Nasal cholesteatoma

Nasal cholesteatoma is actually a misnomer. This is another name for Rhinitis caseosa. The term “Rhinitis caseosa” was coined by Duplay in 1868. Eggston and Wolff after a detailed study in 1947 concluded that this condition could occur secondarily following pent up secretions in the sinus cavities. Their studies revealed that this condition is more common in patients with extensive bilateral ethmoidal polyposis. The presence of polypi in the nasal cavities caused obstruction to the normal drainage mechanism of the paranasal sinuses. This led to accumulation of secretions. Whitish to yellow cheesy material were found within the nasal cavities of these patients behind the nasal polypi. This cheesy material also caused expansion of sinus cavities, erosion of bone and extension into orbit.

Could this actually be fungal infection? Now the consensus seems to be pointing towards this direction.

Case details:

30 years old male patient came with complaints of:

1. Foul smelling discharge left nasal cavity - 2 years

2. Head ache on and off - 2 years

3. Watering from left eye - 1 year

Patient gave no history of nasal bleed.
He was not a diabetic

Imaging:

CT scan plain of paranasal sinuses showed:

This coronal CT of nose and paranasal sinuses show opacification of
left maxillary sinus with expansion of its walls. The lesion appears to be
heterodense ? fungal sinusitis. Air shadow could be seen within the
maxillary sinus cavity on the affected side ? entrapment ? abscess.
Patient was taken up for surgery. Endoscopic sinus surgery was performed on this patient.
After middle meatal antrostomy the maxillary sinus L was found to be filled with cheesy material
which was removed. The walls of the maxillary sinus was found to be intact.
Probable diagnosis:
Fungal sinusitis
Nasal cholesteatoma

Video clipping of the surgical procedure: