ENT Specialist ATROPHIC RHINITIS

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 and the patient himself suffers from anosmia. It is also termed as Ozaena. Types: Atrophic rhinitis is of two types:
  1. Primary.
  2. Secondary.
Aetiology: The exact aetiology is unknown. It is more common in females. Aetiology of primary atrophic rhinitis includes:
    1. Hereditary factors: The disease runs in family.
    2. Endocrinal disturbance: The disease usually starts at puberty. It involves females more than males. It tends to cease after menopause. These factors have raised the possibility of disease being an endocrinal disorder.
    3. Racial factors: White and yellow races are more susceptible than natives of equatorial Africa.
    4. Nutritional deficiency: Due to deficiency of vitamin A, D or iron or some other dietary factors.
    5. Infective: Organisms involved includes Klebsiella ozaenae, Diphtheroids, Proteus vulgaris, Escherichia coli, staphylococci and streptococci.
    6. Autoimmune process.
Aetiology of Secondary atrophic rhinitis includes:
    1. Infections like syphilis, leprosy, tuberculosis, Lupus vulgaris.
    2. Extensive surgery.
Organisms isolated are:
    1. Klebsiella ozaenae
    2. Diphtheroids
    3. Proteus vulgaris
    4. Escherichia coli
    5. Staphylococci
    6. Streptococci
Histopathology: There is a metaplasia of columnar or ciliated epithelium to squamous epithelium with decrease in the number of compound alveolar glands. Histopathologically, there are 2 types of atrophic rhinitis:
  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.
  1. Type II: Characterized by vasodilation of capillaries which may become worse by oestrogen therapy.
Clinical features:
Symptoms:
  1. Nose emits foul smell.
  2. Anosmia- There is foul smell from nose which patient himself is unaware of it due to marked anosmia (merciful anosmia) which accompanies degenerative changes.
  3. Dryness.
  4. Epistaxis.
  5. Blocking of nose.
  6. There is atrophy of nerves as well, hence the patient loses sensation of smell.
ENT Specialist Screenshot 2020 11 28 Ganpati nose
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.
Investigations:
  1. Hemogram.
  2. VDRL test to rule to out syphilis.
  3. Nasal smear for tuberculosis and leprosy.
  4. X-ray paranasal sinuses may reveal sinusitis.
  5. CT scan PNS shows atrophy of turbinate and mucosa.
ENT Specialist Screenshot 2020 11 28 Ganpati nose
Treatment:
Local Conservative treatment: 
  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 loosening 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 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 varying periods ranging from 6 months to 1 year.
  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 medialized to narrow the nasal cavity.

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