Medical (ENT) Case of the day

  This patient had the sensation of food sticking in the back of her nose when inadvertently coughing or sneezing whilst eating. Initially I was sceptical but when examining from below with the HD endoscope I could clearly see small adenoids that had deep fissures within, where I could easily see food trapping on occasion - see photo. The treatment would probably be a form of adenoidectomy under general anaesthetic.

  Nasal polyps are benign swelling of the nose lining. They are basically a severe form of rhinitis, a common problem often due to allergy or infection. They are linked to asthma and often present with loss of sense of smell and taste, plus nose blockage. The case in this photo shows a polyp almost coming out of the front of the nose - quite bad. Treatment is with medical therapy first, including antihistamines, antileukotrienes, steroids, saline washes, depot injections of steroid and as a last resort, surgery.

  Tonsil stones can arise from a number of different areas in the throat. The vast majority do arise in the faucial or palatine tonsils. However even in this area watch out for deep pockets behind the tonsils themselves as a cause for tonsil stone formation, as in this picture.

  Here's a bend in the nasal septal cartilage, also called a deviated nasal septum. It causes disruption to air flow, which leads to drying, scabbing and then new blood vessel formation, which you can see if you look closely. These new blood vessels are not as robust as those originally within the septum, and are prone to rupture, causing nose bleeds, or epistaxis. They can be treated in the clinic with cautery. Longer term a septoplasty will be required to straighten the deviated nasal septum.