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Acute and chronic rhinitis.pptx
- 1. Acute and chronicrhinitis Dr.Vijaya kumar.L Asst professor
- 2. Rhinitis/Rhinosinusitis Rhinitis: inflammation of themucosa of the nasal fossae Rhinosinusitis
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- 6. Chronic rhinitis- Specific Syphilis Leprosy Tuberculosis Rhinosporidiosis Rhinoscleroma Fungal infection Leishmaniasis + -Wegener’s granulomatosis -Sarcoidosis Chronic granulomatous diseases of nose
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- 9. Acute rhinitis Acute Rhinitis ViralBacterial Irritative type
- 10. Viral rhinitis • Aetiology: Several viruses (adeno virus,picorna virus and its sub-groups such as rhinovirus, coxsackie, and ECHO) • Clinical features : Nasal stuffiness, rhinorrhoea, sneezing, low grade fever. • Secondary bacterial invasion may occur. • Treatment : Bed rest, Plenty of fluids, Anthihistaminics, Nasal decongestants, Analgesics & Antibiotics when secondary infection supervenes. Common cold (Coryza)
- 11. • Sinusitis, pharyngitis, tonsillitis,bronchitis,pneumonia and otitis media. Complications : • Influenza viruses a, b or c. • c/f are similar to common cold Influenzal rhinitis • Measles, rubella, chickenpox. • Precede exanthemas by 2-3 days Rhinitis associated with exanthemas.
- 12. Bacterial rhinitis • Primary/Secondary to faucial diphtheria • May occur in acute or chronic form • Greyish membrane is seen covering the inferior turbinate and the floor of nose; • Membrane is tenacious and its removal causes bleeding • Treatment : Isolation of the patient, systemic penicillin and diphtheria antitoxin. Diphtheritic rhinitis
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- 14. Chronic rhinitis Chronic rhinitis SpecificNon specific
- 15. Chronic rhinitis- Specific Syphilis Leprosy Tuberculosis Rhinosporidiosis Rhinoscleroma Fungal infection Leishmaniasis + -Wegener’s granulomatosis -Sarcoidosis Chronic granulomatous diseases of nose
- 16. Chronic rhinitis • Chronicsimple rhinitis • Hypertrophic rhinitis • Atrophic rhinitis • Rhinitis sicca • Rhinitis caseosa. Chronic non- specific inflammations of nose include :
- 17. Chronic simple rhinitis •Predisposing factors • a. Persistence of nasal infection due to sinusitis, tonsillitis, and adenoids. • b. Chronic irritation from dust, smoke, cigarette smoking, snuff. • c. Nasal obstruction. • d. Vasomotor rhinitis • e. Endocrinal or metabolic factors, e.g.hypothyroidism. • Pathology : • Hyperaemia and oedema of mucous membrane, • Hypertrophy of seromucinous glands, increase in goblet cells. Aetiology
- 18. • a. Nasalobstruction • b. Nasal discharge. It may be mucoid or mucopurulent. Postnasal drip. • c. Headache • d. Swollen turbinates – They pit on pressure, shrink with application of vasoconstrictor drops (this differentiates the condition from hypertrophic rhinitis). • e. Post-nasal discharge- Mucoid or mucopurulent discharge. Clinical features
- 19. • a. Treatthe predisposing factor. • b. Nasal irrigations with alkaline solution. • c. Nasal decongestants. • d. Antibiotics help to clear nasal infection. Treatment
- 20. Hypertrophic rhinitis Characterized bythickening of mucosa,submucosa, seromucinous glands, periosteum and bone. Aetiology : • Recurrent nasal infections • Chronic sinusitis • Chronic irritation of nasal mucosa.
- 21. • Nasal obstruction • Nasal discharge: thick and sticky. • Headache • Heaviness of head • Transient anosmia. Symptoms • Hypertrophy of turbinates • Turbinal mucosa is thick, does not pit on pressure, • Little shrinkage with vasoconstrictor drugs due to underlying fibrosis. • Maximum changes in the inferior turbinate. • Mulberry appearance of inferior turbinate. Signs
- 23. • Discover thecause and remove it. • Reduction in size of turbinates by • a. Liner cauterisation • b. Submucosal diathermy • c. Cryosurgeryof turbinates • d. Partial or total turbinectomy • e. Submucous resection of turbinates bone. • f. Lasers Treatment
- 24. Compensatory hypertrophic rhinitis •Roomier side of the nose shows hypertrophy of inferior and middle turbinates. • To reduce the wide space to overcome the ill effects of drying and crusting. In cases of marked deviation of septum to one side.
- 25. Atrophic rhinitis Chronic inflammationof nose Characterized by atrophy of nasal mucosa and turbinate bones • Aetiology : Exact cause is not known, • Various theories regarding its causation are: • a. Hereditary factors • b. Endocrinal disturbances : Starts at puberty, involves females more than males, tends to cease after menopause. Primary atrophic rhinitis :
- 26. c. Racial factors: White. d. Nutritional deficiency : Deficiency of vitamin A, D or iron. e. Infective : Klebsiella ozaenae, (Perez bacillus), diphtheroids, P.vulgaris, Esch.Coli, Staphylococci and Streptococci .but they are all considered to be secondary invaders. f. Autoimmune process : The body reacts by a destructive process to the antigens released from the nasal mucosa.
- 27. • Ciliated columnarepithelium is replaced by stratified squamous type. • Atrophy of seromucinous glands,venous sinusoids and nerve elements. • Obliterative endarteritis. • The bone of turbinates undergoes resorption. • Paranasal sinuses are small. Pathology
- 28. • Charecterised byendarteritis and periarteritis of terminal arterioles • Result of chronic infection • Benefits from vasodilator effect of oestrogen therapy Type 1: • Vasodilatation of capillaries • Might be made worse by oestrogen therapy Type 2:
- 29. • Commonly seenin females and starts around puberty. • Foul smell from the nose.(Cacosmia) • Marked anosmia (merciful anosmia) • Nasal obstruction • Epistaxis • Nasal cavity full of greenish or greyish black dry crusts. • Nasal cavities appear roomy. • Nasal mucosa appear pale. Clinical features
- 30. • Disease persistsfor years Prognosis : • Medical : • a. Alkaline nasal irrigation and removal of crusts. • b. 25% glucose in glycerine. – Inhibits the growth of proteolytic organisms which are responsible for foul smell. • c. Local antibiotics – KemicetineTM antiozaena solution contains chloromycetin, oestradiol and vitamin D2. Treatment
- 31. • Medical • d.Oestradiol spray – increase vascularity of nasal mucosa and regeneration of seromucinous glands. • e. Placental extract injected submucosally. • f. Systemic use of streptomycin – reducing crusting and odour. Effective against Klebsiella organisms. • g. Potassium iodide by mouth promotes and liquefies nasal secretion. Treatment
- 32. • Surgical : •a. Young’s operation – • Both the nostrils are closed completely just within the nasal vestibule by raising flaps. They are opened after 6 months or later. • Modified young’s operation - Aims to partially close the nostrils. • b. Narrowing the nasal cavities. • Submucosal injection to teflon paste. • Insertion of fat, cartilage, bone or teflon strips under the mucoperiosteum of the floor and lateral wall of nose and the mucoperichondrium of the septum. • Section and medial displacement of lateral wall of nose. Treament
- 34. • Specific infectionslike syphilis, lupus,leprosy and rhinoscleroma. • Longstanding purulent sinusitis, • Radiotherapy of nose or excessive surgical removal of turbinates. SECONDARY ATROPHIC RHINITIS • Extreme deviation of nasal septum. • Atrophic rhinitis on the wider side. UNILATERAL ATROPHIC RHINITIS
- 35. Rhinitis sicca Crust-forming disease Seenin patients who work in hot, dry and dusty surroundings. Confined to the anterior third of nose. The ciliated columnar epithelium undergoes squamous metaplasia. Atrophy of seromucinous glands (Crusts,epistaxis, septal perforation). • Bland ointment or an antibiotic and steroid. • Nasal douche. Treatment
- 36. Rhinitis caseosa Unilateral andmostly affecting males. Nose is filled with offensive purulent discharge and cheesy material. Sinus mucosa becomes granulomatous. Bony walls of sinus may be destroyed. Treatment : Removal of debris and granulation tissue , Free drainage of the affected sinus.
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Editor's Notes
- #4Â 1)Owing to the continuity of the mucosa of the nasal mucosa and that of the sinuses some degree of inflammation is often present in the latter at the same time so constituting a rhinosinusitis 2) When the inflammation of the sinus is primary or overshadows that of the nasal fossae the condition called sinusitis