Rhinitis

1. Atrophic Rhinitis
Mohan Bansal, MS, PhD, FICS, FACS
Otorhinolaryngology Head and Neck Surgery

2. ATROPHIC RHINITIS (OZENA)
Etiology: Exact cause not known.
 Hereditary: Family history
 Hormonal: Puberty, Females, Spontaneous regression after m
enopause.
 Racial: White and yellow races
 Dietary: Deficiency of vitamin A, D or iron Low socioeconomic l
evel.
 Infective: Klebsilla ozaenae (Perez bacillus), diphtheroids, P. v
ulgaris, Escherichia coli, Staphylococci and streptococci. Primar
y causative organisms or secondary invaders. Foul smell.
 Autoimmune: Antigenicity of nasal mucosa leads to antibodies
which destruct nasal mucosa.
Bansal M. (2018) Diseases of Ear, Nos
e & Throat 2nd Ed. Jaypee Brothers

3. ATROPHIC RHINITIS (OZENA)
Pathology
Ciliated columnar epithelium replaced by stratifi
ed squamous.
Atrophy of seromucinous glands, venous blood
sinusoids and nerve elements.
Obliterative endarteritis causes resorption of tur
binates and widening of nasal chambers (muco
sa, periosteum and bone).
Course
Recovers spontaneously in middle age.
Bansal M. (2018) Diseases of Ear, Nos
e & Throat 2nd Ed. Jaypee Brothers

4. ATROPHIC RHINITIS (OZENA)
Clinical Features
Females around puberty, emit foul smell, social
outcast. Merciful anosmia
Nasal obstruction, large Greenish or grayish bla
ck dry crusts, unduly wide nasal chambers.
Epistaxis
Easy visibility of posterior wall of nasopharynx a
nd ostium of sinuses.
Nasal mucosa pale.
Bansal M. (2018) Diseases of Ear, Nos
e & Throat 2nd Ed. Jaypee Brothers

5. ATROPHIC RHINITIS (OZENA)
Clinical Findings
 Septal perforation and saddle nose deformity not unco
mmon.
 Atrophic pharyngitis: Mucosa dry and glazed with crust
s.
 Obstruction to Eustachian tube: Middle ear effusion
 Atrophic laryngitis: Cough and hoarseness of voice.
 X-ray of paranasal sinuses: Small, underdeveloped an
d thick walled sinuses. Appear opaque. Arrested devel
opment.
 Antral puncture difficult.
Bansal M. (2018) Diseases of Ear, Nos
e & Throat 2nd Ed. Jaypee Brothers

6. Atrophic Rhinitis:
 Patients cannot perceive offensive sm
ell emanating from their own noses. D
egenerative changes in olfactory muc
osa results in anosmia.
 Alkaline nasal douche: This mixture c
ontains sodium chloride (2 parts), sod
ium bicarbonate (1 part) and sodium b
orate (1 part). It does not contain gluc
ose.
Bansal M. (2018) Diseases of Ear, Nos
e & Throat 2nd Ed. Jaypee Brothers

7. ATROPHIC RHINITIS (OZENA)
Treatment: Complete cure not possible.
A. Medical – General
 Nasal hygiene: Removal of crusts take care of putrefy
ing smell.
 Warm normal saline or alkaline nasal irrigation: On
e TSF alkaline powder (soda bicarbonate 1 part, Sodiu
m biborate 1 part, and Sodium chloride 2 parts) is diss
olved in 280 ml of water. Irrigating nasal cavities 2 or 3
times a day.
 25% glucose in glycerin: Application after the remov
al of crusts. Inhibits growth of proteolytic organisms re
sponsible for foul smell.
Bansal M. (2018) Diseases of Ear, Nos
e & Throat 2nd Ed. Jaypee Brothers

8. ATROPHIC RHINITIS (OZENA)
A. Medical – Specific
 Antibiotics: Spraying or painting eliminate secondary infection.
 Kemicetine antiozaena solution: Chloromycetin, estradiol an
d vitamin D2
 Inj. Streptomycin (Klebsilla) 1 g/day for 10 days, reduce crus
ting
 Estradiol nasal spray: Increase vascularity, regenerate serom
ucinous glands.
 Placental extract: Submucosal injection provides symptomatic
relief.
 Potassium iodide: Promote and liquefy nasal secretions.
Bansal M. (2018) Diseases of Ear, Nos
e & Throat 2nd Ed. Jaypee Brothers

9. ATROPHIC RHINITIS (OZENA)
B. Surgical Treatment
 Young’s operation: Both nostrils are completely closed within t
he nasal vestibule with flaps. Nasal mucosa revert to normal an
d crusting reduced. Nostrils opened after 6 months or later.
 Modified Young’s operation: Nostrils partially closed.
 Narrowing the nasal cavities: Decrease crusting.
 Submucosal intranasal injection of teflon paste.
 Fat, cartilage, bone or Teflon grafts under the mucoperiostiu
m of the floor and lateral wall of nose and the mucoperichon
drium of the septum.
 Medial displacement of lateral nasal wall.
Bansal M. (2018) Diseases of Ear, Nos
e & Throat 2nd Ed. Jaypee Brothers

10. RHINITIS SICCA
 Ciliated columnar epithelium of anterior part of nose undergoes
squamous metaplasia with atrophy of seromucinous glands.
 Bakers, Iron & goldsmiths work in hot, dry & dusty surroundings
 Clinical features: Crust-forming lesion of anterior third of nose
(especially nasal septum)
 Anterior part of septum ulceration, nosebleed & septal perfor
ation.
 Treatment: Correct occupational surroundings. Use of masks a
nd filters.
 Application of bland or antibiotic-steroid ointments
 Avoidance of frequent nose pricking and removal of crusts
 Nasal saline douche
Bansal M. (2018) Diseases of Ear, Nos
e & Throat 2nd Ed. Jaypee Brothers

11. RHINITIS CASEOSA
 Uncommon condition
 Granulomatous sinus mucosa destroys bony walls of s
inus.
 Clinical features: One side of nose, mostly males.
 Offensive purulent discharge and inspissated cheesy material,
 DD: Malignancy.
 Treatment: Removal of debris and granulation tissue r
estore free drainage of the affected sinus.
 Prognosis: Good.
Bansal M. (2018) Diseases of Ear, Nos
e & Throat 2nd Ed. Jaypee Brothers