ATROPHIC RHINITIS

MEGHA.V4061

CONTENTS:

•DEFINITION•HISTORY•ETIOLOGY•PATHOLOGY•SYMPTOMS & SIGNS•RADIOLOGICAL FINDINGS•COMPLICATIONS•DIFFERENTIAL DIAGNOSIS•TREATMENT

DEFINITION

CHRONIC INFLAMMATORY DISEASE

ATROPHY

HISTORY

•Dr. Spencer Watson(1875)•Dr. Bernhard Fraenkel(1876) : TRIAD of

atrophy

fetorcrusts

Synonyms:

•OZAENA •MERCIFUL ANOSMIA•DRY RHINITIS

ETIOLOGICAL TYPES

•PRIMARY ATROPHIC RHINITIS

•SECONDARY ATROPHIC RHINITIS

CAUSES OF PRIMARY ATROPHIC RHINITIS

H E R N I A

H E R N I A HEREDITY

H E R N I A

ENDOCRINALDISTURBANCE

H E R N I A

RACIAL FACTORS

H E R N I A NUTRIONAL DEFICIENCY

H E R N I A

INFECTIVE

H E R N I A AUTOIMMUNE

PROCESS

SECONDARY ATROPHIC RHINITIS1.Chronic specific infections

syphilis

leprosy

Lupus vulgaris

2. Extensive surgery of the nose(turbinectomy)

SECONDARY ATROPHIC RHINITIS

SECONDARY ATROPHIC RHINITIS3. Severe deviated nasal septum

PATHOLOGY:

•Microscopic changes

NORMAL

squamous metaplasia

Absence of cilia

Atrophy of muscosal glands

Normal Atrophy of nerve endings and olfactory nerve

SYMPTOMS

Why nasal obstruction even in the presence of roomy nasal cavity?

Why nasal obstruction even in the presence of roomy nasal cavity?

PARADOXICAL NASAL OBSTRUCTION

SIGNS :

EXTERNAL NOSE:

SIGNS :

ANTERIOR RHINOSCOPY:

PALE & ATROPHIC MUCOSA

GREENISH FOUL SMELLING CRUSTS

ATROPHIED TURBINATES

• Mucoperiosteal thickening of paranasal sinuses

• Loss of definition of osteomeatal complex• Enlargement of nasal cavity with erosion

and bowing of the lateral nasal wall•Atrophy of inferior and middle turbinates•hypoplastic maxillary sinuses

Radiological findings :

Complications

Differential diagnosis

Differential diagnosis

Differential diagnosis

TREATMENTMEDICAL THERAPY - LOCAL SYSTEMIC

SURGICAL THERAPY

ALKALINE NASAL DOUCHE

Sodium biborate (28.4 g)Sodium carbonate (28.4 g)Sodium chloride (56.7 g)

mixed in 280 ml of luke warm water.

Nasal drops

•25% glucose in glycerine

Chloramphenicol & streptomycin drops

oetradiol spray

Kemicetine(local antibiotic)

Placental Extracts

Potassium iodide

Systemic :

•Streptomycin (1 g/day)•Vitamin A •Vasodilators

Surgical :

•Young’s operation•Modified young’s operation•Wilson’s procedure•Whitmaack’s operation•Other volume reduction procedures•Denervating operations

Young’s operation

Modified Young’s operation

Quick note for treatment of atrophic rhinitis

ATROPI In Young GirlsA- antibiotic sprayT- teflon pasteR- remove crustO- oetradiol therapyP-potassium iodide ,placental extractsI- irrigationIn- insertion of fat,cartilageY- young’s operationG-glucose in glycerineGirls- (more in females)

References :

•A short book of E.N.T (K.B.bhargava), 9th edition,”atrophic rhinitis”,pg 158.

•Diseases of E.N.T ,P.L.Dhingra,5th edition•http://www.drtbalu.co.in/atro_rhinitis.html •http://www.utmb.edu/otoref/grnds/

Atrophic Rhinitis 050330/Atrophic Rhinitis 050330.htm