NOSE - Atrophic rhinitis

What is Atrophic Rhinitis?

Atrophic Rhinitis is a chronic inflammatory nasal disease characterized by progressive atrophy of the mucosa, and underlying bone of the turbinates. There is a viscid secretion in the nose which rapidly dries and forms crusts which emits a characteristic foul odour called ozaena (a stench) and the patient himself suffers from anosmia.

What is the Aetiology of atrophic rhinitis?

 The exact Aetiology is unknown
1. Sex: More common in females
2. Geographical distribution: Occurs in tropical countries, rare in natives of equatorial Africa.
3. Hereditary is an important factor
4. Nutrition
5. Hormonal imbalance
6. Autoimmune disease
7. Secondary:a. Infections like syphilis, leprosy, tuberculosis, lupus vulgaris.
b. Extensive surgery.
8. Iron and vitamin A deficiency.

Organisms isolated are:
1. Coccobacillus
2. Bacillus mucosus
3. Coccobacillus Ozaena
4. Klebsiella Ozaena

 

 

What is the pathology of atrophic rhinitis?

Histo-pathology:
There is a metaplasia of columnar or ciliated epithelium to squamous epithelium with decrease in the number of compound alveolar glands 2 types of atrophic rhinitis histopathologically

1. Type I : Characterized by endarteritis and periarteritis, which may be as a result of chronic infection. These patients may benefit by vasodilator effect of oestrogen therapy.

2. Type II : Characterized by vasodilation of capillaries which may become worse by oestrongen therapy.

What are the clinical features of atrophic rhinitis?

Symptoms emits:
1. Nose emits foul smell
2. Anosmia
3. Dryness
4. Epistaxis
5. Blocking of nose
6. There is atrophy of nerve as well, hence the patient loses sensation of smell.

Signs:1. External Nose : Bridge of the nose appears depressed due to atrophy of the nasal septum
2. Anterior rhinoscopy reveals roomy nostrils with crusts, occasionally with septal perforation
3. Posterior rhinoscopy shows crusts

What investigations are required for the diagnosis of atrophic rhinitis?

1. Haemogram
2. VDRL test to rule to out syphilis
3. Nasal smear for tuberculosis and leprosy
4. X-ray paranasal sinuses
5) CT Scan of Paranasal Sinuses

 

What is the treatment of Atrophic rhinitis?

 Conservative treatment: Local
1. Glucose in glycerin nasal drops : 25% glucose in glycerin, inhibits the growth of proteolytic organisms
2. Kemicetine antiozoenal solution containing chloramphenicol 90 mg, vitamin D2 and oestradiol Di-propionate.
3. Alkaline nasal douche: In 280 ml warm water the following are added
a. Sodium bicarbonate 28.4 gm for loosing the crusts
b. Sodium diborate 28.4 gm
c. Sodium Chloride for isotonicity 56.7 gm

Surgical:
Numerous surgical attempts have been made to narrow the nasal passage. Various surgical procedures indicated are:
1. Inspection of Teflon strips, polythene, cartilage in the mucoperichondrial flap.
2. Stellate ganglion blocks
3. Young’s surgery: Young in 1967 invented a procedure to close the nostril which is later re-opened after varing periods.
4. Modified young’s closure: This is similar to Youngs closure but the anterior nares are partially closed, permitting minimal breathing for the patient.
5. Raghav Sharan’s operation: This includes implantation of maxillary sinus mucosa in the nostril.
6. Wittmack’s surgery: Implantation of the Stenson’s duct (parotid duct) into the maxillary antrum.
7. Lautenslager’s Surgery: The lateral wall of the nose is medialised to narrow the nasal cavity.

 



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