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Atrophic Rhinitis Notes

Atrophic Rhinitis is a chronic nasal condition marked by the atrophy of nasal mucosa and turbinate bones, prevalent in lower socioeconomic groups and tropical regions. It can be classified into primary and secondary types, with various etiological factors including hereditary, nutritional deficiencies, infections, and chronic diseases. Management includes medical treatments such as nasal douches and vitamin supplementation, as well as surgical options aimed at reducing nasal cavity size and improving lubrication.

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7 views2 pages

Atrophic Rhinitis Notes

Atrophic Rhinitis is a chronic nasal condition marked by the atrophy of nasal mucosa and turbinate bones, prevalent in lower socioeconomic groups and tropical regions. It can be classified into primary and secondary types, with various etiological factors including hereditary, nutritional deficiencies, infections, and chronic diseases. Management includes medical treatments such as nasal douches and vitamin supplementation, as well as surgical options aimed at reducing nasal cavity size and improving lubrication.

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shivamgupta.lic2011
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We take content rights seriously. If you suspect this is your content, claim it here.
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Atrophic Rhinitis

A chronic nasal condition characterized by progressive atrophy of nasal mucosa and underlying
turbinate bones. Common in lower socioeconomic groups and tropical countries.

Types
1. Primary Atrophic Rhinitis (Hernia pneumonica) 2. Secondary Atrophic Rhinitis

Etiology – Primary AR
• Hereditary factors • Endocrine: common in females, during puberty; improves after menopause •
Racial predisposition • Nutritional deficiency: Vitamin A, D, iron, protein • Infections: Klebsiella
ozaenae (most common), Proteus, cocobacilli, streptococci, staphylococci • Autoimmune causes
(autoantibodies against nasal mucosa)

Secondary Atrophic Rhinitis – Causes


• Chronic rhinosinusitis • Granulomatous diseases: TB, syphilis, Wegener’s granulomatosis,
sarcoidosis • Radiotherapy • Nasal or maxillofacial surgery / trauma • Occupational exposure
(phosphorus, silica dust, miners)

Pathology
• Metaplasia of ciliated columnar epithelium into squamous epithelium • Atrophy of seromucinous
glands → dry nose • Obliterative endarteritis • Atrophy of nerve endings • Resorption of turbinate
bones → roomy nasal cavity

Clinical Features
• Usually bilateral disease • Nasal obstruction due to crusting • Green colored crusts • Foul smelling
mucopurulent discharge • Choking sensation • Merciful anosmia (patient unaware of foul smell) •
Pharyngitis sicca • Septal perforation may be present

Investigations
• Mainly clinical diagnosis • Culture and sensitivity of nasal discharge • Diagnostic nasal endoscopy
• ESR, CRP • X-ray PNS, Mantoux test to rule out TB • Serum protein levels in malnutrition

Medical Management
• Alkaline nasal douche (NaHCO■ + NaCl + Na biborate) • Glucose and glycerine nasal drops •
Oestradiol nasal spray • Submucosal injection of placental extract • Vitamins A, D, B12, iron
supplementation • Antibiotics (e.g., streptomycin) • High protein diet • Kemicetine solution • Oral
potassium iodide

Surgical Management – Principles


• Reduce the size of nasal cavity • Increase lubrication of nasal cavity • Sympathetic denervation
Surgical Procedures
• Young’s operation / Modified Young’s operation • Lautenschlager’s operation • Wilson’s operation
(Teflon paste injection) • Vestibuloplasty • Raghavan operation • Whitmark’s operation (implantation
of parotid duct into nose)

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