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Rhinitis
Rhinitis is inflammation of the nasal mucosa that can be acute or chronic. It is classified based on etiology into infectious and non-infectious types. Common infectious causes are viral infections like the common cold, while non-infectious causes include allergies. Clinical features vary depending on type but may include nasal obstruction, rhinorrhea, sneezing, and loss of smell. Treatment involves managing symptoms, treating underlying causes, and antibiotics for secondary bacterial infections. Complications can include sinusitis if left untreated.
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Rhinitis
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- 2. contents • Definition • Classification •Clinical features • Signs • Investigation • Complication • treatment
- 3. RHINITIS • It isthe inflammation of the nasal mucous membrane
- 4. rhinitis infected Acute bacterial viral chroni c specific Non specific Atrophic rhinitis Simple chronic rhinitis Hypertroph ic rhinitis Rhinitis sicca Rhinitis caseosa Granuloma tousrhiitis Non infected allergic seasonal perinial vasomoto r
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- 6. Coryza • It isan acute non specific infective rhinitis. • Also known as “common cold”.
- 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. Pathology • Viral infectionof the nasal mucosa • Acute generalised hyperaemia of the nasal mucosa • Engorgement of the secretory gland and goblet cells • Profuse secretion involvement of sinus
- 9. • sinusitis • Involvementof Eustachian tube opening • ASOM &SOM
- 10. CLINICAL FEATURES • Incubationperiod:1-3 days • Four stages – Ischaemic stage – Hyperaemic stage – Stage of secondary inflammation – Stage of resolution
- 11. ISCHAEMIC STAGE • Rawsensation & irritation in the pharynx. • Irritation & dryness in the nose. • Sneezing attack. • Malaise with chills. •
- 12. HYPEREMIC STAGE • Profusewatery rhinorrhea • Anosmia • Blocking of nose • Fever and malaise with chills. • Congested nasal mucosa • Headache and otalgia
- 13. STAGE OF SECONDARYINFECTION • Nasal discharge becomes thicker and yellowish and greenish. • Fever & malaise with chill. • Headache • Otalgia • Congested nasal mucosa
- 14. COMPLICATION • Sinusitis • Acuteotitis media. • Pharyngitis. • Pneumonia. • Laryngitis.
- 15. STAGE OF RESOLUTION •Resolution of uncomplicated cases occurs within 6 -10 days.
- 16. Treatment • Antibiotics • Analgesics •Antipyretics • Antihistamine • Vitamin C
- 17. • Rest andwarm • Give high protein diet • Nasal decongestants locally • Steam inhalation
- 18. CHRONIC SIMPLE RHINITIS •Aetiology • Predisposing factors • Vasomotor rhinitis • DNS • Nasal polypi • Tonsillitis • Sinusitis • Smoking and alcoholism
- 19. Clinical feature • Rhinorrhoea-mucopurulent •Headache • Nasal obstruction • Anosmia
- 20. SIGNS • Hyperemic mucosawith oedema. • Post nasal drip . • Thick viscid mucopurulent nasal secreation. • Pharyngitis.
- 21. TREATMENT • Alkaline nasaldouching. • Treat the indisposing factors if present. • Stop smoking &alcohol.
- 22. Chronic hypertrophic rhinitis •Etiology • Usually it result from recurrent attack from acute rhinitis. • Predisposing factors: • sinusitis • Pollution • Dust • Smoke • Tonsilitis
- 23. • Nasal polyp •Overuse of nasal drops • Vitamin deficiency
- 24. CLINICAL FEATURE • Nasalobstruction • Rhinorrhoea • Anosmia • Dull headache • Otalgia • Sore throat due to pharyngitis
- 25. SIGNS • Anterior rhinoscopy:Hypertrophy of inferior nasal turbinates. • Posterior rhinoscopy:Mullbery like appearance
- 26. TREATMENT • Removal ortreatment of predisposing factors • Local nasal decongestants drops • Antihistamine • Surgical management for turbinate hypertrophy • Partial turbinectomy
- 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. CLASSIFICATION • Unilateral orbilateral • Primary or secondary
- 29. AETIOLOGY • Primary: • Exactaetiology not known but predisposing factor include: • Age : common between 15-40 yrs occurs usually at puberty. • Sex : more common in female. • Heredity • familial
- 30. • Environmental • Nutritional •Hormonal • Vitamin a deficiency • Infection • Secondary : • Chronic specific infection • Extensive surgery • Chronic sinusitis • DNS
- 31. PATHOLOGY • It isa 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. • Turbinates' undergoatrophy 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. CLINICAL FEATURE • Nasalobstruction : – 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. SIGNS • External nasalexamination: – 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. • Posterior rhinoscopy –Diminished sensation of the mucosa due to the atrophy of sensory nerve ending
- 36. COMPLICATION • Sinusitis • Middleear infection • Atrophic pharyngitis • Maggots
- 37. INVESTIGATION • X-ray ofnose/sinus • VDRL test • Complete haemogram • Dermatographical examination • XRAY chest • Nasal smear for leprosy and T.B • Biopsy
- 38. TREATMENT • Primary causeshould be treated • Nasal drops: – 25% glycerine drops – Chloramphenicol drops – Streptomycin drops • Placental extract • Antibiotics • Nutritional improvement vitamin A,B,B6 • vasodilators
- 39. Surgical treatment • Narrowingof nasal cavity • Submucosal grafting • Partial closure • Cervical sympathectomy
- 40. Rhinitis caseosa • synonym;cholesteatoma. Itis a condition characterized by accumulation of a caseosa (cheesy) material in the nasal cavity &maxillary sinus .
- 41. Aetiology • The exactetiology is not known. • Associated with inflammation and granulation of the lining mucosa. • There may be erosion of lateral nasal wall
- 42. Clinical feature • Nasalobstruction • Foul smell • Headache • Thick viscid rhinorrhoea
- 43. SIGNS • Thick cheesyor caseous material • Foetid odor • Involvement of maxillary sinus
- 44. TREATMENT • Caldwell lucoperation
- 45. RHINITIS SICCA • Itis a disease of nose characterised by drying and crusting affecting only the anterior portion of the nasal cavity.
- 46. Aetiology • Seen inperson working dry hot dusty environment like rubber factory worker bottle factory workers.
- 47. CLINICAL FEATURE • Crusting •Drying • Nasal obstruction • Irritation • Epistaxis • Ulceration • Septal perforation
- 48. SIGNS • Anterior rhinoscopy:dry dark red mucosa ulceration • Posterior rhinoscopy: nasal mucosa normal • No any crust or drying
- 49. TREATMENT • Lubrication ofnose-vaseline,oil • Alkaline nasal douching • Change of environment /job
- 50. DIPHTHERETIC RHINITIS • Alsoknown as nasal diptheria. • It is a form of acute infective rhinitis.
- 51. Aetiology • Causative organism:corynebacterium diphtheria. • Age :common in children. • It is of two types – Primary – Secondary
- 52. Primary • It mayaffect the nose first without involvement of other tissues. Secondary • It may affect the nose secondary to faucial diphtheria.
- 53. CLINICAL FEATURES • Bloodstained 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. Investigation • Swab culturemay show diphtheria bacilli
- 55. Treatment • Patient ishospitalised and isolated. • Antitoxin serum are given after a skin sensitivity test. • Penicillin and ampicillin.
- 56. ALLERGIC RHINITIS • Allergicrhinitis is a common disorder which is usually characterized by spasmodic attack of severe sneezing and rhinorrhea.
- 57. Aetiology • Age:all age •Sex: both sex • Predisposing factors: • Hereditary • Harmonasl • Climate • Emotional
- 58. • Precipatating factor(allergens) •inhalents • Ingestants • Contactants • Cosmetic powder • Drugs • Irritants • Infection • Intestinal helmenthis
- 59. TYPES • Two types •Seasonal • Perinial
- 60. SYMPTOMS • Irriritants • Paroxysmalsneezing • Rhinorrhoea • Nasal obstruction • Anosmia • Headache
- 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. 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. TREATMENT • Avoidance ofallergen • Desensitisation • Symptomatic: • antihistamine • Steroids • General: • Vitamin c • Calcium
- 64. LOCAL TREATMENT • Hydrocortisoninjection • Zinc ionisation • Cryosurgery • Laser therapy
- 65. SURGICAL • Nasal obstruction •Infection • Vidian neurectomy
- 66. CORRELATION WITH MIASM •Rhinitis covers all the three miasm, psora and syphilis & sycosis.
- 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. • Epistaxis moreor less profusely more or less frequently. • Ulcerated nostrils • Nostrils as if it were stuffed up. • Disagreeble sensation of dryness in the nose.
- 69. SYPHILIS • It alsocovers 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. SYCOTIC • It alsocovers 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. • New babiesof sycotic patient often get snuffles nose dry stuffed up frequently in Childs. • Screams with anger in its attempt with breathe with its mouth closed