Download - Vasomotor and atrophic rhinitis
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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.
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Vasomotor And Atrophic rhinitisBy Lt Col Saeed Ullah, MBBS, MCPS, FCPS Classified ENT, Head and Neck surgeon CMH Quetta
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Anatomy of Nose
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Anatomy of Nose
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Histology
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Sensory nerve supply of nose
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Sensory nerve supply- septum
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Sensory nerve supply-lateral wall
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Autonomic nerve supply
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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
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Definition of rhinitis•Inflammation of nasal lining,
characterized by one or more of the following symptoms▫Nasal congestion▫Rhinorrhoea▫Sneezing▫Itching
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Classification of rhinitis
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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)
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Vasomotor rhinitis(NANIPER)•Non allergic, non infectious perennial
rhinitis•Clinically simulates allergic rhinitis
▫Paroxysmal sneezing▫Watery nasal discharge▫Nasal obstruction
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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
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Pathogenesis •Unstable autonomic nervous system
▫Parasympathetic dominance•Nasal mucosa is hyper reactive
▫Change in temp▫Humidity▫Blasts of air▫Dust and smoke
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Symptoms •Paroxysmal sneezing•Excessive rhinorrhea•Nasal obstruction•Post nasal drip
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Signs •Congested nasal mucosa•Hypertrophy of nasal mucosa•Mucoid nasal discharge•Nasal polypi •Hypertrophy of turbinates
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Investigations •Diagnosis of exclusion
▫Skin prick tests▫Serum IgE level▫Specific antibodies against IgE▫Eosinophils level in nasal smear
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Treatment •Medical
▫Avoidance of trigger factores▫Antihistamins▫Nasal decongestants▫Topical steroids
•Surgical ▫Turbinates reduction▫Vidian neurectomy
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Atrophic rhinitis
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Atrophic rhinitisChronic inflammatory condition in which nasal mucosa, glands & bones are atrophied There is widening of nasal cavities with greenish crusts in nasal cavities
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Types of Atrophic rhinitis
1. Primary: exact cause is not known
2. Secondary: to some underlying factors
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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
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Organisms (cause,effect)1. Bacillus ozaenae2. Coccobacillus3. Klebsiella ozaenae4. Diphtheroid bacilli
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Secondary Atrophic Rhinitis1. Chronic purulent sinusitis2. Enthusiastic surgery on nose3. Syphilis4. Tuberculosis5. Marked DNS with wide nasal cavity on
one side
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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
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Symptoms Nasal obstruction due to:
CrustsLoss of sense of air passage
Recurrent Epistaxis Offensive smell (stench) Anosmia due to Atrophy of Olfactory
nerve Headache Choking
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Signs •External nasal deformity•Very wide nasal cavities•Inf. Turbinates shrunken / rudimentary•Greenish / dirty crusts•Stench (dead body like smell)•Maggots
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Wide nasal cavities
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Crust formation
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Greenish nasal discharge- foul smelling
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Investigations
1. X-RAY PNS2. Blood CP, ESR3. X-RAY chest PA4. Swab C/S5. Serology6. Serum iron & Proteins7. Biopsy
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TreatmentConservative: Alkaline nasal douches with ¼ lit. of
warm lotion ofSod. Chloride 2 partsSod. Bicarbonate 1 partSod. Diborate 1 part
Removal of crusts 25% Glucose in glycerin nasal drops Oestradiol in Arachis oil
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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 holeYoung’s operation
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Thank you