Abstract Proceedings EROC 2011 - New York Osteopathic Medical ...

EROC 2011 Abstract Proceedings – March 4, 2011
Dept. of Family Practice, Good Samaritan Hospital Medical Center, West Islip, NY
Title: Nasal Septal Abscess: A Rare Complication of Acute Sinusitis
Authors: K Tangsuan, DO 1 , T Campbell, MD 2 , H Larsen DO 1
1 Department of Family Practice, 2 Department of Surgery, Division of Otolaryngology
Good Samaritan Hospital Medical Center, West Islip, NY 11795
Introduction: Nasal septal abscess (NSA) is an exceedingly rare diagnosis. It is defined as a
collection of purulent material between the bony or cartilaginous nasal septum and the overlying
mucoperichondrium or mucoperiostium. While nasal trauma accounts for 75-80% of cases,
atraumatic causes of NSA, such as sinusitis, are more unusual. A rhinological emergency, NSA
may mimic symptoms of other diagnoses including sinusitis. As our case demonstrates, NSA is
easily misdiagnosed because of its rarity and similar symptomatology to other conditions.
Case: A 13 year old male presents to the emergency department complaining of increased
difficulty breathing through his nose, rhinorrhea, headaches and fevers for six days. Physical
exam revealed sinus tenderness, edema and tenderness of the nose with a swollen nasal septum.
Our patient was admitted with acute sinusitis and subsequently diagnosed with NSA after
physical exam and imaging review by otolaryngology. He immediately underwent incision and
drainage. The patient’s symptoms gradually resolved and his septum was found to be well
healed at follow up.
Discussion: There is unanimous agreement in the literature that septal abscesses must be
promptly identified and treated. Delayed management exposes patients to a myriad of
complications ranging from saddle nose deformities to intracranial infections to death. Although
sinusitis appeared to be the inciting cause of our patient’s septal abscess, the literature suggests
that other possibilities should be considered. Regardless of the cause, promoting physician
awareness of this rare condition will lead to earlier diagnosis and treatment in order to prevent
the dangerous sequelae of NSA.
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