Overview of the Management of Nasal Septal Hematoma/Abscess at Golden Cross Infirmary Private Facility in Lagos, Nigeria

Background: Nasal septal abscess is an uncommon nasal disorder which was recently diagnosed and confirm to require meticulous and urgent management.

This study is aimed at determining the clinical presentation, diagnosis, and management of septal abscess at Golden cross infirmary center in Lagos.

Method: This research is a prospective hospital-based study about consecutive patients diagnosed with nasal septal abscess over a five-year period at the Golden cross infirmary private facility in Lagos, Nigeria. Consented patients were enrolled in the study, and data obtained were collated and analyzed using SPSS version 18.

Results: Forty-seven (47) patients comprising 32 males (68.1% of total patients) and 15 females (31.9% of total patients) were enrolled in the study which is a male to female ratio of 2:1.

The peak age groups of incidences were ≤10 and 41-50 years age group.

Patients duration of illness at presentation were; 14 patients (29.8% of total patients) with illness within a week, 4 patients (8.5% of total patients) with illness within 2 weeks, and 29 patients (61.7% of total patients) with illness within 3 weeks. Sources of referral were 19 patients (40.4% of total patients) from a general practitioner and 24 patients (51.1% of total patients) from a family physician.

45 patients (95.7% of total patients) who form the majority in our research were from the Ear, Nose, and Throat (ENT) outpatient clinic, while 1 patient (2.1% of total patients) was from the casualty center (accident and emergency), and 1 patient (2.1% of total patients) from the hospital wards.

Clinical features at presentation were 47 patients (100% of total patients) with nasal blockage, 43 patients (91.5% of total patients) with difficulty breathing, 38 patients (80.9% of total patients) with nasal pain, 45 patients (95.7% of total patients) with rhinorrhea, 26 patients (55.3% of total patients) with mouth breathing, 19 patients (40.4% of total patients) with Snoring issues, 28 patients (59.6% of total patients) with headache, 12 patients (25.5% of total patients) with poor appetite and 8 patients (17.0% of total patients) with fever.

Hematoma/abscess was bilateral in 43 patients (91.5% of total patients). Needle aspiration of the nasal septum confirmed hematoma in 4 patients (8.5% of total patients), and abscess in 43 patients (91.5% of total patients). Aspirates microscopy, culture, and sensitivity tests were negative in 7 patients (14.9% of total patients) with growth of Staphylococcus aureus in 23 patients (48.9% of total patients), Streptococcus spp in 15 patients (31.9% of total patients), and Hemophilia influenza in 2 patients (4.3% of total patients).

Implicated aetiological factors were complicated acute rhinosinusitis in 31 patients (66.0% of total patients), trauma in 9 patients (19.1% of total patients), furunculosis/vestibulitis in 5 patients (10.6% of total patients), and idiopathic in 2 patients (4.3% of total patients).

All our patients had a combination of surgery (incision and drainage with drains), antibiotics, analgesic, and daily dressing. Complications recorded were; recurrence with 3 patients (6.4% of total patients), septal edema with 37 patients (78.7% of total patients), and facial cellulitis with 6 patients (12.8% of total patients).

Conclusion: Nasal septal hematoma/abscess are uncommon among the patients as acute sinonasal infection and trauma were identified as the main aetiological factors. A prolonged nasal obstruction, and not responding to nasal decongestant is a major pointer to early diagnosis as immediate surgical intervention was needed to prevent avoidable complications.