times or may have multiple sites of snoring
This makes surgical correction difficult
The sites of snoring are:

soft palate
tonsillar pillars
laryngopharynx

OSA stands for:

Obstructive Sleep Apnoea

Respiratory Disturbance Index (RDI) is the number of apnoea and hypopnea events per hour during sleep
RDI upto 5 per hour is considered normal
Based on the the value of RDI, sleep aponea can be classified:

Sleep Apnoea
RDI

Mild
5-14

Moderate
15-30

Severe
>30

RDI stands for:

Respiratory Disturbance Index

It is a bony canal in the temporal bone through which the facial nerve passes
Starts at internal acoustic meatus
Ends at stylomastoid foramen
It is the longest bony canal for a nerve in our body
Clinical importance:

As the presence of a rigid bony canal does not provide for any space for expansion, inflammatory swelling of facial nerve can cause ischemia of nerve
When the bony canal is dehiscent, infections of the middle ear can affect the facial nerve

Synonyms / Alternate names:

Aqueduct of Falloppio
Canalis nervi facialis
Facial canal
Aqueductus fallopii
Fallopian aqueduct

The facial nerve gets it’s blood supply from 4 vessels:

Anterior inferior cerebellar artery – at the cerebellopontine angle
Labyrinthine artery  (branch of anterior inferior cerebellar artery) – within internal acoustic meatus
Superficial petrosal artery (branch of middle meningeal artery) – geniculate ganglion and nearby parts
Stylomastoid artery (branch of posterior auricular artery) – mastoid segment

The arteries form a external plexus lying within the epineurium and an internal plexus which in intraneural.

Open book fracture is a type of nasal fracture caused by a frontal blow
There is collapse of the nasal septum with splaying out of the nasal bones like the pages of an open book
Externally, the nose has a widened appearance

Overview

Medical polypectomy refers to medical treatment for nasal polyps
It is used mostly for ethmoidal polyp as allergy is considered as an etiological factor in them
Drugs used for medical polypectomy are systemic and topical steroids
Other anti allergic medications like leukotriene antagonists can also be used
Medical treatment can be used before surgical intervention and in those not consenting for surgery
Nowadays, the definitive treatment for nasal polyps is Functional Endoscopic Sinus Surgery (FESS)

Treatment schedule

A short couse of systemic steroids (prednisolone) is given
This is accompanied by long term use of topical steroids (spray / …

Samter’s triad is a condition characterised by:

Asthma
Nasal polyps
Aspirin intolerance

Clinical course

Starts as nasal symptoms of sneezing, running nose and congestion
Progresses to asthma and nasal polyposis (especially ethmoidal polyps)
Aspirin intolerance comes last
Allergic reaction to aspirin in these patients may cause

Exacerbation of asthma
Uriticaria
Angioedema – It is a life threatening condition and hence a medical emergency

Pathophysiology:

Aspirin being a cyclooxygenase inhibitor, causes increased activity of the leukotriene synthesis pathway
The excess production of leukotrienes cause allergic reactions like asthma

Treatment:

Each component of Samter’s triad is treated separately

Aspirin intolerance

Stop aspirin intake
Leukotriene antagonsits (montelukast, zafirlukast)
Aspirin desentisation therapy
Steroids

Asthma – treat …

Nasal polyp
Turbinate hypertrophy

Colour
Pale
Pink

Consistency
Soft
Hard

Sensitivity to probing
Insensitive
Sensitive

Mobility
Mobile
Immobile

Decongestant test
No change
Shrinks in size