Atrophic rhinitis / Ozaena

• Secondary atrophic rhinosinusitis is a condition that follows the destruction of the nasal mucosa by any of many inflammatory processes including inflammatory diseases nasal/sinus surgery, and antiangiogenic therapy.
• Diagnostic criteria include patient-reported recurrent epistaxis or episodic anosmia; or physician documented nasal purulence, nasal crusting, a chronic inflammatory disease involving the upper airway (e.g. sarcoidosis, Wegener’s granulomatosis, etc.) or two or more sinus surgeries.
• The disease is commonly seen in females and starts around puberty. 
• There is a foul smell from the nose making the patient a social outcast through patient himself is unaware of the smell due to marked anosmia (merciful anosmia) which accompanies these degenerative changes. 
• The patient may complain of nasal obstruction despite unduly wide nasal chambers. 
• This is due to large crusts filling the nose. 
• Epistaxis may occur when the crusts are removed.

RHINOSCLEROMA:

• It is a chronic granulomatous disease caused by Gramnegative bacillus called Klebsiella rhinoscleromatis or Frisch bacillus.

CLINICAL FEATURES:-

The disease runs through the following stages: 

1. Atrophic stage: It resembles atrophic rhinitis and is characterized by foul-smelling purulent nasal discharge and crusting.

2. Granulomatous stage: Granulomatous nodules form in the nasal mucosa. There is also subdermal infiltration of the lower part of the external nose and upper lip giving a “woody” feel. Nodules are painless and nonulcerative.

3. Cicatricial stage: This causes stenosis of nares, distortion of the upper lip, adhesions in the nose, nasopharynx and oropharynx. There may be subglottic stenosis with respiratory distress.

Ans. is c i.e. DNS

Vasomotor rhinitis is non-allergic rhinitis clinically simulating nasal allergy with symptoms of nasal obstruction, rhinorrhoea and sneezing.

The condition usually persists throughout the year and all the test of nasal allergy are negative.

Clinical features:

• Paroxysmal sneezing
• Excessive rhinorrhoea
• Nasal obstruction
• Postnasal drip

Signs are:

• Nasal mucosa over the turbinates is generally congested and hypertrophic (Mulberry like nasal mucosa).

Strawberry like lesions in the nose- Rhinosporidiosis.

Surgical treatment is Vidian neurectomy in refractory cases

 Atrophic rhinitis:

• It is a chronic inflammation of nose characterized by atrophy of nasal mucosa and turbinate bones. The nasal cavities are roomy and full of foul-smelling crusts.

Clinical Features:

• The disease is commonly seen in females and starts around puberty
• The foul smell from the nose makes the patient a social outcast though the patient himself is unaware of the smell due to marked anosmia which accompanies the degenerative changes. This is called as merciful anosmia.
• The patient may complain of nasal obstruction despite unduly wide nasal chambers. 
• This is due to large crusts filling the nose. 
• Epistaxis may occur when the crusts are removed.

Ans. is ‘a’ i.e., Klebsiella ozaena

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 : –

i) Hereditary

ii) Endocrinal pathology – Starts at puberty. Stops after menopause

iii) Racial factors – Seen more in Whites and Yellow races

iv) 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.

vi)  Autoimmune process – Causing destruction of nasal, neurovascular and glandular elements may be the cause.

2) Secondary atrophic Rhinitis

Specific infections, such as syphilis, lupus, leprosy, and rhinoscleroma, may destroy the nasal structures leading to atrophic changes. Can also result from long-standing purulent sinusitis, radiotherapy of the nose, excessive surgical removal of the turbinate and as a complication of DNS on the root side of the nose.

Ans. is ‘a’ i.e., Atrophic rhinitis

Surgical treatment of Atrophic rhinitis

1) Young’s operation

2) Modified Young’s operation

3) Narrowing of the nasal cavity by (Lautenslagers operation) ‑

4) Lautenslagers operation

Cottle test : It is used to test nasal obstruction due to abnormality of nasal valve as in case of deviated nasal septum.

In this test, cheek is drawn laterally while the patient breathes quietly. If the nasal airway improves on the test side, the test is positive, and indicates abnormality of the vestibular component of nasal valve.