rhinitis
TRANSCRIPT
RHINITISDEPARTMENT OF SURGERY
By d.Gautam
contents
• Definition • Classification• Clinical features• Signs • Investigation• Complication• treatment
RHINITIS• It is the inflammation of the nasal mucous
membrane
rhinitis
infected
Acute
bacterial viral
chronic
specific Non specific
Atrophic rhinitis
Simple chronic rhinitis
Hypertrophic rhinitis
Rhinitis sicca
Rhinitis caseosa
Granulomatous rhiitis
Non infected
allergic
seasonal perinial
vasomotor
specific
syphilis
leprosy
Tuberculosi
rhinosporidiosis
Rhinoscleroma
Fungal infection
leishmaniosis
Coryza
• It is an acute non specific infective rhinitis.• Also known as “common cold”.
Aetiology • Causative organism: virus and may be either
influenza virus rhinovirus or adenovirus etc.• Spread : is by air borne droplet infection or by
direct contact.• Secondary infection by bacteria may occur
streptococcus staphylococcus pneumococcus etc.
Pathology
• Viral infection of the nasal mucosa
• Acute generalised hyperaemia of the nasal mucosa
• Engorgement of the secretory gland and goblet cells
• Profuse secretion involvement of sinus
• sinusitis
• Involvement of Eustachian tube opening
• ASOM &SOM
CLINICAL FEATURES
• Incubation period:1-3 days• Four stages – Ischaemic stage – Hyperaemic stage– Stage of secondary inflammation – Stage of resolution
ISCHAEMIC STAGE
• Raw sensation & irritation in the pharynx.• Irritation & dryness in the nose.• Sneezing attack.• Malaise with chills.•
HYPEREMIC STAGE
• Profuse watery rhinorrhea• Anosmia • Blocking of nose • Fever and malaise with chills.• Congested nasal mucosa• Headache and otalgia
STAGE OF SECONDARY INFECTION
• Nasal discharge becomes thicker and yellowish and greenish.
• Fever & malaise with chill.• Headache• Otalgia• Congested nasal mucosa
COMPLICATION
• Sinusitis • Acute otitis media.• Pharyngitis.• Pneumonia.• Laryngitis.
STAGE OF RESOLUTION
• Resolution of uncomplicated cases occurs within 6 -10 days.
Treatment
• Antibiotics • Analgesics• Antipyretics• Antihistamine• Vitamin C
• Rest and warm • Give high protein diet • Nasal decongestants locally• Steam inhalation
CHRONIC SIMPLE RHINITIS
• Aetiology • Predisposing factors • Vasomotor rhinitis• DNS• Nasal polypi• Tonsillitis• Sinusitis • Smoking and alcoholism
Clinical feature• Rhinorrhoea-mucopurulent• Headache • Nasal obstruction• Anosmia
SIGNS
• Hyperemic mucosa with oedema.• Post nasal drip .• Thick viscid mucopurulent nasal secreation.• Pharyngitis.
TREATMENT
• Alkaline nasal douching.• Treat the indisposing factors if present.• Stop smoking &alcohol.
Chronic hypertrophic rhinitis
• Etiology • Usually it result from recurrent attack from acute
rhinitis.• Predisposing factors:• sinusitis• Pollution • Dust• Smoke• Tonsilitis
• Nasal polyp• Overuse of nasal drops• Vitamin deficiency
CLINICAL FEATURE
• Nasal obstruction• Rhinorrhoea• Anosmia• Dull headache• Otalgia• Sore throat due to pharyngitis
SIGNS
• Anterior rhinoscopy: Hypertrophy of inferior nasal turbinates.
• Posterior rhinoscopy:Mullbery like appearance
TREATMENT
• Removal or treatment of predisposing factors• Local nasal decongestants drops• Antihistamine• Surgical management for turbinate
hypertrophy• Partial turbinectomy
ATROPHIC RHINITIS • Synonym:ozeana• It is a chronic inflammatory disease of the
nasal mucosa which characterised by progressive atrophy of the mucosa and turbinates', formation of crust and foul smell from the nose known as ozaena.
CLASSIFICATION
• Unilateral or bilateral • Primary or secondary
AETIOLOGY
• Primary:• Exact aetiology not known but predisposing
factor include:• Age : common between 15-40 yrs occurs
usually at puberty.• Sex : more common in female.• Heredity• familial
• Environmental• Nutritional• Hormonal • Vitamin a deficiency• Infection • Secondary :• Chronic specific infection• Extensive surgery• Chronic sinusitis• DNS
PATHOLOGY• It is a condition characterised by atrophic
changes in all the nasal tissues.• Mucosa undergoes atrophy and metaplasia• Cilia and secretory glands also undergo
atrophy with a resultant pale , dry, thin mucosa with thick scanty secretion dry to form crust which may bleed on removal.
• Secondary infection usually results in foul foetid smelling
• Turbinates' undergo atrophy resulting in loss of anatomical landmarks on the nose and a roomy nasal cavity.
• Blood vessels undergo periarteritis & endaritis resulting in ischemia .
• Sensory nerves undergo atrophy and hence the patients may complain of nasal obstruction as he does not feels the air passing through the nose.
• Atrophy of the olfactory nerve ending resulting in anosmia
CLINICAL FEATURE
• Nasal obstruction :– Crust in nasal cavity– Atrophy of sensory nerves
• Crusting of nose(ozaena)• Foul smell of nose• Anosmia • Epistaxis • Headache• dryness of nose and throat
SIGNS
• External nasal examination:– Bridge of nose may be depressed ( saddle shaped)
• Anterior rhinoscopy– Nasal cavity is roomy – Causative factors like DNS– Mucosa is pale shiny dry and atrophy – Crust are seen
• Posterior rhinoscopy – Diminished sensation of the mucosa due to the
atrophy of sensory nerve ending
COMPLICATION
• Sinusitis • Middle ear infection • Atrophic pharyngitis • Maggots
INVESTIGATION
• X-ray of nose/sinus• VDRL test• Complete haemogram• Dermatographical examination• XRAY chest• Nasal smear for leprosy and T.B• Biopsy
TREATMENT
• Primary cause should be treated • Nasal drops:– 25% glycerine drops– Chloramphenicol drops– Streptomycin drops
• Placental extract• Antibiotics• Nutritional improvement vitamin A,B,B6• vasodilators
Surgical treatment
• Narrowing of nasal cavity• Submucosal grafting• Partial closure• Cervical sympathectomy
Rhinitis caseosa
• synonym;cholesteatoma. It is a condition characterized by accumulation
of a caseosa (cheesy) material in the nasal cavity
&maxillary sinus .
Aetiology
• The exact etiology is not known.• Associated with inflammation and granulation
of the lining mucosa.• There may be erosion of lateral nasal wall
Clinical feature
• Nasal obstruction• Foul smell • Headache • Thick viscid rhinorrhoea
SIGNS
• Thick cheesy or caseous material • Foetid odor• Involvement of maxillary sinus
TREATMENT
• Caldwell luc operation
RHINITIS SICCA
• It is a disease of nose characterised by drying and crusting affecting only the anterior portion of the nasal cavity.
Aetiology
• Seen in person working dry hot dusty environment like rubber factory worker bottle factory workers.
CLINICAL FEATURE
• Crusting • Drying • Nasal obstruction• Irritation • Epistaxis • Ulceration • Septal perforation
SIGNS
• Anterior rhinoscopy: dry dark red mucosa ulceration
• Posterior rhinoscopy: nasal mucosa normal • No any crust or drying
TREATMENT
• Lubrication of nose-vaseline,oil• Alkaline nasal douching• Change of environment /job
DIPHTHERETIC RHINITIS
• Also known as nasal diptheria.• It is a form of acute infective rhinitis.
Aetiology
• Causative organism: corynebacterium diphtheria.
• Age :common in children.• It is of two types – Primary– Secondary
Primary
• It may affect the nose first without involvement of other tissues.
Secondary • It may affect the nose secondary to faucial
diphtheria.
CLINICAL FEATURES
• Blood stained watery rhinorrhoea.• Skin near the nasal vestibule may show
excoriation due to continuous nasal discharge.• Nasal obstruction• Greyish white membrane is seen on the
turbinate's or nasal septum, it is difficult to remove.
• Constitutional symptoms such as fever malaise etc.
Investigation
• Swab culture may show diphtheria bacilli
Treatment
• Patient is hospitalised and isolated.• Antitoxin serum are given after a skin
sensitivity test.• Penicillin and ampicillin.
ALLERGIC RHINITIS
• Allergic rhinitis is a common disorder which is usually characterized by spasmodic attack of severe sneezing and rhinorrhea.
Aetiology
• Age:all age• Sex: both sex• Predisposing factors:• Hereditary• Harmonasl• Climate• Emotional
• Precipatating factor(allergens)• inhalents • Ingestants• Contactants• Cosmetic powder• Drugs• Irritants• Infection• Intestinal helmenthis
TYPES
• Two types• Seasonal • Perinial
SYMPTOMS
• Irriritants• Paroxysmal sneezing• Rhinorrhoea• Nasal obstruction• Anosmia• Headache
SIGNS
• Mucosa –Acute stage :paleChronic stage :bluish purple– Infection:present– Polyp :present– Allergic salute(tip of nose salute like)– dorrer’s line (crease on dorsum of nose)
INVESTIGATION
• Nasal secretion : eosinophilia• Haemogram• Stool examination• History about allergy• Skin test by intradermal injection• Inhalation of allergens• Elimination test for food• RAST (radio allergosorbant test)
TREATMENT
• Avoidance of allergen• Desensitisation • Symptomatic: • antihistamine • Steroids• General:• Vitamin c• Calcium
LOCAL TREATMENT
• Hydrocortison injection• Zinc ionisation• Cryosurgery• Laser therapy
SURGICAL
• Nasal obstruction• Infection• Vidian neurectomy
CORRELATION WITH MIASM• Rhinitis covers all the three
miasm, psora and syphilis & sycosis.
PSORA
• Psora-functional changes• Rhinitis covers the psora miasm; psora leads
to functional disturbances; i.e. in rhinitis there is inflammation of mucus membrane of nose leading to ischemic conditions and burning, irritation like symptoms.
• Sensation of dryness in the nose troublesome even when the air passes freely.
• Epistaxis more or less profusely more or less frequently.
• Ulcerated nostrils• Nostrils as if it were stuffed up.• Disagreeble sensation of dryness in the nose.
SYPHILIS • It also covers the syphilis miasm because of
the nasal discharge.• Loss of smell.• Snuffle children.• The bones of the nose are destroyed.• Syphilis produce ulceration• The crust of syphilis are dark greenish black or
brown,thick and not always offensive
SYCOTIC
• It also covers the sycotic miasm because t leads to nasal destruction.
• Sense of smell loss.• Sycotic has a red nose with prominent
cappilaries • There is often nasal stoppage due thickening
of the membrane ,there is enlarged turbinated bones.
• New babies of sycotic patient often get snuffles nose dry stuffed up frequently in Childs.
• Screams with anger in its attempt with breathe with its mouth closed