Question

A woman visited ENT OPD with nasal obstruction. On examination, greenish black crusts were present in the nasal cavity covering turbinate and septum. She also had merciful anosmia. What other sign will you find in this case on examination?

• A. Roomy nasal cavity
• B. Hypertrophied inferior turbinate
• C. Polyp
• D. Foreign antibody

Hint:

Think about what happens to the turbinate bones in a condition where the mucosa undergoes atrophy.

Answer 1

The Correct Option is A

Step 1: Identify the condition. The clinical picture of nasal obstruction, greenish-black crusts covering the turbinate and septum, and merciful anosmia is classic for atrophic rhinitis (ozaena). Merciful anosmia occurs because the olfactory nerve endings have atrophied, so the patient cannot smell her own foul odour.

Step 2: Understand the pathology. Atrophic rhinitis is a chronic inflammation of the nasal mucosa characterised by progressive atrophy of the mucosal glands, turbinate bones, and nerve elements. The turbinate bones shrink due to atrophy, leading to a paradoxically roomy (wide/spacious) nasal cavity despite the patient complaining of nasal obstruction.

Step 3: Identify additional signs. Because turbinate bones undergo atrophy, the nasal cavity appears wide and spacious on examination. This is the hallmark examination finding -- a roomy nasal cavity. Other features include foul-smelling green or black dry crusts, epistaxis when crusts are removed, septal perforation, and saddle-nose deformity.

Step 4: Eliminate distractors. Hypertrophied inferior turbinate occurs in hypertrophic rhinitis, not atrophic rhinitis. Polyps occur in allergic or chronic sinusitis, not atrophic rhinitis. Foreign antibody is not a clinical sign.

Conclusion: The correct additional sign is a roomy nasal cavity.