ACUTE AND CHRONIC RHINITIS

1. ACUTE AND CHRONIC RHINITIS

2. ACUTE RHINITIS • Acute Rhinitis can be – • Viral • Bacterial • Irritative type

3. VIRAL RHINITIS 1) Common cold (Coryza) • Aetiology : Several viruses (adeno virus, picorna virus and its sub-groups sucha s rhinovirus, coxsackie, and ECHO) • Clinical features : Nasal stuffness, rhnorrhoea, sneezing, low grade fever, secondary bacterial invasion may occur.

4. Treatment : Bed rest, Plenty of fluids, Anthihistaminics, Nasal decongestants, Analgesics, Antibiotics, when secondary infection supervenes. Complications : • Sinusitis, pharyngitis, tonsillitis, bronchitis, pneumonia and otitis media.

5. Influenzal rhinitis Rhinitis associated withexanthemas.

6. BACTERIAL RHINITIS • Non specific infections • Diphtheritic rhinitis : • Primary • Secondary to faucial diphtheria • May occur in acute or chronic form • Treatment

7. CHRONIC RHINITIS • Chronic non-specific inflammations of nose include : • Chronic simple rhinitis • Hypertrophic rhinitis • Atrophic rhinitis • Rhinitis sicca • Rhinitis caseosa.

8. 1) CHRONIC SIMPLE RHINITIS • Aetiology : • Predisposing factors • Persistence of nasal infection • Chronic irritation • Nasal obstruction. • Vasomotor rhinitis • Endocrinal or metabolic factors

9. Pathology : • Hyperaemia and oedema of mucous membrane • Hypertrophy of seromucinous glands • increase in goblet cells.

10. Clinical features : • Nasal obstruction • Nasal discharge. • Headache • Swollen turbinates • Post-nasal discharge.

11. Treatment : • Treat the predisposing factor. • Nasal irrigations with alkaline solution. • Nasal decongestants. • Antibiotics help to clear nasal infection.

12. 2) HYPERTROPHIC RHINITIS • Characterized by thickening of mucosa, submucosa, seromucinous glands, periosteum and bone. Aetiology : • Recurrent nasal infections • Chronic sinusitis • Chronic irritation of nasal mucosa. • Vasomotor and allergic rhinitis

13. Symptoms : • Nasal obstruction • Nasal discharge : thick and sticky. • Headache • Heaviness of head • Transient anosmia. Signs : • Hypertrophy of turbinates • Turbinal mucosa is thick, does not pit on pressure, little shrinkage with vasoconstrictor drugs due to underlying fibrosis. • Maximum changes in the inferior turbiante. • Mulberry appearance of inferior turbiante.

16. Treatment : • Discover the cause and remove it. • Reduction in size of turbinates by • Liner cauterisation • Submucosal diathermy • Cryosurgeryof turbinates • Partial or total turbinectomy • Submucous resection of turbinates bone. • Lasers

20. Compensatory hypertrophic rhinitis • In cases of marked deviation of septum to one side. • Roomier side of the nose shows hypertrophy of inferior and middle turbinates. • Reduction of turbinates may be required

21. 3) ATROPHIC RHINITIS (OZAENA) • Chronic inflammation of nose characterized by atrophy of nasal mucosa and turbinate bones. Primary atrophic rhinitis : • Aetiology : Exact cause is not known, Various theories regarding its causation are: • Hereditary factors • Endocrinal disturbances

22. Racial factors • Nutritional deficiency : Deficiency of vitamin A, D or iron • Infective : Klebsiella ozaenae, (Perez bacillus), diphtheroids, P.vulgaris, Esch. Coli, Staphylococci and Streptococci but they are all considered to be secondary invaders. • Autoimmune process : The body reacts by a destructive process to the antigens released from the nasal mucosa.

23. Pathology : • Ciliated columnar epithelium is replaced by stratified squamous type. • Atrophy of seromucinous glands, venous sinusoids and nerve elements. • Obliterative endarteritis. • The bone of turbinates undergoes resorption. • Paranasal sinuses are small.

24. Clinical features : • Commonly seen in females and starts around puberty. • Foul smell from the nose. • Marked anosmia (merciful anosmia) • Nasal obstruction • Epistaxis when the crusts are removed.

28. Nasal cavity full of greenish or greyish black dry crusts. • Nasal cavities appear roomy. • Nasal mucosa appear pale. • Septal perforation and dermatitis of nasal vestibule. • Nose shows saddle deformity.

29. Treatment : • Medical : • Nasal irrigation and removal of crusts- ( Sodium bicarbonate – 1 part , sodium biborate – 1 part, sodium chloride – 2 parts in 280 ml water) • 25% glucose in glycerine. – Inhibits the growth of proteolytic organisms which are responsible for foul smell.

30. Local antibiotics – KemicetineTM antiozaena solution contains chloromycetin, oestradiol and vitamin D2. • Oestradiol spray – increase vascularity of nasal mucosa and regeneration of seromucinous glands. • Placental extract injected submucosally. • Systemic use of streptomycin – Effective against Klebsiella organisms. • Potassium iodide by mouth promotes and liquefies nasal secretion.

31. Surgical • Young’s operation – Both the nostrils are closed completely just within the nasal vestibule by raising flaps. They are opened after 6 months or later. Modified young’s operation - Aims to partially close the nostrils.

32. Surgical

34. 2. Surgical : Narrowing the nasal cavities. Among the techniques followed, some are : • Submucosal injection to teflon paste. • 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. • Section and medial displacement of lateral wall of nose.

35. SECONDARY ATROPHIC RHINITIS : • Specific infections like syphilis, lupus, leprosy and rhinoscleroma. • Longstanding purulent sinusitis, radiotherapy or nose or excessive surgical removal of turbinates. UNILATERAL ATROPHIC RHINITIS : • Extreme deviation of nasal septum. • Atrophic rhinitis on the wider side.

36. RHINITIS SICCA • Crust-forming disease • Seen in patients who work in hot, dry and dusty surroundings. • Confined to the anterior third of nose. • The ciliated columnar epithelium undergoes squamous metaplasia. • Atrophy of seromucinous glands (Crusts, epistaxis, septal perforation). Treatment : • Bland ointment or an antibiotic and steroid. • Nasal douche.

37. RHINITIS CASEOSA • Unilateral and mostly affecting males. • Nose is filled with offensive purulent discharge and cheesy material. • Sinus mucosa becomes granulomatous. Bony walls of sinus may be destroyed. Treatment : • Removal of debris and granulation tissue • Free drainage of the affected sinus.

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