nayyarENT Thursday Grand Round no. 1

32 yrs old female reported with c/o Recurrent left sided nasal obstruction for past 2 years, occasional few drops of epistaxis left side, recurrent sneezing and bilateral rhinitis for past 2-3 yrs. Two yrs back, after 2 months of onset, patient had undergone a nasal surgery at some distant medical facility by ENT surgeon. However no documents are available. According to patient, some mass was removed and after which nasal obstruction was relieved for few months but later has slowly progressed to the present conditon. Patient also has c/o recurrent bilateral fronto occipital headache.

Based on the above case, answer the following.

1. Any other relevant history you will like to ask about.

2. How will you manage this case and what investigations will you like to get done.

3. Give a differential diagnosis with pros & cons for each diagnosis. Also mention accepted criteria if any.

4. What are the different types of stains with their advantages you will like to use to investiagte in this case.

5. How will you treat this case. What are the problems you anticipate during surgery if planned.

Guidelines for nayyarENT Thursday Grand Rounds

A case will be described.

5 questions pertaining to the case will be put forward.

Participants are required to forward the best answers according to them for these five questions in following format.


Specialist/ PG student / UG student

Ans 1

Ans 2

Ans 3

Ans 4

Ans 5

The answers can be forwarded in the following ways

  1. Write in comment thread of the particular post in either “” or facebook page “NayyarENT” or facebook group “nayyarENT
  2. You can also write in your own writing on any paper, and then scan it or photograph it (writing should be legible), and forward in email to “” or to dropbox of “
  3. You can also record your answer on voice recorder in your mobile phone and forward it as email attachment to “” or via whatsapp to number “91-9707118035
  4. You can also write your answers via whatsapp to “91-9707118035” or via twitter to “ssnayyar

All answers will be evaluated by a Respected panel of teachers and the Best answer will be declared on in the next week.


Dr SS Nayyar

PS :- for any queries, please write in the comment thread of this post on

Requiremnt of re constitution of adrenaline & lignocaine at time of surgery

  • Adrenaline is unstable at normal or higher pH
  • Lignocaine is ionized at normal or higher pH and so more active (reason why sodium bicarbonate is added to moffet’s solution)
  • In dental cartridge, to maintain adrenaline stability –> low pH –>  but leads to low activity of lignocaine
  • In self pre constituted mixture, adrenaline being unstable becomes inactive à adrenaline effect lost –>  lignocaine systemic absorption faster –> pain intra operatively
  • Therefore, best is re constitution of mixture immediately before surgery