rhinitis sinusitis

1. ACUTE AND CHRONIC RHINITIS

2. RHINITIS
An inflammation
& swelling of
mucous membrane
of the nose.

3. SYMPTOMS OF RHINITIS
o Running nose
sneezing, itchy
nose/eyes &
stuffiness.

4. INFECTIVE RHINITIS
 Acute
 Non Specific Viral
 Common Cold/ Cough
 Influenza Rhinitis
 Rhinitis with Exanthemas
 Bacterial
 Non Specific rhinitis
 Strepto, Staphylo / Pneumococcus
 Diphtheria

5. CHRONIC RHINITIS
A) Non-Specific
1. Simple Chronic Rhinitis
2. Hypertrophic Rhinitis
3. Atrophic rhinitis
4. Rhinitis Sicca
5. Rhinitis Caseosa
6. Malignant Granuloma

6. CHRONIC RHINITIS SPECIFIC
1. Rhinosporidiosis
2. Rhinoscleroma
3. Syphilis
4. Leprosy
5. Tuberculosis
6. Lupus Vulgaris
7. Fungal Infection a)Aspergillosis
b)Actinomycosis

7. COMMON COLD (CORYZA)
a) Airborne droplet infection
b)Caused by several viruses
A. Adenovirus
B. Picorna virus such as
i. Rhinovirus
ii. Coxsachie
c) Incubation period : 3-4 days
Illness lasts 2-3 weeks.

8. SIGN AND SYMPTOMS
COMMON COLD
1. Nasal Itching
2. Nasal Blockage
3. Rhinorrhea
4. Chills and rigors
5. Low grade fever
 Initially nasal discharge watery and profuse then
goes to form thick mucopurulent due to
secondary infection due to Strepto. Haemolyticus ,
H. Influenzae, Kleb. Pneumoniae

9. BACTERIAL RHINITIS
 Non Specific Infection
1. Primary : Seen in Children and Causative Org. are
Pneumococcus, Streptococcus, and
Staphylococcus. May form a tenaceous
membrane over nasal mucosa which bleeds on
removal.
2. Secondary: Due to secondary bacterial infection
over the acute viral infection. Causative Org. are
Pneumococcus, Streptococcus, Staphylococcus
and H.Influenzae.
o Diphtheritic rhinitis:

10. IRRITATIVE RHINITIS
 Due to exposure to dust, smoke, irritative gases
such as ammonia, formalin, acid fumes.
 Due to trauma while handling nasal mucosa eg
While removing foreign body nose.
 Leads to immediate catarrhal reaction as
 Sneezing
 Rhinorrhea
 Nasal congestion
 Symptoms pass of immediately after removing
offending agent
 Recovery depends on extent of damage.

11. CHRONIC SIMPLE RHINITIS
 Recurrent attacks of acute rhinitis in presence of
pre disposing factors lead to chronic rhinitis
 Persistence Sinusitis, DNS, Vasomotor Rhinitis
 Ch. Adeno tonsillitis,
 Endocrinal: Hypothyroidism/ Metabolic Factors.
 Constant exposure to dust, smoke, cigarette
smoking, snuff, exposure to industrial and chemical
smoke ,alcohol indulgence are the main
predisposing factors.

12. CHRONIC SIMPLE RHINITIS
PATHOLOGY
 Hyperemia
 Edema mucosal membrane
 Increase no. of globet cells, hypertrophy of
seromucinus gland
 Blood sinusoids over the turbinate are distended if
untreated leads to hypertrophy chronic rhinitis.

13. CLINICAL FEATURES
 Nasal obstruction which increases in supine
position
 Nasal discharge
 Hypertrophy of turbinates
 Post nasal drip
Treatment
 Treatment of cause
 Nasal douching, Decongestant and antibiotics

14. HYPERTROPHIC RHINTIS
 Mucosal thickening, hypertrophy of submucosal
seromucinous glands, periosteum of bone
 Changes marked over turbinate due to
• Recurrent nasal infection
• Ch. Sinusitis
• Ch. Irritation due to smoking, industrial irritants,
prolonged nasal drops usage, recurrent vasomotor
or allergic rhinitis

15. HYPERTROPHIC RHINITIS
SIGNS AND SYMPTOMS
 Symptoms
• Nasal obstruction
• Headache
• Thick tenaceous nasal discharge
o Signs
• Hypertrophic nasal turbinates with minimal or no effect
of nasal decongestion drops due to underlying fibrosis
involvement of inferior turbinate is common
• There may be compensatory hypertrophy of inferior
turbinate of opposite site if there is gross DNS.

16. TREATMENT
 Treat the cause
 Avoid exposure to causative agents
 May require cauterization / sub mucosal diathermy
 Partial / Total turbinectomy
A. Middle
B. Inferior turbinate.

17. ATROPHIC RHINITIS ( OZAENA)
 Chronic rhinitis characterized by
1. Atrophy of nasal mucosa and turbinate bones.
2. Nasal cavities are roomy with foul smelling crust.
 Primary Atrophic Rhinitis
1. Idiopathic
2. Hereditary
3. Endocrinal disturbances
 More common in females
 starts at puberty
 Crusting decreases after menopause suggestive
of possibility of endocrinal pathology

18. 4. Nutritional factors : Vit A, D,E and Iron deficiency.
5. Infective pathology : Kleb. Ozaenae
Diptheroids,
Ecoli,
Staphylococcal considered
as secondary invaders causing ozaenae.
6. Auto immune disease
7. Racial Factors Common in races with broad noses

19. PATHOLOGY
 Nasal mucosa : ciliated columnar epithelium is lost
and replaced by stratified squamous type
 Atrophy of seromucinus glands , venous blood
sinusoides, nerves.
 Arteries,of mucosa / periosteum / bone show
obliterative end arteritis.
 Bone of turbinates undergo resorption and widening
of nasal cavity.

20. CLINICAL FEATURES
 Females> Males
 Around puberty
 Foul smelling – socially unaccepted
 Pt will have anosmia due to degenerative changes.
 Pt will have decrease sensations and will complain
of nasal obstruction.
 Nasal crusting, bleeding on removal
 O/E Nasal cavity will roomy, crusting++, mucosa
pale and dry.

21. TREATMENT
 Disease may persist for years
Medical line of treatment.
 Nasal irrigation/ manual removal of crusts.
 Nasal douche with NAHCO3 + Sodium biborate + NaCl
(1+1+2), in 280 ml of water.
 25 % glucose in glycerine nasal drops (inhibits growth of
proleolytic organisms ),
 local antibiotics nasal drops– Kemicetine antiozaena
Solution (Chloromycetin ,Oestradiol, Vitamin D)
 Hormonal therapy(Oestradiol) to increase vascularity of
mucosa and to decrease crusting and mucosal atrophy.
 Placental extract injection to reduce mucosal atrophy

22. Systemic Use Of Streptomycin :1gm/day effective against
Klebsiella
Potassium iodide by mouth Promotes and liquefies the nasal
secretion

23. ATROPHIC RHINITIS
 Surgical line of treatment
 Young’s operation
 Modified Young’s operation
 Narrowing of the nasal cavity
1. Injection of Teflon paste submucosally
2. Insertion of fat , cartilage, bone / Teflon grafts
submucosally

24. SECONDARY ATROPHIC RHINITIS
 Associated with chronic granulamatous condition
such as leprosy, Syphilis, rhinoscleroma, lupus.
 Unilateral Atrophic Rhinitis
 May occur in patient with marked DNS.
 The concave side may lead to atrophic changes
due to drying of nasal secretions in grossly deviated
nasal septum

25. RHINITIS SICCA
 Occupational disease
 Crust formation ++
 Common in people who work in dry atmosphere
such as bakeries / cooks/ Iron and Gold smiths.
 Treatment : To avoid exposure to dry conditions and
routine treatment of atrophic rhinitis

26. RHINITIS CASEOSA
 Unilateral
 Affects male > female
 Purulent, cheesy discharge from nose
 O/E : Ch. Sinusitis with inspissated pus leading to
cheesy discharge which gets secondarily infected
giving rise to Ozaenae.
 Bony walls may get disrupted
 It has to be differentiated from malignancy
 Treatment: Surgical removal of debris.