medial wall - formed by the nasal septum, which can be slightly deviated in most people

lateral wall - made of three curved bony structures (turbinates or conchae) that are covered by highly vascular mucous membrnaes. Below each turbinate is a groove or meatus, named by the turbinate above it.

Middle and inferior turbinates are visible through the nares on general physical exam.

inferior meatus - nasolacirimal duct

middle meatus - drainage pathwyas from maxillary sinus, frontal sinus, and anterior ethmoid cells

superior meatus arise

superior meatus - drainage pathway from posterior ethmoid cells arises 

symptoms: clear nasal discharge, nasal congestion, sneezing, and itching in nose, eyes, and roof of the mouth

exam: blue-grey or purple coloration of dematous mucous membranes (normally red)

nasal polyps - freely moveable, non-tender overgrowths of the mucosa that frequently accompany allergic rhinitis

triad of nasal polyps, asthma, and sensitivity to NSAIDS (aspirin) - precipitate asthma

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also consider rhinitis medicamentosa - nasal congestion due to vasoconstriction upon withdrawal of mediction

epistaxis (nose bleed)

anterior (most common) - originates form the lower anterior septum at kiesselbach's plexus - highly vascular since it receives blood from 5 different arteries;

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etiology: trauma (nose picking) or drying, aspirin (platelet dysfunction), warfarin (clotting factor deficiency)

tx: apply firm pressure on alar cartilages bilaterally on the septum

posterior - originates from the back 1/3 of the inferior meatus

etiology: severe systemic hypertension

tx: posterior nasal packing (needs ENT doc)

Significance: When you see guaic positive stools or iron deficiency anemia, think about nosebleed as a differential, lest you do an unnecessary work-up for GI blood loss

sinusitis - an infection of the paranasal sinuses that may be caused by bacteria or fungi

usually follows a viral URI, which closes off the ostia and causes stasis of secretions that ehn become infected

symptoms: facial pain and tenderness, headache, fever, eye pain, and purulent or blood nasal discharge, maxillary toothache, abnormal transillumination of maxillary and frontal sinuses)

Frontal sinusitis = pain and tenderness in the forehead above the supraorbital ridge (and same findings below)

Maxillary sinusitis: 4/5 symptoms = LR 6.4

Maxillary toothache
Purulent secretions
Poor response to decongestants
Abnormal transillumination
History of colored nasal discharge

Ethmoid sinusitis = retro-orbital pain, and pain medial to the eye; no tenderness to palpation and no abnormalities during transillumination; dx with radiography; orbital infection may be a complication

sphenoid sinusisits = pain behind the eye and at the vertex of the skull. no tenderness to palpation nor abnormal transillumination; dx with radiography.