types of rhinitis

2. uran 29:45 (O Prophet) convey to people all that is revealed to you of the
Book, and establish system of Salat (establish the Divine System). For, verily,
establishment of Salat (the Divine System) will shut off lewdness, stinginess and
behavior contrary to the Divine Values. This is so, because Allah’s Law is the Greatest
Law that can give you eminence. And (O People) Allah knows whatever you contrive on
your own.

3. Vasomotor And Atrophic rhinitis
By
Lt Col Saeed Ullah, MBBS, MCPS,
FCPS Classified ENT, Head and
Neck surgeon CMH Quetta

4. Anatomy of Nose

5. Anatomy of Nose

6. Histology

7. Sensory nerve supply of nose

8. Sensory nerve supply- septum

9. Sensory nerve supply-lateral wall

10. Autonomic nerve supply

11. Autonomic nerve supply
• Sympatheitic stimulation
▫ Vasoconstriction
▫ Smooth muscle around sinusoids constrict
▫ Decongestion and opening of nose
• Parasympathetic stimulation
▫ Engorgement of nasal mucosa
▫ Increase glandular activity
▫ Nasal congestion and blockage

12. Definition of rhinitis
• Inflammation of nasal lining, characterized by
one or more of the following symptoms
▫ Nasal congestion
▫ Rhinorrhoea
▫ Sneezing
▫ Itching

13. Classification of rhinitis

14. Classification
• Non allergic rhinitis
▫ Idiopathic rhinitis
 Vasomotor rhinitis(non allergic, non infectious
prennial rhinitis(NANIPER)
 Non allergic occupational rhinitis
 Hormonal rhinitis
 Drug induced rhinitis
 Atrophic rhinitis
 NARES(non allergic rhinitis with eosinophilia
syndrome)

15. Vasomotor rhinitis(NANIPER)
• Non allergic, non infectious perennial rhinitis
• Clinically simulates allergic rhinitis
▫ Paroxysmal sneezing
▫ Watery nasal discharge
▫ Nasal obstruction

16. Pathogenesis
• Rich blood supply of nasal mucosa
• The turbinate’s erectile tissues
• Sinusoids surrounded by smooth muscle fibers
• Under control of autonomic nerves
• Autonomic nerves under control of
hypothalamus
• Sympathetic stimulation leads to
vasoconstriction
• Parasympathetic stimulation causes
vasodilatation

17. Pathogenesis
• Unstable autonomic nervous system
▫ Parasympathetic dominance
• Nasal mucosa is hyper reactive
▫ Change in temp
▫ Humidity
▫ Blasts of air
▫ Dust and smoke

18. Symptoms
• Paroxysmal sneezing
• Excessive rhinorrhea
• Nasal obstruction
• Post nasal drip

19. Signs
• Congested nasal mucosa
• Hypertrophy of nasal mucosa
• Mucoid nasal discharge
• Nasal polypi
• Hypertrophy of turbinates

20. Investigations
• Diagnosis of exclusion
▫ Skin prick tests
▫ Serum IgE level
▫ Specific antibodies against IgE
▫ Eosinophils level in nasal smear

21. Treatment
• Medical
▫ Avoidance of trigger factores
▫ Antihistamins
▫ Nasal decongestants
▫ Topical steroids
• Surgical
▫ Turbinates reduction
▫ Vidian neurectomy

22. Atrophic rhinitis

23. Atrophic rhinitis
Chronic inflammatory condition in which nasal
mucosa, glands & bones are atrophied There is
widening of nasal cavities with greenish crusts
in nasal cavities

24. Types of Atrophic rhinitis
1. Primary:
exact cause is not known
2. Secondary:
to some underlying factors

25. Primary atrophic rhinitis
• Infection
 Klebsiella Ozaenae
 Diphthroid Bacillus
 Coccobacillus foetidus ozaenae
• Hormonal imbalance
 At puberty
 More common in females
• Nutritional
 Poor socioeconomic status
 Vit D and iron deficiency
• Heredity
• Autoimmune

26. Organisms (cause,effect)
1. Bacillus ozaenae
2. Coccobacillus
3. Klebsiella ozaenae
4. Diphtheroid bacilli

27. Secondary Atrophic Rhinitis
1. Chronic purulent sinusitis
2. Enthusiastic surgery on nose
3. Syphilis
4. Tuberculosis
5. Marked DNS with wide nasal cavity on one
side

28. Pathology
• Epithelium
 Patches of metaplasia
 Transition from ciliated columner into stratified
squamous
• Lamina propria
 Chronic cellular infilterats
 Granulation tissues, fibrosis
• Mucous glands
 Decrease in size and number
• Vascular
 Decreased vascularity

29. Symptoms
 Nasal obstruction due to:
Crusts
Loss of sense of air passage
 Recurrent Epistaxis
 Offensive smell (stench)
 Anosmia due to Atrophy of Olfactory nerve
 Headache
 Choking

30. Signs
• External nasal deformity
• Very wide nasal cavities
• Inf. Turbinates shrunken / rudimentary
• Greenish / dirty crusts
• Stench (dead body like smell)
• Maggots

31. Wide nasal cavities

32. Crust formation

33. Greenish nasal discharge- foul smelling

34. Investigations
1. X-RAY PNS
2. Blood CP, ESR
3. X-RAY chest PA
4. Swab C/S
5. Serology
6. Serum iron & Proteins
7. Biopsy

35. Treatment
Conservative:
 Alkaline nasal douches with ¼ lit. of warm
lotion of
Sod. Chloride 2 parts
Sod. Bicarbonate 1 part
Sod. Diborate 1 part
 Removal of crusts
 25% Glucose in glycerin nasal drops
 Oestradiol in Arachis oil

36. Treatment
Surgical Treatment:
 Narrowing nasal cavities:
Injecting Paraffin or Teflon submucosally
Insertion of cartilage graft
 Stellate ganglion block
 Parotid duct transposition
 Closure of one / both nostrils leaving 3mm
hole
Young’s operation

37. Thank you