Atrophic rhinitis

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  • 1. Atrophic RhinitisRhinosporidiosisRhinoscleroma.

2. Atrophic RhinitisChronic nasal disease characterized byprogressive atrophy of the mucosa andunderlying turbinates forming dry crust andviscid secretions with characteristic foulodour, Ozaena. 3. Aetiology: Primary: cause unknown Secondary: due to specific aetiological factor 4. Primary: InfectionKlebsiella ozaenaeDiptheroid bacilliCocccobacillus foetidus ozaena Hormonal imbalanceat pubertymore common in females Nutritionalcommon in poor socioeconomic statusIn Vit A / D and iron-deficiency Heredity AutoimmuneAltered cellular reactivityRelease of nasal mucosal antigen into systemic circulation 5. Secondary: Chronic Rhinosinusitis Chronic granulomatous lesionsTuberculosisSyphilisLeprosy SurgeryExcessive destruction nasal tissues 6. Pathology: Epithelium:Patches of metaplasiaTransition from ciliated columnar to non kerainizedor keratinized squamous epithelium Lamina propria:chronic cellular infiltration, granulation tissue andfibrosis. Mucous glands:decreased in size and number Vascular:decreased vascularity, periarteritis and endarteritisof terminal arterioles 7. Clinical Features: Merciful anosmiabecause of atrophy of nerve elements (responsible for theperception of smell). Nasal obstruction Bleeding from the nose when the dried discharge(crusts) are removed. Nasal cavities:roomy, filled with dry foul smelling black or dark green crusts Septal perforation and dermatitis of nasal vestibule Nose may show a saddly nose deformity. Associated with similar atrophic changes in thepharynx, larynx producing symptoms pertaining tothese structures. Hearing impairment due to Eustachian tube blockagecausing middle ear effusion. Permanent loss of smell and impairement of taste 8. Treatment medical surgical.Medical measures include: Nasal irrigation using normal saline Nasal irrigation and removal of crusts using alkalinenasal douches (280ml of water, 28.4g of Sodbicarbonate, 28.4 g of Sod diborate, 56.7g ofSod.Chloride.) 25% glucose in glycerine, Local antibiotics like Kemicetine antiozaena solution(Chloramphenicol + Ostradiol + Vit D2 ) Ostradiol spray Systemic streptomycin / rifampicin Oral potassium iodide Human placental extract : systemicinjected in the submucosa 9. Surgical Interventions include: Young's operation Modified Young's operation Narrowing of nasal cavities,submucosal injection of Teflon paste,section and medial displacement of lateral wall ofnose Transposition of parotid duct to maxillarysinus or nasal mucosa. 10. RhinosporidiosisEndemic in southern India and Sri Lanka.In Nepal: Rajbiraj and Janakpur.Chronic infection of the upper respiratory tract most commonly in the inferior turbinate of thenasal cavity.Causative agent: the ? fungus Rhinosporidium seeberi the waterborne organism Cyanobacterium microcystisaeruginosaOther sites of involvement include: ears, larynx, esophagus, conjunctiva, andtracheobronchial tree, any part of body 11. RhinosporidiosisCausative agent present in water and dust,readily infects the nasal mucosa.matures into a sporangiumsubsequently bursts to release multipleendospores,infects surrounding tissues. 12. RhinosporidiosisClinical Presentation: Patients with nasal involvement present withnasal obstruction,epistaxis, andrhinorrhea. Systemic dissemination rare On Examination:Unilateral beefy-red granulomatous lesion withwhite spots. (Strawberry appearance) 13. RhinosporidiosisTreatment: Medical therapy with antibiotics or anti-fungal(not proven to be helpful) Treatment of choice :Wide excision with electrocauterization of thelesional base.surgical excision of the lesion, (recurrence ~10%) Dapsone 14. RhinoscleromaProgressive granulomatous disease commencing innose and extending into other areas of airwayoccurs in regions of poor standard of domestic hygiene.Causative organism: K. rhinoscleromatis (Gm ve bacillus)Histology:marked cellular infiltrates consisting of lymphocytes and plasma cells. Thereare many macrophages with clear to foamy cytoplasm (Mikulicz cells) Plasmacells eccentric nucleus with deep eosin-staining cytoplasm (Russel Bodies.) 15. RhinoscleromaClinical stages: 1) rhinitic (Atrophic) 2) florid (Granulation) 3) fibrotic (Cicatrizing).Symptoms : vary with the location of the infection. nasal cavity (septum): most common site, other sites of infection include:paranasal sinuses, orbit, larynx, tracheobronchial tree, and middleear.Treatment : Tetracycline Streptomycin x 6 weeks Acriflavine solution ( in vitro killed K. rhinoscleromatis) Significant airway obstruction requires surgical excision. Radiotherapy Laser treatment. 16. THANK YOU