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What Does Keratosis And Parakeratosis Of The Nasal Mucosa Mean?

Posted on Thu, 26 Feb 2015

Question: I did a biopsy test of the left nasal septum, test report reveals that septum : thereby contain squamousmucosa, and there is hyperkeratosis and parakeratosis under the heading of (microscopic description). Respiratory mucosa is also identified. No malignancy is present. It also suggest a papilloma is diagnose. My Ent doc says that it removed by surgery, but he wants to leave it for now and have me continue using the corticosteriod cream( it helps to aleviate the nasal discomfort for about an hour). Should i go through the surgery procedure to put this thing to bed?, i can hardly breed most time, great discomfort and burning and dry sensation feeling due to the hard skin. Tell me what you think?, could you please explain respiratory mucosa for me. Thanks.

-- XXXXXXX

Answered by Dr. Naveen Kumar Nanjasetty (1 hour later)

Brief Answer:
Please post the complete histopathology report...

Detailed Answer:
Hi

Thanks for posting the query

I do understand your concern; I'll try my best to help you with this.

The lining of the nose after the nasal vestibule is pseudostratified columnar ciliated epithelium, that is characteristic of the nasal mucosa and rest of the respiratory system. Therefore, the epithelium is also called respiratory epithelium.

Keratosis and parakeratosis of the nasal mucosa means, there is a change in the nature of the lining mucosa from the normal towards abnormal. That means, the there is loss of cilia (microscopic hair like structure) and instead, a more solid layer is getting formed, thus causing the mucosa to go dry and irritated.

Papilloma of the nasal mucosa is matter of concern. If you can mail me the histopathology report and the CT scan report (if any), I'll be able to help you in a better way. With the bits and pieces of the information provided by you, it's difficult to get a complete picture of the situation.

Depending upon the findings in the histopathology, I can guide you towards the appropriate management of your problem.

Hope I have answered your query; I'll be available for the follow up queries.

Regards
Dr. Naveen Kumar N
ENT and Head & Neck Surgeon

Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju

Follow up: Dr. Naveen Kumar Nanjasetty (2 days later)

Hi
Thanks again, very well grateful for the information with respect to nasal
vestibule topic, insightful. The hospitable( Mount Sinai) should able to provide
me the histopathology report of the nasal biopsy test?. I'm located in toronto,
canada( you maybe familiar with how the medical system work on these issue).

I just want to add something else to the mix in regards to the right nostril.
In the dry winter months( Dec. thru April), the right nostril clogs up more
than the left nostril, warmer outdoor temps the mucous colour variation
changes from yellow brownish to completely crusty dark red blood and
sometime blood with watery mucous in the heart of dry winter months. The
left nostril is somewhat empty in terms of crustiness(10- 20% of the right).
In saying that though, the left nostril feels so much greater in discomfort
and pain sensations. Ironic, it is as if the right nostril has no problem in
comparison to the left nostril.

From you viewing the previous report sent, can you make an hypothetical
conclusion basis as for why both nostrils are continuously secreting mucous
in all season, whereas the mucous dries up to block the nasal passage, 24/7
i encounter that, even in hot summer -- being inside make the situation worsen.
While outside, i think the vast outside atmosphere breaks up the mucous to
suit the discomfort level for more moisture inside the nose -- problem still there
though.

I Just feel that something in my nasal system is not producing something
that should be normal, tell me if i'm on a right track in regards to my
vestibule.

Now these days 5yrs up, my summer months are crucial ruin even being
inside -- quite bizarre! ( maybe that's normal with these nasal condition).
I just want to be outside!!.

Thanks again.

-- XXXXXXX

Answered by Dr. Naveen Kumar Nanjasetty (23 hours later)

Brief Answer:
Septal deviation may be the cause of crusting...

Detailed Answer:
Hi XXXXXXX

Thanks for writing back

I sincerely apologize for the delay in answering the query.

1. I'm sorry! I'm unable to see any reports in the 'reports section', except for your photo. Could you kindly re-post the histopathology report.

2. Any anatomical deformity in the nose can cause pain as well as nasal crusting and nasal block.

To explain in detail, nasal septum divides the nose into two halves. This enables easy circulation and humidification of the air which we inhale.

When there is anatomical deviation of the nasal septum, the concave side becomes narrow, while the convex portion gets roomy allowing more air to pass in. Thus, due to excess inflow of air in the roomy side, the nasal glands get atrophied and the normal ciliary (microscopic hair like structures) movements in the nasal mucosa loses its function. The atrophied glands combined with reduced ciliary motility causes stagnation and drying of the secretions. I presume, there is similar process happening in your right nasal cavity.

While, on the concave portion, there is always negative pressure created behind the obstructed segment causing pain and headache. Similar process may be taking place in your left nasal cavity too.

Dry climate, whether it is hot or cold, can alter the consistency of secretions. Humidification of air can avoid this problem. As there is excess crusting, you can try using saline nasal spray, followed by saline nasal ointment, as frequently as possible, to keep the nasal cavity moist. Also, do steam inhalation and drink plenty of warm water, this will make the nasal mucosa moist and crust free.

Hope with the above measures you will recover faster.

I wish you good health.

Regards
Dr. Naveen Kumar N
ENT and Head & Neck Surgeon

Note: Consult an experienced Otolaryngologist / ENT Specialist online for further follow up on ear, nose, and throat issues - Book a Call now.

Above answer was peer-reviewed by : Dr. Raju A.T