RHINOSCLEROMA
Definition: Rhinoscleroma is a progressive granulomatous disease of the nose, extending into the nasopharynx, oropharynx, larynx and rarely the trachea.
Aetiology:
- Age– It can occur in any age.
- Sex– Both sexes are equally affected.
- Race– It can affect people of any race.
- Socioeconomic status– It affects the patients staying in rural areas, with poor domestic hygiene.
Symptoms:
(1) Nasal Blockage.
(2) Nasal Discharges.
(3) Externally visible woody shape and feel of nose. Signs: Nose is firm and woody. Anterior Rhinoscopy- Stages (a) Atrophic stage: Foul smelling discharge with changes in the mucous membrane.
(b) Granulation stage: Non ulcerative bluish red, and pale hard rubbery nodules develop.
(c) Cicatrizing stage: Adhesions and stenosis distort the normal anatomy. Treatment:
Medical: (1) Once the diagnosis is confirmed by biopsy, high dosage of antibiotics like tetracycline, chloramphenicol and streptomycin are given for 4-6 weeks.
(2) Local application of acriflavine solution over 6-8 weeks. Treatment is stopped only when two consecutive cultures from the biopsy material are negative. Steroids can be combined to reduce fibrosis. Surgical: Surgical treatment can be used to re-establish the airway without any further atrophic changes. CO2 laser debulking is a good option in treating extensive rhinoscleroma, even in the active stage, as it provides rapid relief of nasal blockage and decreases the time needed for medical treatment, reducing the possible side effects of antibiotics. Surgical treatment includes augmentation rhinoplasty. However, if left untreated the disease can lead to sepsis, bleeding, or other chronic conditions that can be fatal.
(2) Nasal Discharges.
(3) Externally visible woody shape and feel of nose. Signs: Nose is firm and woody. Anterior Rhinoscopy- Stages (a) Atrophic stage: Foul smelling discharge with changes in the mucous membrane.
(b) Granulation stage: Non ulcerative bluish red, and pale hard rubbery nodules develop.
(c) Cicatrizing stage: Adhesions and stenosis distort the normal anatomy. Treatment:
Medical: (1) Once the diagnosis is confirmed by biopsy, high dosage of antibiotics like tetracycline, chloramphenicol and streptomycin are given for 4-6 weeks.
(2) Local application of acriflavine solution over 6-8 weeks. Treatment is stopped only when two consecutive cultures from the biopsy material are negative. Steroids can be combined to reduce fibrosis. Surgical: Surgical treatment can be used to re-establish the airway without any further atrophic changes. CO2 laser debulking is a good option in treating extensive rhinoscleroma, even in the active stage, as it provides rapid relief of nasal blockage and decreases the time needed for medical treatment, reducing the possible side effects of antibiotics. Surgical treatment includes augmentation rhinoplasty. However, if left untreated the disease can lead to sepsis, bleeding, or other chronic conditions that can be fatal.
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