CONSULTATION
This 17-year-old woman was seen in consultation with her mother regarding problems referable to her nose. The patient has had progressive problems of congestion and sniffing with difficulty moving air through her nose and sensation of pressure. She is a “mouth breather,” and has a history of allergy to pollens and dust. Patient feels these problems are becoming more severe. Her complaints are fairly consistent.
EXAMINATION
She presents with edema of her nasal mucosa, increase in the size of the turbinates, deviation of the nasal septum, and a rather narrowed nasal airway.
DIAGNOSES
1. Probable allergic rhinitis with hypertrophy of the turbinates.
2. Deviated nasal septum.
3. Narrow inadequate nasal airway.
COMMENTS
1. I have discussed with this patient and with her mother the surgical approach to improving her nasal airway with septoplasty, possible submucous resection of deviated portions of the septum, and possible reduction of the inferior turbinates. At the same time I would be performing a rhinoplasty procedure to smooth out the dorsal nose as well.
2. Because of the history of allergies to pollens, dust, and environmental pollutants, it is quite possible patient will continue to have some sniffing, and consequently the degree of improvement of her nasal airway with surgery cannot be precisely determined.
FOOTNOTE
Line 7. This was added to avoid beginning the sentence with a numeral.
Lines 20-23. Enumerate the diagnoses.
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