EN4.{21-26,28-29} | Nose Airway and Rhinitis Disorders — Glossary

Self-limiting viral upper respiratory tract infection caused predominantly by rhinoviruses; follows three stages (irritation → secretion → resolution over 5–10 days); yellow-green discharge in later stages is NOT bacterial — antibiotics not indicated unless bacterial superinfection occurs.

The characteristic facial appearance of children with long-standing adenoid hypertrophy and chronic mouth breathing: open mouth, elongated face, narrow maxillary arch, high-arched palate, and prognathic jaw.

A radiological measurement on the lateral soft tissue neck X-ray indicating adenoid size relative to the nasopharyngeal airway; ratio >0.7 indicates significant hypertrophy; widely used in resource-limited settings.

Surgical removal of adenoid tissue performed under general anaesthesia by curettage or suction diathermy; the standard treatment for symptomatic adenoid hypertrophy; often combined with grommets for OME or tonsillectomy for OSA.

A single midline pad of lymphoid tissue on the posterior and superior wall of the nasopharynx; part of Waldeyer's ring; lacks a capsule; peaks in size at ages 3–7, involutes at puberty.

First-line surgical treatment for OSA in children with adenotonsillar hypertrophy; curative in the majority of paediatric OSA cases; produces rapid improvement in sleep quality, daytime behaviour, school performance, and cardiovascular markers.

The only disease-modifying treatment for allergic rhinitis; involves administration of increasing doses of specific allergen (subcutaneous SCIT or sublingual SLIT) to induce immune tolerance via regulatory T cells and IgG4 blocking antibodies; indicated for moderate-severe disease uncontrolled by pharmacotherapy.

An IgE-mediated Type I hypersensitivity inflammatory disease of the nasal mucosa, presenting with sneezing, watery rhinorrhoea, nasal itch, and bilateral obstruction; triggered by specific allergens (HDM, pollen, cockroach, animal dander).

The characteristic gesture of upward nose-rubbing with the palm of the hand performed to relieve nasal itch; creates a horizontal crease across the lower third of the nose (transverse nasal crease) — a clinical sign of long-standing allergic rhinitis in children.

Nosebleed arising from Little's area on the anteroinferior nasal septum; accounts for ~90% of all epistaxis; blood flows forward from the nostril; usually self-limiting with first aid; common in children and young adults.

Examination of the anterior nasal cavity using a Thudichum's speculum and headlight, allowing inspection of the nasal septum, inferior turbinate, and anterior nasal floor; the primary bedside ENT investigation for nasal complaints.

A single, unilateral polyp arising from the maxillary antrum mucosa, passing through the accessory ostium into the nasal cavity and posteriorly through the choana into the nasopharynx; more common in children and young adults.

The number of apnoeic and hypopnoeic events per hour of sleep on polysomnography; AHI <5 normal; 5–15 mild OSA; 15–30 moderate OSA; >30 severe OSA.

Allergic Rhinitis and its Impact on Asthma — the international guideline that classifies allergic rhinitis by duration (intermittent vs persistent) and severity (mild vs moderate-severe) to guide treatment decisions.

A genetic predisposition to produce IgE antibodies in response to environmental allergens; the diathesis underlying allergic rhinitis, asthma, eczema, and food allergy; autosomal polygenic inheritance.

Chronic rhinitis characterised by progressive atrophy of the nasal mucosa and turbinate bones, producing wide nasal passages, thick fetid crusts, anosmia, and paradoxical nasal obstruction; primary (ozaena) or secondary (post-surgical, granulomatous, radiotherapy).

The underlying mechanism of vasomotor rhinitis: exaggerated parasympathetic and/or reduced sympathetic response to normally sub-threshold physical or chemical nasal stimuli, producing disproportionate congestion and secretion.

Bismuth iodoform paraffin paste ribbon gauze: classical anterior nasal pack layered into the nasal cavity; antimicrobial properties; left in situ 24–48 hours; largely superseded by pre-formed expanding foam packs (Merocel).

Congenital bony or membranous obstruction of one or both posterior choanae; bilateral form is a neonatal emergency; unilateral form presents in childhood with unilateral obstruction; distinguished from adenoids on CT scan.

Chronic rhinitis characterised by fibrous hypertrophy of the inferior turbinate mucosa and submucosa; the turbinate is permanently enlarged, firm, and does not respond to topical decongestants; requires surgical turbinate reduction.

A modern technique for adenoid removal using bipolar radiofrequency energy in a saline medium to dissolve tissue at low temperatures; bloodless technique with lower thermal injury compared to monopolar diathermy; increasingly used in paediatric ENT.

Enlargement of the inferior turbinate on the side opposite a septal deviation; the turbinate fills the widened air space; must be addressed during septoplasty to achieve a satisfactory functional result.

The gold-standard non-surgical treatment for moderate-severe OSA; a mask delivers continuous positive airway pressure (5–15 cm H2O) acting as a pneumatic splint to prevent pharyngeal collapse; eliminates apnoeas immediately on first use; requires nightly compliance.

Applying topical oxymetazoline or xylometazoline and re-examining the inferior turbinate 10 minutes later; turbinate shrinkage = reversible mucosal swelling (allergic/vasomotor); no shrinkage = established fibrosis (hypertrophic rhinitis), needing surgery.

Displacement of the nasal septum from the midline, reducing one nasal passage; the most common structural cause of nasal obstruction; treated surgically by septoplasty after skeletal maturity.

The clinical pattern in acute viral rhinitis where initial improvement is followed by worsening — characteristic of bacterial superinfection (acute rhinosinusitis); the most reliable indicator for antibiotic therapy in an acute cold.

The immediate (within minutes) allergic response to allergen exposure; driven by IgE-mediated mast cell degranulation releasing histamine; responsible for sneezing, rhinorrhoea, and nasal itch.

Endoscopic surgical clipping or cauterisation of the sphenopalatine artery at the sphenopalatine foramen; the gold-standard surgical intervention for refractory posterior epistaxis; performed under general anaesthesia.

A validated 8-item questionnaire assessing subjective daytime sleepiness by rating the likelihood of dozing in eight common situations; scored 0–24; ≥10 indicates clinically significant EDS; ≥16 indicates severe EDS.

Bilateral, multiple, pale grey oedematous outgrowths from the ethmoidal mucosa and middle meatus; associated with allergic rhinitis, asthma, and aspirin sensitivity (Samter's triad); arise in adults; cause hyposmia/anosmia.

Impaired opening and ventilation of the Eustachian tube (connecting nasopharynx to middle ear), caused by adenoid obstruction of the tube ostia; results in negative middle ear pressure, OME, and conductive hearing loss.

Pathological tendency to fall asleep during the day; the cardinal daytime symptom of OSA caused by nocturnal sleep fragmentation; impairs cognitive function, driving performance, and quality of life.

Endoscopic surgery to remove nasal polyps and restore the natural drainage pathways of the paranasal sinuses; standard surgical treatment for nasal polyposis and chronic rhinosinusitis refractory to medical therapy.

The main tongue protruder muscle (fan-shaped, arising from the genial tubercle of the mandible and inserting into the tongue and hyoid); innervated by the hypoglossal nerve (CN XII); the most important pharyngeal dilator — its tone prevents tongue-base collapse into the oropharynx during sleep.

Small ventilation tubes surgically inserted through the tympanic membrane to ventilate the middle ear and drain OME fluid; commonly inserted at the time of adenoidectomy in children with chronic glue ear and hearing loss.

A subtype of vasomotor rhinitis in which eating hot or spicy food triggers profuse watery anterior rhinorrhoea via a vagally mediated cholinergic reflex; treated with intranasal ipratropium bromide before meals.

Autosomal dominant vascular dysplasia (Osler-Weber-Rendu disease) causing recurrent bilateral epistaxis from nasal telangiectasias; telangiectasias also on lips, tongue, fingers, and gastrointestinal tract; associated pulmonary and hepatic arteriovenous malformations; family history is strongly positive.

A muffled nasal voice quality caused by obstruction of the nasopharynx reducing resonance; characteristic of adenoid hypertrophy — 'M' sounds become 'B' sounds, 'N' becomes 'D'; opposite of the hypernasal voice of VPI.

The largest of the three turbinates, a separate scroll-shaped bone covered by vascular erectile mucosa containing autonomic sinusoids; the primary site of allergic and vasomotor mucosal swelling causing nasal obstruction.

Surgical reduction of hypertrophied inferior turbinates (by submucosal diathermy, radiofrequency ablation, or partial turbinectomy); addresses the structural obstruction component of vasomotor rhinitis without treating the underlying autonomic dysregulation.

Topical corticosteroids applied to the nasal mucosa (e.g. mometasone, fluticasone, budesonide); the most effective pharmacological treatment for inflammatory nasal obstruction; first-line for allergic rhinitis, vasomotor rhinitis, and nasal polyps.

An anticholinergic nasal spray that blocks muscarinic receptors on nasal seromucous glands, reducing secretion; the treatment of choice for rhinorrhoea-dominant vasomotor rhinitis and gustatory rhinitis.

A benign but locally aggressive highly vascular fibrovascular tumour of the nasopharynx occurring exclusively in adolescent males; presents with progressive unilateral nasal obstruction and recurrent profuse epistaxis; MUST NOT be biopsied — diagnose on contrast CT/MRI.

The standard access incision for septoplasty: a vertical incision on the concave side of the deviation, placed just inside the nasal vestibule at the mucocutaneous junction; provides access to the subperichondrial plane.

The gram-negative organism most commonly isolated from the nasal crusts of primary atrophic rhinitis; may be a primary cause or secondary coloniser; target of antibiotic therapy (ciprofloxacin or co-trimoxazole).

The 1 cm-wide strip of cartilage at the dorsal and caudal margins of the quadrilateral cartilage that must be preserved during septoplasty to maintain nasal bridge height (dorsal strut) and tip support (caudal strut); loss of the L-strut causes saddle-nose deformity.

The delayed (4–8 hours after allergen exposure) allergic response driven by leukotrienes, cytokines (IL-4, IL-5, IL-13), and eosinophil/Th2 cell recruitment; responsible for persistent nasal obstruction and mucosal oedema.

Drug (montelukast) that blocks cysteinyl leukotriene receptors; useful add-on therapy for allergic rhinitis with co-existing asthma; effective for nasal congestion (leukotriene-mediated late-phase obstruction).

The anastomotic vascular network on the anteroinferior nasal septum, approximately 1 cm posterior to the columella, where five arteries converge (anterior/posterior ethmoidal, sphenopalatine, greater palatine, septal branch of superior labial); the site of ~90% of all epistaxis.

A custom-fitted oral appliance that holds the mandible and tongue in a protruded position during sleep, enlarging the posterior airway space; first-line treatment for mild-moderate OSA or as CPAP alternative; less effective than CPAP for severe OSA.

The primary upper airway innate defence mechanism: coordinated ciliary beating moves the overlying mucus blanket (and trapped particles, bacteria, viruses) posteriorly toward the nasopharynx for swallowing or expectoration.

A non-allergic rhinitis subtype with negative allergy tests but eosinophilia on nasal smear (>25%); responds well to intranasal corticosteroids; distinct from vasomotor rhinitis which has no nasal eosinophilia.

The physiological alternating congestion and decongestion of the two nasal passages every 2–6 hours, driven by autonomic nervous system changes in turbinate sinusoidal blood flow; results in one passage being relatively more open while the other is more congested at any given time.

An exaggerated nasal response to non-allergen stimuli (cold, smoke, perfumes) that develops after repeated allergen exposures cause priming of nasal mast cells; explains why patients with allergic rhinitis react to environmental irritants that do not affect non-atopic individuals.

The midline partition of the nasal cavity, composed of the quadrilateral cartilage anteriorly and the perpendicular plate of ethmoid and the vomer posteriorly; divides the nasal cavity into left and right passages.

The narrowest region of the nasal airway, bounded by the alar cartilages, the anterior end of the inferior turbinate, and the nasal septum; cross-sectional area approximately 0.5–0.7 cm² in adults — the critical flow-limiting zone.

A subtype of vasomotor rhinitis in which bilateral nasal congestion predominates; responds best to intranasal corticosteroids and, if needed, inferior turbinoplasty.

A sleep-disordered breathing condition characterised by repeated episodes of partial (hypopnoea) or complete (apnoea) upper airway obstruction during sleep, causing oxygen desaturation and arousal; diagnosed by polysomnography with AHI ≥5 events/hour.

Repeated episodes of upper airway obstruction during sleep causing oxygen desaturation and sleep disruption; in children, adenoid and tonsillar hypertrophy is the commonest cause; presents as loud snoring, nocturnal apnoeas, restless sleep, and daytime behavioural changes.

The functional drainage unit of the anterior paranasal sinuses (maxillary, frontal, anterior ethmoid), located in the middle meatus; obstruction of the OMC by mucosal oedema or polyps leads to sinusitis.

Accumulation of non-infected, viscous fluid in the middle ear cavity due to chronic Eustachian tube dysfunction; causes conductive hearing loss (20–40 dB); tympanometry shows type B (flat) curve; a major complication of adenoid hypertrophy.

The characteristic foul nasal odour of primary atrophic rhinitis caused by anaerobic breakdown of crusts; the patient cannot smell the odour because of anosmia — a paradox causing severe social disability.

The sensation of nasal blockage in wide nasal passages (as in atrophic rhinitis); caused by loss of normal mucosal turbulence sensation in the absence of turbinate mucosa — the brain requires normal airflow turbulence to register a sense of nasal patency.

The gold-standard diagnostic study for sleep disorders; conducted in a sleep laboratory; simultaneously measures EEG, EMG, EOG, airflow, respiratory effort, oxygen saturation, ECG, and body position; generates the AHI and characterises sleep architecture.

OSA that occurs predominantly or exclusively in the supine position; due to gravity displacing the tongue and soft palate posteriorly; treated by enforcing lateral sleeping using positional devices; a subset of OSA patients can avoid CPAP with positional therapy alone.

Nosebleed arising from the sphenopalatine artery territory or Woodruff's plexus; accounts for ~10% of epistaxis but most serious cases; blood runs down the throat (posterior pharynx); no visible anterior source; more common in elderly hypertensives on anticoagulation.

Indirect examination of the nasopharynx using a post-nasal mirror; visualises the adenoid pad, choanae, and Eustachian tube ostia; largely replaced by nasal endoscopy in modern practice.

The large anterosuperior component of the nasal septum, forming the flexible mobile part of the nose; its anterior free edge forms the membranous septum; critical to nasal support — the L-strut (dorsal and caudal margins) must be preserved during surgery.

Blood pressure not controlled despite adherence to three antihypertensive drugs of different classes including a diuretic; OSA is the most common identifiable secondary cause; treated OSA with CPAP produces modest BP reduction.

Rebound nasal congestion that occurs after prolonged use (>5–7 days) of topical nasal decongestants (oxymetazoline, xylometazoline); treated by tapering the decongestant and substituting intranasal corticosteroids.

Vasomotor rhinitis worsening during pregnancy due to oestrogen-mediated effects on nasal mucosal vasculature; resolves post-partum; management limited to saline rinses and short-term decongestants — INCS safety in first trimester is debated.

A subtype of vasomotor rhinitis in which anterior rhinorrhoea and post-nasal drip predominate; responds best to intranasal ipratropium bromide (anticholinergic).

A chronic granulomatous infection of the upper respiratory tract caused by Klebsiella rhinoscleromatis (Frisch bacillus); endemic in parts of India, Eastern Europe, Latin America; characterised by progressive nasal nodular infiltration and eventual fibrosis; histology shows Mikulicz cells (large macrophages with intracellular organisms) and Russell bodies.

Collapse of the nasal bridge (dorsum) due to loss of dorsal cartilage or bony support; appears as a flattened nasal profile; an important complication of over-aggressive SMR or inadequate L-strut preservation during septoplasty.

The clinical association of nasal polyps + asthma + aspirin/NSAID sensitivity (aspirin-exacerbated respiratory disease, AERD); the triad strongly suggests aspirin-sensitive polyposis and is a contraindication to aspirin and non-selective NSAIDs.

The clinical triad of nasal polyps + asthma + aspirin/NSAID sensitivity (aspirin-exacerbated respiratory disease); a severe form of eosinophilic airway disease; aspirin and non-selective NSAIDs are contraindicated.

Non-sedating H1-receptor antagonists (cetirizine, loratadine, fexofenadine, desloratadine); effective for early-phase symptoms (sneezing, rhinorrhoea, itch); less effective for nasal obstruction than INCS; preferred over sedating first-generation agents.

A collection of blood between the septal perichondrium and the cartilage after nasal trauma or surgery; a surgical emergency — if untreated, the cartilage loses its blood supply and undergoes avascular necrosis, leading to saddle-nose deformity.

A hole through the nasal septum; after septoplasty, caused by bilateral mucosal tears at the same level with loss of the intervening cartilage; presents as nasal crusting, epistaxis, and a whistling noise during breathing.

A sharp angular bony or cartilaginous ridge at the floor of the nasal septum, typically at the cartilage-vomer or cartilage-maxillary crest junction; can contact the inferior or middle turbinate causing localised epistaxis and Sluder's neuralgia.

Surgical correction of DNS by submucosal resection of the deviated septal cartilage or bone, preserving the mucosal flaps; the definitive treatment for DNS causing significant nasal obstruction; not performed before age 16–18 (risk of nasal growth disturbance).

Chemical cauterisation of a nasal bleeding point using a 75% silver nitrate stick applied to the visible vessel; effective for small anterior bleeds; never applied to both sides of the septum at the same level — risk of septal perforation.

An in-vivo allergy test in which small amounts of common aeroallergen extracts (house dust mite, pollens, moulds, animal dander) are introduced into the skin; a wheal-and-flare response of ≥3 mm indicates sensitisation; the standard investigation for allergic rhinitis.

A contact headache caused by a septal spur pressing against the nasal lateral wall (inferior or middle turbinate); presents as dull, non-pulsatile, periorbital or facial pain; confirmed by abolition of pain with topical lignocaine applied to the spur.

The terminal branch of the internal maxillary artery, entering the nasal cavity through the sphenopalatine foramen in the posterior middle meatus; the dominant arterial supply to the posterior nasal cavity and the target of ESPAL for refractory posterior epistaxis.

An incomplete cleft of the soft palate in which the mucosa is intact but the underlying muscles and bony structures are deficient; signs include bifid uvula, midline palatal translucency, and notching of the posterior hard palate; adenoidectomy in this condition unmasks permanent velopharyngeal incompetence.

An older septal procedure (Killian's SMR) that removes the central portion of the quadrilateral cartilage; more extensive than septoplasty; higher risk of saddle-nose deformity due to loss of dorsal cartilage support; largely replaced by septoplasty.

The tissue plane between the septal perichondrium/periosteum and the underlying cartilage/bone; the correct surgical plane for mucosal flap elevation in septoplasty; working in this plane preserves mucosal integrity and reduces the risk of septal perforation.

An antifibrinolytic agent (inhibits plasminogen activation) used topically (nasal soaking) or systemically as an adjunct in mucosal epistaxis; reduces clot dissolution and helps consolidate formed clots.

The correct first-aid technique for anterior epistaxis: sit upright, lean slightly forward, pinch the soft cartilaginous part of the nose firmly for 10–15 minutes; do NOT tilt the head back.

Surgical reduction of hypertrophied inferior turbinates by submucosal diathermy, radiofrequency ablation, cryotherapy, or partial turbinectomy; indicated for hypertrophic rhinitis unresponsive to medical therapy; preserves turbinate mucosa where possible to maintain humidification.

Surgical reduction of a hypertrophied inferior turbinate, performed by submucosal diathermy, radiofrequency ablation, or partial turbinectomy; often combined with septoplasty to address compensatory hypertrophy on the contralateral side.

The pathophysiological principle that allergic rhinitis and asthma are manifestations of the same atopic Th2-driven inflammatory disease affecting the upper and lower airway respectively; controlling nasal allergic inflammation improves bronchial disease control.

Surgical excision of the uvula, redundant soft palate tissue, and pharyngeal faucial pillars to widen the oropharyngeal airway; effective in 40–50% of selected patients with mild-moderate OSA and tonsillar hypertrophy; not curative for severe or multi-level OSA.

Non-allergic, non-infectious chronic rhinitis caused by autonomic dysregulation of the nasal mucosa; characterised by bilateral obstruction and rhinorrhoea triggered by physical/chemical stimuli; negative allergy tests; no eosinophilia.

Failure of the soft palate to close against the posterior pharyngeal wall during speech and swallowing; causes hypernasal speech and nasal regurgitation of food; can be unmasked by adenoidectomy in a patient with submucous cleft palate.

The nerve of the pterygoid canal, carrying parasympathetic secretomotor fibres from the pterygopalatine ganglion to the nasal glands and sympathetic fibres to the nasal vasculature; target of vidian neurectomy for refractory vasomotor rhinitis.

Surgical division of the vidian nerve in the pterygopalatine fossa to interrupt parasympathetic secretomotor input to the nose; highly effective for refractory rhinorrhoea-dominant vasomotor rhinitis; risk of dry eye from inadvertent denervation of the lacrimal gland; reserved for specialist centres.

The ring of lymphoid tissue guarding the aerodigestive tract entrance, comprising the adenoids (posteriorly), palatine tonsils (laterally), lingual tonsil (at tongue base), and tubal tonsils (at Eustachian tube ostia).

The venous plexus on the posterior inferior nasal septum near the posterior choana, receiving drainage from the sphenopalatine system; the site of posterior venous epistaxis in elderly patients.

Surgical partial obliteration of the anterior nares to reduce airflow through the nasal cavity in severe atrophic rhinitis; maintained for 6 months to allow mucosal rest and regeneration; the nares are then reopened.