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