Atrophic Rhinitis
Atrophic rhinitis
→ chronic inflammation of nose characterized by atrophy of nasal mucosa and the turbinate bones
Types:
Atrophic rhinitis
Primary Secondary
Infective Endocrinal Others Infections Purulent sinusitis
disturbance ( hereditary and racial factors) - long standing
Nutritional Autoimmune
process Excessive surgical
deficiency
removal
Primary atrophic rhinitis
Aetiology:
→ Theories,
① Hereditary - known to involve more than one member in the same family
② Racial factors - white and yellow races, more susceptible
③ Endocrinal disturbance - more in females, tends to cease after menopause
④ Nutritional deficiency - of vit-A,D or iron
⑤ Autoimmune process - destructive response to some antigens released from nasal mucosa
⑥ Infections:
→ Klebsiella ozanae ( also k/a Perez bacillus)
→ others - diphtheroids, proteus mirabilis, E. coli, staph, strep
→ mostly secondary invaders, rather then primary cause
→ responsible for foul smell
Pathology:
1. Metaplasia - ciliated columnar epithelium is replaced by stratified squamous epi.
2. Atrophy - seromucinous glands, venous blood sinusoids, ner ve elements
3. Obliterative endarteritis( inflammation of intima of artery and occlusion of the lumen)
- in mucosa, periosteum and bone
4. Bone resorption - of turbinates, cause widening of nasal chambers
5. Arrested development - paranasal sinuses, small
Clinical features:
1. Merciful anosmia - foul smell from the nose- degenerative ner ve changes makes him unaware of
the smell, makes him a social outcast
2. Paradoxical nasal obstruction - abnormally wide nasal chambers but complains of nasal
obstruction, d/t degenerative ner ve changes in nasal mucosa - cannot sense airflow
3. Epistaxis - when crusts are removed.
O/E,
① Nasal cavity is full of greenish or greyish black dry crusts covering the turbinates and septum
② Removal of crusts:
- may cause bleeding
- nasal cavities appear roomy after removal, posterior wall of nasopharynx can be seen
③ Nasal turbinates - atrophy, reduced to mere ridges
④ Septal perforation seen
⑤ Dermatitis of vestibule may be present
⑥ Saddle nose deformity
→ Atrophic changes may be seen in pharynx (Atrophic pharyngitis), larynx (Atrophic laryngitis)
→ hearing impairment - d/t obstruction of ET and middle ear effusion
→ in X-ray, opaque, under developed paradisal sinuses are seen. Astral wash is difficult to perform due
to thick walls.
Prognosis: May persist for years but recover spontaneously in middle age
Treatment
Medical: Surgical:
→ Complete cure is not possible ① Young's operation:
→ Aim is to maintain nasal hygiene → raise flaps within the nasal vestibule
- Remove crusts and associated putrefying smell
- Prevent further crust formation → close the nostril completely with the flaps
→ opened after 6 months
① Nasal irrigation and → mucosa may revert to normal, crusting may
removal of crusts: Loosens the crust
reduce
→ Solution used: Warm normal saline or a freshly made
alkaline solution( 1 part- NaHCO3; 1 part- Na2B4O7; 2
②Modified Young's operation:
part - NaCl in 280mL of water) → partially close the nostrils - to avoid
→ Irrigated through one and comes out through the other discomfort
nostril ③ Narrowing the nasal cavities: By
→ 2-3 times per day ; later, once in 2-3 days → insertion of autologous fat, cartilage or bone
→ Hard crusts- difficult to remove by irrigation; loosened under the periosteum of floor and lateral wall of
and removed mechanically by forceps or suction nose and perichondrium of septa
② 25% glucose in glycerine: inhibit growth of proteolytic
→ Lautenschlaeger technique - section and medial
organisms
displacement of the lateral wall of nose
→ Applied after crusts are removed
* releives the symptoms
→ proteolytic organisms are responsible for foul smell
③ Antibiotics: Eliminate sec. infections
→ 7-10 days course
→ systemic antibiotics- fluoroquindones with
metronidazole
④ Mucolytics: promote and liquify nasal secretions
→ 8-10 drops of KI mixed with juice
⑤ Diet: balanced ,enriched in micronutrients