ATROPHIC RHINITIS

ATROPHIC RHINITIS

ATROPHIC RHINITIS

It an chronic inflammation of nose characterised by atrophy of nasal mucosa and turbinate bone.
The nasal cavities are roomy and full of foul smelling crusts. Atrophic rhinitis is of two type primary and secondary.

ATIOLOGY
A PRIMARY
1 AGE bet the age 15-40 start at puberty
2 SEX common in female
3 common in tropical counties like india
4 heredity may be responsibe.
5 HORMONAL
6 NUTRITION  poorly nourished person.
7 VIT A DEFICIENCY
8 AUTONOMIC IMBALANCE may be the cause of the disease.

9 INFECTION Coccobacillus of perez, klebsiella foetidis ozaenae etc.
10 EXAMTHEMATA in childhood may cause atrophic rhitintis.
11 BROAD NOSE atrophic space in the nose, which leads to drying of the mucous by strong blast of
air is the nose. Patient with deviated nasal septum.

B SECONDARY
1> chroic specific infections like syphilis.,rhinoscleroma,
2> extensive surgery of nose and post part of the turbinate may lead to atropic rhinitis.
3> Chronic sinusitis.

PATOLOGY
is characterised by atrophic changes of all parts of nose,
1 MUCOSA AND SUBMUCOSA under go ischaemic Atrophic and metaplasia to cuboidal or stratified epithelium. May lead to pale mucosa with thick scanty secretion. The secretion dry and from scabs. Foetid smell.
2 TURBINATES undergo atrophic., producing a wide roomy nasal cavity.,
3 BLOOD VESSELS are affected by periarteritis and endarteritis obliterans.
4 Nerve become atrophied and the patient may complain about blocking of nose as he does not feel the air passing through the nose, though the nose may be roomy,
5 OLFACTORY NERVES atrophy of nerve causing the loss of smell.

SYMPTOMS
1 FOUL SMELL - the nose emits foul smell. Cause social problem.
2 ANOSMIA- Loss of smell
3 DRYNESS- the patient may complain of dry nose.
4 CRUSTING-often come out from the nose, they are foul smelling.
5 EPISTAXIS-as the crusts separate, mild epistaxis may occur.
6 BLOCKING OF THE NOSE- crusts block the nose.

SIGNS
1 EXTERNAL NOSE the bridge of the nose is sometime depressed due to the atrophy of the nasal septum.
2 ANTERIOR RHINOSCOPY -mucosa is sale and atrophic and is is covered with greyish or greenish foul smelling crust. The turbinate r atropic, resulting roomy nose. Some time nose may perforated.
3 POSTERIOR RHINOSCOPY reveales crusting.
     COMPLICATIONS
1>Sinusitis=may b responsible for atrophic rhinitis
2>middle ear inf.common with atrophic rhinitis
3>atrophic pharyngitis=mucosa of pharynx appears glazed,pale nd wrinkle on gagging
4>psychological complication=due 2 foul smell
5>maggots in nose
   INVESTIGATION
1>Radiographs of paranasal sinuses reveal sinusitis
2>VDRL test=syphilis is ruled out
3>haemogram=for detecting anaemia
4>dermatological exam. 2 detect leprosy.
5>radiograph of chest=2 detect pulmonary TB
6>nasal smear for leprosy nd tubercle bacilli

DIFFRENTIAL DIAGNOSIS
1>Chronic inf.Like syphilis nd leprosy may cause this condition
2>rhinitis sicca=charactorised by crusting only in ant part of nose nd no foul smell
3>rhinoscleroma=biopsy can establish diagnosis
4>sinusitis=crusting absent.
    TREATMENT
1>MEDICAL=Complete cure is not possible.Treatment aims 2 maintain nasal hygeine
a>nasal irrigation nd removal of crusts=warm normal saline used 2 irrigate nasal cavity. 2-3 times a day.
b>25%glucose in glycerine=used after crust removal to inhibit growth of proteolyticorganisms
c>local antibiotics=2 eliminate secondary inf.
d>oestradiol spray=helps 2 increase vascularity of ndsal mucosa
e>systemic use of streptomycine
2>SURGICAL
a>youngs operation=both nostril closed completely within nasal vestibule by raising flaps.In these cases mucosa may revert 2 normal nd crusting reduced
b>narrowing nasal cavities=helps 2 relive crusting.