Chronic Rhinits Flashcards
Chronic nonspecific inflammations of nose include:
- Chronic simple rhinitis.
- Hypertrophic rhinitis
- Atrophic rhinitis.
- Rhinitis sicca.
- Rhinitis caseosa
AETIOLOGY of chronic simple rhinitis
Recurrent attacks of acute rhinitis in the presence of predisposing factors leads to chronicity
The predisposing factors of chronic rhinitis
- Persistence of nasal infection due to sinusitis, tonsillitis and adenoids.
- Chronic irritation from dust, smoke, cigarette smoking, snuff, etc.
- Nasal obstruction due to deviated nasal septum, synechia leading to persistence of discharge in the nose.
- Vasomotor rhinitis
- Endocrinal or metabolic factors, e.g. hypothyroidism, excessive intake of carbohydrates and lack of exercise.
Pathogenesis of chronic simple rhinitis
Etiology ➡️ hyperaemia and Edema of mucous membrane with hypertrophy of seromucinous glands and increase in goblet cells. Blood sinusoids particularly those over the turbinates are distended.
Clinical features of chronic simple rhinitis
- nasal obstruction
- nasal discharge
- headache
- swollen turbinates
- post nasal discharge
Mech of headache in chronic simple rhinitis
is due to swollen turbinates impinging on the nasal septum
How to differentiate the condition from hypertrophic rhinitis and chronic simple rhinitis from swollen turbinate ?
In chronic simple rhinitis they pit on pressure and shrink with application of vasoconstrictor drops
Rx for chronic simple rhinitis
Treat the cause
Nasal irrigations with alkaline solution Nasal decongestants
Antibiotics
How does nasal irrigation help chronic simple rhinitis
Nasal irrigations with alkaline solution help to keep the nose free from viscid secretions and also remove superficial infection
Excessive use of nasal drops and sprays can lead to
rhinitis medicamentosa
HYPERTROPHIC RHINITIS
It is characterized by thickening of mucosa, submucosa, seromucinous glands, periosteum and bone.
AETIOLOGY of HYPERTROPHIC RHINITIS
- recurrent nasal infections,
- chronic sinusitis,
- chronic irritation of nasal mucosa due to smoking, industrial irritants, prolonged use of nasal drops and vasomotor and allergic rhinitis.
SYMPTOMS of HYPERTROPHIC RHINITIS
- Nasal obstruction (predominant)
- Nasal discharge is thick and sticky.
- headache, heaviness of head or transient anosmia.
SIGNS of hypertrophic rhinitis
- hypertrophy of turbinates.
- Turbinal mucosa is thick and does not pit on pressure. It shows little shrinkage with vasoconstrictor drugs due to presence of underlying fibrosis.
What happens to inf turbinate in hypertrophic rhinitis
Maximum changes are seen in the inferior turbinate.
It may be hypertrophied in its entirety or only at the anterior end, posterior end or along the inferior border giving it a mulberry appearance.
Rx for hypertrophic rhinitis
- Treat the cause
- Nasal obstruction can be relieved by reduction in size of turbinates.
Etiopathogenesis of COMPENSATORY HYPERTROPHIC RHINITIS
marked deviation of septum to one side ➡️to reduce the wide space of the roomier side ➡️ hypertrophy of inferior and middle turbinates ➡️ to prevent ill effects of drying and crusting
ATROPHIC RHINITIS (OZAENA)
It is a chronic inflammation of nose characterized by atrophy of nasal mucosa and turbinate bones. The nasal cavities are roomy and full of foul-smelling crusts.
Types of Atrophic rhinitis
primary and secondary
Etiology of atropic rhinitis
- hereditary factors
- endocrinal disturbance
- racial factors
- nutritional deficiency
- infective
- Autoimmune
How endocrine disturbance cause atrophic rhinitis
Disease usually starts at puberty, involves females more than males, the crusting and foetor associated with disease tends to cease after meno- pause
Which races are more susceptible for atropic rhinitis
White and yellow races
Which vitamin or nutrition deficiency causes atropic rhinitis
A
D
And iron
Which infection causes atropic rhinitis
Klebsiella ozaenae, (Perez bacillus), diphtheroids, Proteus vulgaris, Escherichia coli, staphylococci and streptococci but they are all consid- ered to be secondary invaders responsible for foul smell rather than the primary causative organisms of the disease.
Which agent trigger the autoimmune process of atropic rhinitis
Viral infection trigger antigenicity of nasal mucosa
Pathology of atropic rhinitis
Ciliated columnar epithelium is lost and is replaced by stratified squamous type. There is atrophy of seromucinous glands, venous blood sinusoids and nerve elements. Arter- ies in the mucosa, periosteum and bone show obliterative endarteritis. The bone of turbinates undergoes resorption causing widening of nasal chambers. Paranasal sinuses are small due to their arrested development
Clinical Features of atropic rhinitis
- foul smell from the nose
- merciful anosmia due to degenerative changes
- nasal obstruction due to large crusts filling the nose
- Epistaxis may occur when the crusts are removed.
Examination of nose in atropic rhinitis reveals
Nasal cavity is Full of greenish or greyish black dry crusts covering the turbinates and septum.
When they are removed, nasal cavities appear roomy with atrophy of turbinates
Nasal turbinates may be reduced to mere ridges.
Nasal mucosa appears pale.
Septal perforation and dermatitis of nasal vestibule may be present. Nose may show a saddle deformity.
What are the changes seen in pharynx and laryngeal mucosa in atropic rhinitis
- pharyngeal mucosa which may appear dry and glazed with crusts
- Similar changes may occur in the larynx with cough and hoarseness of voice (atrophic laryngitis).
Hearing impairments in atropic rhinitis is due to
obstruction to eustachian tube and middle ear effusion
How does paranasal sinus appear in atropic rhinitis
small and underdeveloped with thick walls.
They appear opaque on X-ray
Medical Rx in primary atropic rhinitis
- Nasal irrigation and removal of crusts
- 25 % glucose in glycerine - inhibits the growth of proteolytic organisms
- Local antibiotics -KemicetineTM antiozaena solution contains chloromycetin, oestradiol and vitamin D2 and may be found useful.
- Oestradiol spray-increase vascularity of nasal mucosa and regeneration of seromucinous glands
- Placental extract
- Systemic use of streptomycin. 1 g/day for 10 days
- Potassium iodide given by the mouth promotes and liquefies nasal secretion.
Surgical methods for primary atropic rhinitis
- Young’s operation
- modified Young’s operation
- Narrowing the nasal cavities
Narrowing of nasal cavities for primary atropic rhinitis is done by
(i) Submucosal injection of teflon paste.
(ii) Insertion of fat, cartilage, bone or teflon strips under the mucoperiosteum of the floor and lateral wall of nose and the mucoperichondrium of the septum.
(iii) Section and medial displacement of lateral wall of nose.
Secondary atropic rhinitis causes
syphilis, lupus, leprosy and rhinoscle- roma may cause destruction of the nasal structures leading to atrophic changes. Atrophic rhinitis can also result from long-standing purulent sinusitis, radiotherapy to nose or excessive surgical removal of turbinates.
Unilateral atrophic rhinitis is caused by
Extreme deviation of nasal sep- tum may be accompanied by atrophic rhinitis on the wider side.
RHINITIS SICCA is also called as
crust-forming disease
RHINITIS SICCA is seen in people who work In
hot, dry and dusty surroundings, e.g. bakers, iron- and gold- smiths.
RHINITIS SICCAis confined to which part of the nose
anterior third of nose particularly of the nasal septum
Pathogenesis of RHINITIS SICCA
Here, the ciliated columnar epithelium undergoes squamous metaplasia with atrophy of seromucinous glands. Crusts form on the anterior part of septum and their removal causes ulceration and epistaxis, and may lead to septal perforation.
Rx for Rhinitis sicca
correction of the occupational sur- roundings and application of bland ointment or one with an antibiotic and steroid to the affected part.
Rhinitis caseosa affects mainly which gender
Males
Presentation of rhinitis caseosa
- unilateral, Nose is filled with offensive purulent discharge and cheesy material.
- The disease possibly arises from chronic sinusitis with collection of inspissated cheesy material.
- Sinus mucosa becomes granulomatous.
- Bony walls of sinus may be destroyed, requiring differentiation from malignancy.
Rx for rhinitis caseosa
Treatment is removal of debris and granulation tissue and free drainage of the affected sinus. Prognosis is good.
Hypertrophic rhinitis changes are more marked in
turbinates
