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RHINITIS
DEPARTMENT 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
chroni
c
specific
Non
specific
Atrophic
rhinitis
Simple
chronic
rhinitis
Hypertrop...
specific
syphilis
leprosy
Tuberculosi
rhinosporidiosis
Rhino
scleroma
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...
Pathology
• Viral infection of the nasal mucosa
• Acute generalised hyperaemia of the nasal
mucosa
• Engorgement of the se...
• sinusitis
• Involvement of Eustachian tube opening
• ASOM &SOM
CLINICAL FEATURES
• Incubation period:1-3 days
• Four stages
– Ischaemic stage
– Hyperaemic stage
– Stage of secondary inf...
ISCHAEMIC STAGE
• Raw sensation & irritation in the pharynx.
• Irritation & dryness in the nose.
• Sneezing attack.
• Mala...
HYPEREMIC STAGE
• Profuse watery rhinorrhea
• Anosmia
• Blocking of nose
• Fever and malaise with chills.
• Congested nasa...
STAGE OF SECONDARY INFECTION
• Nasal discharge becomes thicker and
yellowish and greenish.
• Fever & malaise with chill.
•...
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
• Sinus...
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 fac...
• 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 mana...
ATROPHIC RHINITIS
• Synonym:ozeana
• It is a chronic inflammatory disease of the
nasal mucosa which characterised by
progr...
CLASSIFICATION
• Unilateral or bilateral
• Primary or secondary
AETIOLOGY
• Primary:
• Exact aetiology not known but predisposing
factor include:
• Age : common between 15-40 yrs occurs
...
• Environmental
• Nutritional
• Hormonal
• Vitamin a deficiency
• Infection
• Secondary :
• Chronic specific infection
• E...
PATHOLOGY
• It is a condition characterised by atrophic
changes in all the nasal tissues.
• Mucosa undergoes atrophy and m...
• Turbinates' undergo atrophy resulting in loss
of anatomical landmarks on the nose and a
roomy nasal cavity.
• Blood vess...
CLINICAL FEATURE
• Nasal obstruction :
– Crust in nasal cavity
– Atrophy of sensory nerves
• Crusting of nose(ozaena)
• Fo...
SIGNS
• External nasal examination:
– Bridge of nose may be depressed ( saddle shaped)
• Anterior rhinoscopy
– Nasal cavit...
• 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 s...
TREATMENT
• Primary cause should be treated
• Nasal drops:
– 25% glycerine drops
– Chloramphenicol drops
– Streptomycin dr...
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 i...
Aetiology
• The exact etiology is not known.
• Associated with inflammation and granulation
of the lining mucosa.
• There ...
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 n...
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 ...
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
– Se...
Primary
• It may affect the nose first without
involvement of other tissues.
Secondary
• It may affect the nose secondary ...
CLINICAL FEATURES
• Blood stained watery rhinorrhoea.
• Skin near the nasal vestibule may show
excoriation due to continuo...
Investigation
• Swab culture may show diphtheria bacilli
Treatment
• Patient is hospitalised and isolated.
• Antitoxin serum are given after a skin
sensitivity test.
• Penicillin ...
ALLERGIC RHINITIS
• Allergic rhinitis is a common disorder which is
usually characterized by spasmodic attack of
severe sn...
Aetiology
• Age:all age
• Sex: both sex
• Predisposing factors:
• Hereditary
• Harmonasl
• Climate
• Emotional
• Precipatating factor(allergens)
• inhalents
• Ingestants
• Contactants
• Cosmetic powder
• Drugs
• Irritants
• Infection...
TYPES
• Two types
• Seasonal
• Perinial
SYMPTOMS
• Irriritants
• Paroxysmal sneezing
• Rhinorrhoea
• Nasal obstruction
• Anosmia
• Headache
SIGNS
• Mucosa
–Acute stage :pale
Chronic stage :bluish purple
– Infection:present
– Polyp :present
– Allergic salute(tip ...
INVESTIGATION
• Nasal secretion : eosinophilia
• Haemogram
• Stool examination
• History about allergy
• Skin test by intr...
TREATMENT
• Avoidance of allergen
• Desensitisation
• Symptomatic:
• antihistamine
• Steroids
• General:
• Vitamin c
• Cal...
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 rhinit...
• Epistaxis more or less profusely more or less
frequently.
• Ulcerated nostrils
• Nostrils as if it were stuffed up.
• Di...
SYPHILIS
• It also covers the syphilis miasm because of
the nasal discharge.
• Loss of smell.
• Snuffle children.
• The bo...
SYCOTIC
• It also covers the sycotic miasm because t
leads to nasal destruction.
• Sense of smell loss.
• Sycotic has a re...
• New babies of sycotic patient often get
snuffles nose dry stuffed up frequently in
Childs.
• Screams with anger in its a...
Rhinitis
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Rhinitis

rhinitis and its relation with homoeopathic miasms and its treatment

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Rhinitis

  1. 1. RHINITIS DEPARTMENT OF SURGERY By d.Gautam
  2. 2. contents • Definition • Classification • Clinical features • Signs • Investigation • Complication • treatment
  3. 3. RHINITIS • It is the inflammation of the nasal mucous membrane
  4. 4. rhinitis infected Acute bacterial viral chroni c specific Non specific Atrophic rhinitis Simple chronic rhinitis Hypertroph ic rhinitis Rhinitis sicca Rhinitis caseosa Granuloma tous rhiitis Non infected allergic seasonal perinial vasomoto r
  5. 5. specific syphilis leprosy Tuberculosi rhinosporidiosis Rhino scleroma Fungal infection leishmaniosis
  6. 6. Coryza • It is an acute non specific infective rhinitis. • Also known as “common cold”.
  7. 7. 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.
  8. 8. 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
  9. 9. • sinusitis • Involvement of Eustachian tube opening • ASOM &SOM
  10. 10. CLINICAL FEATURES • Incubation period:1-3 days • Four stages – Ischaemic stage – Hyperaemic stage – Stage of secondary inflammation – Stage of resolution
  11. 11. ISCHAEMIC STAGE • Raw sensation & irritation in the pharynx. • Irritation & dryness in the nose. • Sneezing attack. • Malaise with chills. •
  12. 12. HYPEREMIC STAGE • Profuse watery rhinorrhea • Anosmia • Blocking of nose • Fever and malaise with chills. • Congested nasal mucosa • Headache and otalgia
  13. 13. STAGE OF SECONDARY INFECTION • Nasal discharge becomes thicker and yellowish and greenish. • Fever & malaise with chill. • Headache • Otalgia • Congested nasal mucosa
  14. 14. COMPLICATION • Sinusitis • Acute otitis media. • Pharyngitis. • Pneumonia. • Laryngitis.
  15. 15. STAGE OF RESOLUTION • Resolution of uncomplicated cases occurs within 6 -10 days.
  16. 16. Treatment • Antibiotics • Analgesics • Antipyretics • Antihistamine • Vitamin C
  17. 17. • Rest and warm • Give high protein diet • Nasal decongestants locally • Steam inhalation
  18. 18. CHRONIC SIMPLE RHINITIS • Aetiology • Predisposing factors • Vasomotor rhinitis • DNS • Nasal polypi • Tonsillitis • Sinusitis • Smoking and alcoholism
  19. 19. Clinical feature • Rhinorrhoea-mucopurulent • Headache • Nasal obstruction • Anosmia
  20. 20. SIGNS • Hyperemic mucosa with oedema. • Post nasal drip . • Thick viscid mucopurulent nasal secreation. • Pharyngitis.
  21. 21. TREATMENT • Alkaline nasal douching. • Treat the indisposing factors if present. • Stop smoking &alcohol.
  22. 22. Chronic hypertrophic rhinitis • Etiology • Usually it result from recurrent attack from acute rhinitis. • Predisposing factors: • sinusitis • Pollution • Dust • Smoke • Tonsilitis
  23. 23. • Nasal polyp • Overuse of nasal drops • Vitamin deficiency
  24. 24. CLINICAL FEATURE • Nasal obstruction • Rhinorrhoea • Anosmia • Dull headache • Otalgia • Sore throat due to pharyngitis
  25. 25. SIGNS • Anterior rhinoscopy: Hypertrophy of inferior nasal turbinates. • Posterior rhinoscopy:Mullbery like appearance
  26. 26. TREATMENT • Removal or treatment of predisposing factors • Local nasal decongestants drops • Antihistamine • Surgical management for turbinate hypertrophy • Partial turbinectomy
  27. 27. 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.
  28. 28. CLASSIFICATION • Unilateral or bilateral • Primary or secondary
  29. 29. 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
  30. 30. • Environmental • Nutritional • Hormonal • Vitamin a deficiency • Infection • Secondary : • Chronic specific infection • Extensive surgery • Chronic sinusitis • DNS
  31. 31. 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
  32. 32. • 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
  33. 33. 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
  34. 34. 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
  35. 35. • Posterior rhinoscopy – Diminished sensation of the mucosa due to the atrophy of sensory nerve ending
  36. 36. COMPLICATION • Sinusitis • Middle ear infection • Atrophic pharyngitis • Maggots
  37. 37. INVESTIGATION • X-ray of nose/sinus • VDRL test • Complete haemogram • Dermatographical examination • XRAY chest • Nasal smear for leprosy and T.B • Biopsy
  38. 38. 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
  39. 39. Surgical treatment • Narrowing of nasal cavity • Submucosal grafting • Partial closure • Cervical sympathectomy
  40. 40. Rhinitis caseosa • synonym;cholesteatoma. It is a condition characterized by accumulation of a caseosa (cheesy) material in the nasal cavity &maxillary sinus .
  41. 41. Aetiology • The exact etiology is not known. • Associated with inflammation and granulation of the lining mucosa. • There may be erosion of lateral nasal wall
  42. 42. Clinical feature • Nasal obstruction • Foul smell • Headache • Thick viscid rhinorrhoea
  43. 43. SIGNS • Thick cheesy or caseous material • Foetid odor • Involvement of maxillary sinus
  44. 44. TREATMENT • Caldwell luc operation
  45. 45. RHINITIS SICCA • It is a disease of nose characterised by drying and crusting affecting only the anterior portion of the nasal cavity.
  46. 46. Aetiology • Seen in person working dry hot dusty environment like rubber factory worker bottle factory workers.
  47. 47. CLINICAL FEATURE • Crusting • Drying • Nasal obstruction • Irritation • Epistaxis • Ulceration • Septal perforation
  48. 48. SIGNS • Anterior rhinoscopy: dry dark red mucosa ulceration • Posterior rhinoscopy: nasal mucosa normal • No any crust or drying
  49. 49. TREATMENT • Lubrication of nose-vaseline,oil • Alkaline nasal douching • Change of environment /job
  50. 50. DIPHTHERETIC RHINITIS • Also known as nasal diptheria. • It is a form of acute infective rhinitis.
  51. 51. Aetiology • Causative organism: corynebacterium diphtheria. • Age :common in children. • It is of two types – Primary – Secondary
  52. 52. Primary • It may affect the nose first without involvement of other tissues. Secondary • It may affect the nose secondary to faucial diphtheria.
  53. 53. 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.
  54. 54. Investigation • Swab culture may show diphtheria bacilli
  55. 55. Treatment • Patient is hospitalised and isolated. • Antitoxin serum are given after a skin sensitivity test. • Penicillin and ampicillin.
  56. 56. ALLERGIC RHINITIS • Allergic rhinitis is a common disorder which is usually characterized by spasmodic attack of severe sneezing and rhinorrhea.
  57. 57. Aetiology • Age:all age • Sex: both sex • Predisposing factors: • Hereditary • Harmonasl • Climate • Emotional
  58. 58. • Precipatating factor(allergens) • inhalents • Ingestants • Contactants • Cosmetic powder • Drugs • Irritants • Infection • Intestinal helmenthis
  59. 59. TYPES • Two types • Seasonal • Perinial
  60. 60. SYMPTOMS • Irriritants • Paroxysmal sneezing • Rhinorrhoea • Nasal obstruction • Anosmia • Headache
  61. 61. SIGNS • Mucosa –Acute stage :pale Chronic stage :bluish purple – Infection:present – Polyp :present – Allergic salute(tip of nose salute like) – dorrer’s line (crease on dorsum of nose)
  62. 62. 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)
  63. 63. TREATMENT • Avoidance of allergen • Desensitisation • Symptomatic: • antihistamine • Steroids • General: • Vitamin c • Calcium
  64. 64. LOCAL TREATMENT • Hydrocortison injection • Zinc ionisation • Cryosurgery • Laser therapy
  65. 65. SURGICAL • Nasal obstruction • Infection • Vidian neurectomy
  66. 66. CORRELATION WITH MIASM • Rhinitis covers all the three miasm, psora and syphilis & sycosis.
  67. 67. 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.
  68. 68. • 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.
  69. 69. 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
  70. 70. 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.
  71. 71. • 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

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