Atrophic Rhinitis

ATROPHIC RHINITIS(OZAENA)
Atrophic rhinitis is a chronic inflammation of nose characterized by atrophy of nasal mucosa, including the glands, turbinate bones and the nerve elements. Atrophic rhinitis may be primary or secondary :
  1. Primary atrophic rhinitis The primary pathology is inflammation and atrophy of the nose. Generally, atrophic rhinitis refers to primary atrophic rhinitis. Causes are : - 
  2. Hereditary
  3. Endocrinal pathology - Starts at puberty. Stops after menopause
  4. Racial factors - Seen more in Whites and Yellow races
  5. Nutritional deficiency - Deficiency of vitamin A, D, E and iron may be responsible for it. v) Infective - Klebsiella ozanae, Diphtheriods, P. vulgaris, E.coli, Staphylococci, Streptococci.
  6. Autoimmune process - Causing destruction of nasal, neurovascular and glandular elements may be the cause. vii)Exanthemata in chilhood may cause Atrophic Rhinitis.
  7. Nasal deformity: Broad nose:Atrophic change may be due to wide space in the nose. In patients with Deviated Nasal Septum,it may occur on the side opposite to the deviation.
2) Secondary atrophic rhinitis Specific infections, such as syphilis, lupus, leprosy, and rhinoscleroma, may cause destruction of the nasal structures leading to atrophic changes. Can also results from long standing purulent sinusitis , radiotherapy of nose, excessive surgical removal of the turbinate . Atrophic rhinitis is not associated with the chronic use of nasal drops and is uncommon in males and not associated with diabetes.

 CLINICAL FEATURES OF ATROPHIC RHINITIS
  • Atrophy of nasal mucosa and turbinates
  • Nasal cavities are roomy and full of foul-smelling crusts 
  • Ciliated columnar epithelium is replaced by stratified squamous type
  • Commonly seen in females and starts around puberty
  • There is foul smell from the nose of which the patient is unaware due to marked anosmia which accompanies the degenerative changes(merciful anosmia) 
  • Nasal obstruction inspite of wide nasal chambers (due to large crusts filling the nose) Removal of crusts may cause bleeding
  • Atrophic laryngitis or Laryngitis sicca characterized by atrophy of laryngeal mucosa and crust formation may be associated with atrophic rhinitis and pharyngitis.
ORGANISMS CAUSING ATROPHIC RHINITIS
Organism known to cause atrophic Rhinitis are:
  • Coccobacillus ozaena 
  • Diphtheroid bacillus 
  • Kiebsiella ozaenae
  • Bordettela bronchiseptica
  • Pasteurella multocida
  • P. vulgaris 
  • E. coli
  • Staphylococcus
  • Streptococcus
TREATMENT OF ATROPHIC RHINITIS 
 Medical treatment – 
 Nasal irrigation and removal of crusts, 25% Glucos in Glycerine Nasal Drops,local antibiotics like Chloramphenicol or Streptomycin, Oestradiol spray, Alkaline Nasal Douche Surgical treatment of Atrophic rhinitis- 
1. Young's operation
The surgical procedure involves closure of the nasal cavity affected with atrophic rhinitis by creating mucocutaneous flaps. These flaps are sutured together in two layers: first the mucosal layer, then the skin layer. The nasal cavity is kept closed for a period of 6 months or later; then an examination is done - if the crusts have disappeared, a revision surgery is performed and the nasal cavity is reopened 
2. Modified Young's operation
3. Narrowing of the nasal cavity by Lautenslagers operation.
4. Submucosal grafting of Acrylic,Teflon,cartilage,bone or placenta.
DIFFERENTIAL DIAGNOSIS OF ATROPHIC RHINITIS
  • Rhinitis Sicca-characterized by crusting only in the Anterior part of the nose,and there is no foul smell.
  • Rhinoscleroma-In the early stage,it shows Atrophic changes,but the mucosa is pink.A biopsy can establish the diagnosis.
Exam Question
  • Atrophic laryngitis or Laryngitis sicca is characterized by atrophy of laryngeal mucosa and crust formation,often seen in women and is associated with atrophic rhinitis and pharyngitis. 
  • Etiology in a patient with long standing nasal obstruction to develop secondary atrophic rhinitis can be long standing purulent Sinusitis. 
  • Atrophic rhinitis may occur due to Chronic sinusitis ,Nasal deformity ,Strong hereditary factors. 
  • Merciful anosmia is seen in Atrophic Rhinitis.
  • Cause of nasal obstruction in Atrophic rhinitis is Crusting.
  • Organisms is known to cause Atrophic Rhinitis are Coccobacillus ozaena, Diphtheroid bacillus, Kiebsiella ozaenae,Bordettela bronchiseptica,Pasteurella multocida, P. vulgaris, E. coli ,Staphylococcus ,Streptococcus.
  • Atrophic rhinitis is not associated with the chronic use of nasal drops and is uncommon in males and not associated with Diabetes. 
  • Young's operation is done for Atrophic Rhinitis.
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