Atrophic rhinitis is a chronic nasal disease characterized by atrophy of the nasal mucosa and bone of the turbinates. It is associated with thick, foul-smelling secretions and crust formation. The cause is often unknown but may be due to infections, surfactant deficiency, or autonomic imbalances. Treatment involves regular nasal cleansing, topical medications to hydrate the nose, systemic antibiotics, and sometimes surgery to decrease nasal volume or improve vascularity.
Cavity obliteration is a procedure done at the end of Mastoidectomy to get a cavity-less mastoid cavity thus solving the problem of discharging post-operative cavity.
Sinus tymapni shape and depth can influence surgical approach in cholesteatoma surgery. In the case of a shallower ST, an exclusive endoscopic exploration is chosen; while in the case of a deeper ST, a retrofacial approach is usually preferred.
Spaces of middle ear and their surgical importanceDr Soumya Singh
one of the imp topics in ENT that should be understood very thoroughly if u want to pursue as an otologist.I tried to simplify the topic with simple diagrams and models for better understanding .
Cavity obliteration is a procedure done at the end of Mastoidectomy to get a cavity-less mastoid cavity thus solving the problem of discharging post-operative cavity.
Sinus tymapni shape and depth can influence surgical approach in cholesteatoma surgery. In the case of a shallower ST, an exclusive endoscopic exploration is chosen; while in the case of a deeper ST, a retrofacial approach is usually preferred.
Spaces of middle ear and their surgical importanceDr Soumya Singh
one of the imp topics in ENT that should be understood very thoroughly if u want to pursue as an otologist.I tried to simplify the topic with simple diagrams and models for better understanding .
Nasal discharge, also known as rhinorrhea, is a common symptom that can be caused by a variety of conditions related to the ear, nose, and throat (ENT). It is the result of excess mucus production in the nasal cavity, which can be caused by inflammation or infection of the nasal passages.
Common causes of nasal discharge include allergies, colds, sinus infections, and nasal polyps. Allergies can cause the nasal passages to become inflamed and produce excess mucus, leading to a runny nose. Colds and sinus infections can also cause inflammation and infection, leading to nasal discharge.
Nasal polyps are growths in the nasal cavity that can obstruct airflow and cause chronic inflammation and excess mucus production. Other less common causes of nasal discharge include foreign bodies in the nasal cavity, tumors, and hormonal changes during pregnancy.
Treatment for nasal discharge depends on the underlying cause. For allergies, antihistamines and nasal corticosteroids may be recommended. For colds and sinus infections, decongestants, saline nasal sprays, and antibiotics may be used. Nasal polyps may require surgical removal.
In addition to nasal discharge, other symptoms that may be present with ENT-related conditions include nasal congestion, headache, facial pain or pressure, cough, and sore throat. If nasal discharge is persistent, accompanied by other symptoms, or affects quality of life, it is important to seek medical evaluation by an ENT specialist.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
2. DEFINITION
Atrophic rhinitis is a chronic nasal disease
characterized by progressive atrophy of the mucosa
and the underlying bone of the turbinates.
It is associated with viscid secretions which dry
resulting in crust formation with a characteristic foul
odour,called ozaena.
3. HISTORY
Dr Spencer Watson called it ozenae in 1875
Dr Bernhard Fraenkel 1876 described triad
Fetor
Crustings and
Atrophy of nasal structures
4. EPIDEMIOLOGY
0.3-1% in countries with high prevalence
More common in animals- swines and cattle
Predominant in young and middle aged
More common in females
More common in tropical countries
Most common in low socoeconomic classes living
in poor hygenic conditions.
5. AETIOLOGY
The precise aetiology is still unknown.
Cases wherein no specific aetiologic factor can be identified
are designated primary atrophic rhinitis.
Cases wherein a specific aetiologic factor can be implicated
are designated secondary atrophic rhinitis.
7. Infections:
A wide range of bacterial flora have been reported from
the nasal secretions of these patients, namely,
Coccobacillus foetidus ozaena,
Diptheroid bacilli and
Klebsiella ozaenae.
Recent studies have identified
Bordetella bronchoseptica and
Pasteurella multocida, and have suggested that
inoculation of these organisms into animals has produced
changes similar to atrophic rhinitis.
8. Biochemical studies of the nasal aspirate in atrophic rhinitis
have noted a significant decrease in the total phospholipids
and also a change in the phospholipid profile.
This suggests a possible role for surfactant deficiency in
the aetiopathogenesis.
Surfactant deficiency in nasal secretion causing ciliary
dysfunction leading to stasis of nasal secretions and
crusting.
9. Primary atrophic rhinitis usually commences at puberty and is
much more common in females, suggesting that endocrine
imbalance may have some role to play.
The disease is more common in people of low socioeconomic
background and has been associated with poor nutrition and
iron-deficiency.
Heredity is an important factor and there also appears to be a
racial influence.
It is more common in yellow and Latin races and American
blacks are more susceptible as compared to natives of
equatorial Africa.
10. Autoimmune:
viral infection / malnutrition / immune deficiency
triggers destructive autoimmune process on nasal
mucosa
Autonomic Imbalance:
Excessive vasoconstriction from autonomic
imbalances as a reason for development of AR has
been described.
Reflex Sympathetic Dystrophy Syndrome
(R.S.D.S.) causes vasodilatation & hyperaemic
decalcification of turbinates followed by
vasoconstriction
12. PATHOLOGY
Patches of metaplasia -- ciliated columnar epithelium to
nonkeratinized or keratinized squamous epithelium.
Lamina propria--- chronic cellular infiltration, granulation
tissue and fibrosis.
Mucous glands are decreased in size and number.
13. Vascular changes:
Decreased vascularity,
Periarteritis
Endarteritis of the terminal arterioles.
Taylor and young described vasodilatation of the
capillaries with increased alkaline phosphatase
activity leading to bone resorption
14. Accumulation of lymphocytes & plasma cells.
Squamous metaplasia from ciliated columnar
Ciliary destruction & decrease in nasal glands
Bone resorption
Types:
AR type I
Common type (50–80 per cent of all cases),
Endarteritis obliterans, periarteritis and periarterial
fibrosis of the terminal arterioles as a result of
chronic infections with round cell and plasma cell
infiltration.
Benefit from the vasodilator effects of oestrogen
therapy.
15. AR type II
Less common (20–50 per cent of all cases)
Capillary vasodilatation
Endothelial cells of dilated capillaries have more
Cytoplasm than normal and show a positive
alkaline phosphatase reaction suggesting active
bone resorption, which is a feature of the disease
Not amenable to oestrogen therapy.
17. CLINICAL FEATURES
Nasal crusting which is brown black or dark green
in colour
Thick purulent discharge
Foul smell due to the anerobic flora
Anosmia
Headache, epistaxis
Nasal obstruction
Pharyngitis sicca
18. Causes of anosmia
Loss of olfactory neural elements
Thick secretion & crusts over olfactory area
Degeneration of secretory glands
Scanty mucous for dissolving odoriferous materials
Causes of nasal obstruction
Blunting of sensory nerve endings, thus resulting in
a diminished sensation of air flow.
Crust formation
19. CLINICAL EXAMINATION
Presence of fetor
Changes in the nasal passages
Atrophy of turbinates resulting in widening of the
cavity,
Presence of green crusts and thick purulent
discharge.
Occasionally, the condition may be complicated by
maggot infestation in the nose.
20.
21. INVESTIGATIONS
General : hemogram
Specific Investigations
Saccharine test: decreased nasal muco-
ciliaryclearance time
Serum iron & protein levels: malnutrition
Culture & sensitivity of nasal discharge
Diagnostic Nasal Endoscopy
X-ray P.N.S.: maxillary sinusitis
22.
23. C.T. scan P.N.S.
Mucoperiosteal thickening
resorption of ethmoid bulla & uncinate process
Hypoplasia of maxillary sinuses
Roomy nasal cavities
Erosion & bowing of lateral nasal wall
Atrophy of turbinates
24.
25.
26. Other Specific Investigations
Chest X-ray: T.B., bronchiectasis
Serology for syphilis: V.D.R.L.
Sputum for AFB, Mantoux test: T.B
Nasal smear study: Leprosy
Complement fixation test & biopsy:Rhinoscleroma
27. COMPLICATIONS AND SEQUELAE
Nasal septal perforation and saddle nose
deformity:
Severe cases left untreated may be complicated by
destruction of nasal bone and cartilages lead to
septal perforations and saddle nose deformities.
Secondary rhinosinusitis
Local and systemic spread of infection: Spread
of infection to the pharynx, larynx, lungs and ears,
and intracranial spread in immunocompromised
patients is possible
28. Atrophic pharyngitis and laryngitis. Pharyngitis
sicca is a frequent co-morbidity in AR with a dry
pharyngeal mucosa. Dislodged crusts may cause
choking episodes
Chronic dacryocystitis.
A rare complication of ar in the form of dacryocystitis
has been noted
Nasal myiasis.
Seen in neglected cases of primary ar, especially in
patients of lower socioeconomic status living in poor
hygienic conditions.
The putrefied nasal debris and foul smell attract flies of
the genus chrysomia (c. Bezianna vilteneauve).
29. TREATMENT
Aims to restore nasal hydration and minimalisation
of crustings
Medical and conservative treatment
Surgical treatment
30. Regular nasal cleansing is the basis of conservative
treatment.
Alkaline Nasal Douche
Sodium bicarbonate (28.4g) --loosens nasal crusts
Sodium biborate (28.4g) –Antiseptic
Sodium chloride (56.7g) --makes solution isotonic
Mixed in 280 ml of warm water to make the solution
31. Glucose–glycerine nose drops.
Mixing 75g of gycerine and adding 25g of glucose
25% glucose is used to inhibit saprophytic infection and
proteolytic bacteria (glucose on fermentation produces
lactic acid and an acidic pH that inhibits bacterial growth),
and promote the growth of commensal flora.
Glycerine helps as a lubricant and hygroscopic agent
(adsorbs water from the atmosphere and moistens mucosa,
and hence impedes crust formation).
Glycerine may also cause some degree of irritation and
hence improve vascularity.
These nose drops should be applied three or four times a
day after douching the nose.
32. Liquid paraffin nose drops
Effective in lubricating the nasal mucosa and in
removal of crusts
Long-term use is not recommended in view of
reports of paraffin granulomas and inhalational
lipoid pneumonias.
33. Oestradiol in arachis oil.
available for instillation into the nose as drops and
sprays (10 000 units/ml)
oestrogens are only useful for Young and Taylor
Type I AR
oestradiol may worsen the situation in the Type II
variety.
34. Kemicetene antiozaena solution.
90 mg of chloramphenicol
0.64 mg of oestradiol diproprionate
900 IU of vitamin D2 and propylene glycol in each
millilitre.
This is used in the form of nose drops after
douching.
35. Chloramphenicol/streptomycin drops.
use after douching.
Local treatment with injection of a mixture of
streptomycin and novocaine has been tried with
satisfactory results.
36. Injections of human placental extract have been
administered both systemically and locally
(submucosal/intranasal) and have been noted to
result in an improvement.
The extract (0.5 ml) is injected into each nasal
cavity per week for 24 weeks
37. Action of Placental extract
Progesterone leads to hyperplasia of nasal mucosa
& glandular secretion
Oestrogen leads to vasodilatation
Biogenic stimulator of metabolic & regenerative
process
Intra-placental serum boosts up immunity
Mechanical narrowing of nasal passage
38. Antibiotics and antimicrobials
Systemic (intravenous) aminoglycoside (Tobramycin)
therapy for two weeks in addition to topical gentamicin.
Good results have been reported in one study where
Rifampicin 600 mg once daily for 12 weeks was
administered.
More recently, ciprofloxacin in a daily dose of 500–750
mg bid for one to three months has been tried
successfully, i.e. measured by the disappearance of
crusts, odour and K. ozaenae.
39. Iron, zinc, protein and vitamin (A and D)
supplements.
Recommended especially in cases of malnutrition
and established deficiencies.
The use of potassium iodide by mouth with the
object of increasing nasal secretion has been
recommended.
40. Prostheses:
Non-surgical closure of the nasal vestibule using
prostheses
including occlusion of the nostril with an obturator made
from dimethylpolysiloxane.
This is useful in cases of secondary AR where formal
closure of the nostril is contraindicated in view of the
treatment necessary for the primary disease.
Another similar device made of clear acrylic resin called a
‘pin-hole nasal prosthesis’ has been described more
recently.
42. Decongestants or antihistamines.
Strongly contraindicated in AR as they worsen the
pathology and hence the clinical course of the
disease.
43. SURGICAL MANAGEMENT
Aim of Surgery:
o Decrease trauma of air turbulence
Nasal closure
Volume reduction
o Increase nasal secretions
Parotid duct implantation into maxillary sinus
o Increase vascularity of nasal mucosa
Denervation procedures
Nasal implantation of maxillary sinus mucosa
44. The principles of surgery may be divided largely into four
groups.
1. Decreasing the size of the nasal cavities: redudes
turbulence of air currents in roomy air cavities and thus
preventing drying and crustings.
2. Promoting regeneration of normal nasal mucosa.
This may be achieved by allowing the nasal cavities to
rest by temporary closure (complete or partial) of the
nostrils
45. 3.Increasing lubrication of the dry nasal mucosa. This is
achieved by increasing the secretory abilities of the nasal
cavities or by introducing secretions from elsewhere
4.Improving vascularity of the nasal cavities.
This is achieved either by blocking the sympathetic
nervous system (stellate ganglion block or cervical
sympathectomy)
subserving the nose or by introducing grafts (e.G.
Placenta, maxillary mucosal flaps, buccal flaps) that
improve vascularity
46. Types of surgery
Nasal closure: Young
Modified Young
Volume reduction: Lautenslager
Wilson
Sublabial implants
Vestibuloplasty
Denervation: Cervical sympathectomy
Stellate ganglion block
Sphenopalatine ganglion block
Salivary irrigation: Parotid duct implantation
47. Young’s operation:
Only 1 nostril closed
completely by raising 2 circumferential flaps (inner mucosal
& outer cutaneous) in nasalvestibule & suturing them in
midline.
Modified Young’s operation
Similar to youngs but keeping a 3 mm opening on both
sides.
Recannalisation done after few months with a tri-radiate
(Mercedes Benz) incision
48.
49.
50. Advantages of Modified Young
Progress of disease can be monitored with 2.7 mm nasal
endoscope
Glucose in glycerine drops can be instilled
Both nostrils can be operated at one sitting
Nasal breathing preserved
No complaints of de-nasal voice
Better cosmetic result
51. Vestibuloplasty :
Ghosh described an alternative surgical technique
of vestibuloplasty, wherein a posteriorly based skin
flap is raised in the lateral wall of the nasal
vestibule and sutured on itself, thus decreasing the
lateral flow of air into the nasal cavity
53. Raghav Sharan’s operation.
The mucosa of the maxillary antrum is elevated and
brought into the nasal cavity on each side through the
antrostomy.
The benefits are perhaps three-fold: decreasing the size
of the cavity, and improving lubrication and vascularity
54. Cervical Sympathectomy
Stellate ganglion block/ cervical chain block:
through an anterior paratracheal approach, 10-15 cc of 1
per cent xylocaine is injected slowly.
The success of the procedure is judged by the
appearance of Horner’s syndrome, congestion of the
ipsilateral tympanic membrane and congestion of the
ipsilateral nasal mucosa.
It is reported that foetor and crusting are relieved within
eight to 10 blocks and that this is maintained for up to four
to eight days after cessation of blocks.
risk of transient recurrent laryngeal nerve palsy
56. Rhinitis Sicca
Mild form of atrophic rhinitis
Seen in hot, dry, dusty places (bakers, goldsmiths);
alcoholics & anaemics
Crusting present anteriorly only
Bone atrophy & foetor are absent
Tx: Nasal douching + change of surrounding
57. Rhinitis Caseosa
Synonym: Nasal cholesteatoma
Chronic inflammation with deposition of foul
smelling cheesy material in nasal cavity.
Nasal obstruction---stasis of secretions & exfoliated
cells---putrefaction---caseation
Treatment: 1. Removal of cheesy debris
2. Correction of nasal obstruction
58. REFERENCES
Scott brown 7th edition
Dutt, S., & Kameswaran, M. (2005). The aetiology
and management of atrophic rhinitis. The Journal of
Laryngology & Otology, 119(11), 843-852.
doi:10.1258/002221505774783377
Hazarika 3rd edition
Dhingra 6th edition