Atrophic Rhinitis

• 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.

Atrophic laryngitis or Laryngitis sicca is characterized by atrophy of laryngeal mucosa and crust formation.

Condition is often seen in women and is associated with atrophic rhinitis and pharyngitis. Not associated with diabetes.

Ans. is c i.e. DNS

Organism known to cause atrophic Rhinitis are:

• Coccobacillus ozaena
• Diphtheroid bacillus
• Kiebsiella ozaenae                                                                
  
• Bordettela bronchiseptica
• Pasteurella multocida
• P. vulgaris
• E. coli
• Staphylococcus                                                                    
  
• Streptococcus

 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. A: Atrophic rhinitis

Young’s operation is a surgery designed for the treatment of atrophic rhinitis.

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

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