Acute & Chronic Rhinitis Nur Adilah Binti Mohd Radzi 082012100027

Content • Acute rhinitis • Chronic rhinitis • Allergic rhinitis

Rhinitis

Acute rhinitis • Can either be: Common cold (coryza)

1. Viral Rhinitis

Influenza Rhinitis Rhinitis ass/ with exanthemas

2. Bacterial Rhinitis

3. Irritative Rhinitis

Nonspecific Infections Diphtheritic Rhinitis

1. Common cold (coryza) • Clinical Features

• • • •

Caused by virus Airborne droplets IP : 1-4 days Duration: 2-3 weeks Adenovirus Secondary Infections: Streptococcus hemolyticus PicornavirusPneumococcus rhinovirus, coxsackie Staphylococcus virus H. Influenza Enteric cytophatic Klebsiella pneumoniae human orphan virus Morexella catarrhalis

– Onset- Burning sensation behind nose  nasal stuffiness, rhinorrhea, sneezing – Nasal discharge : watery, profuse. (Mucopurulentsecondary infection) – Chills, low grade fever

1. Common cold (coryza) Treatment • • • • •

Bed rest Plenty of fluids Symptoms: Antistaminic, Nasal decongestant Analgesic Antibiotics

Complications • Usually self-limiting • Rarely: – Sinusitis, pharyngitis, tonsillitis, bronchitis, pneumonia and otitis media

2. Influenzal Rhinitis

3. Rhinitis associated with exnthemas

• Caused by influenza viruses A, B or C • Symptoms and signs similar to those coryza • Complications due to bacterial invasion are common

• Measles, Rubella and chickenpox are often associated with rhinitis • Precedes exanthemas by 2-3 days • Secondary infection and complications are more frequent and severe

Bacterial Rhinitis 1. Nonspecific Infections •. May be primary / secondary •. Primary - children ( Pneumococcus, Streptococcus or Staphylococcus) •. A greyish white tenacious membrane may form •. Removal attempt bleeding •. Secondary bacterial rhinitis

Bacterial Rhinitis 2. Diphtheritic Rhinitis • Rare • Primary or secondary to faucial diphtheria • Acute or chronic form • Greyish membrane seen covering the inferior turbinate • Removal  bleeding • Excoriation of anterior nares and upper lip Treatment – isolation – systemic penicillin – diphtheria antitoxin

Chronic Rhinitis • Chronic = long standing, persistent, recurrent 1. Chronic Simple Rhinitis 2. Hypertrophic Rhinitis 3. Atrophic Rhinitis 4. Rhinitis Sicca 5. Rhinitis Caseosa

1. Chronic Simple Rhinitis Aetiology: Recurrent attacks of acute rhinitis in the presence of predisposing factors such as :– – – – –

Persistence of nasal infection Chronic irritation from dust, smoke, snuff, etc. Nasal obstruction due to DNS, synechiae Vasomotor rhinitis Endocrinal or metabolic factors (hypothyroidism, puberty, etc.)

Pathology: • Hyperaemia and oedema of mucous membrane • Hypertrophy of seromucinous glands • Increase in goblet cells • Blood sinusoids distended (particularly over the turbinates area)

1. Chronic Simple Rhinitis cont. Clinical Features: – Nasal obstruction – Nasal discharge – Headache – Swollen turbinates (pit on pressure and shrink with application of vasoconstrictor) – Postnasal discharge

Treatment: – Treat the cause – Nasal irrigation with alkaline solution – Nasal decongestant – Antibiotics

2. Hyperthrophic Rhinitis  Characterized by thickening of mucosa, submucosa,

seromucinous glands, periosteum and bone Aetiology: – Recurrent nasal infections – Chronic sinusitis – Chronic irritation of nasal mucosa (smoking, industrial irritants, etc.) – Allergic and vasomotor rhinitis – Prolonged use of nasal drops

Symptoms: • Nasal obstruction • Nasal discharge (thick and sticky) • Headache, heaviness of head, transient anosmia

2. Hypertrophic Rhinitis cont. Signs: • Hypertrophy of turbinates • Turbinal mucosa is thick and does not pit on pressure • Little shrinkage with vasoconstrictor drugs  underlying fibrosis • Mulberry appearance

COMPENSATORY HYPERTROPHIC RHINITIS

Treatment: • Linear cauterization • Submucosal diathermy • Cryosurgery of turbinates • Partial or total turbinectomy • Submucous resection of turbinate • Lasers

Seen in DNS to one side Septoplasty + reduction of hypertrophy turbinates

bone

3. ATROPHIC RHINITIS (OZAENA) • Chronic inflammation characterized by atrophy of nasal mucosa and turbinate bones • Nasal cavities roomy, full of foul-smelling crusts • Two types : Primary & Secondary I. PRIMARY ATROPHIC RHINITIS Aetiology: – Hereditary factors – Endocrinal disturbance – Racial factors – Nutritional deficiency – Infection (Klebsiella ozaenae, diphtheroids, Proteus vulgaris, E.Coli, etc.) – Autoimmune process

3. ATROPHIC RHINITIS (OZAENA) cont. Pathology: • Ciliated columnar epithelium lost  replaced by stratified squamous type • Atrophy of seromucinous glands, blood sinusoids and nerve elements • Arteries  obliterative endarteritis • Widening of nasal chambers (bone of turbinates undergoes resorption) • Paranasal sinuses  small (arrested development) Greenish or Merciful Nasal Epistaxis greyish black anosmia obstruction dry crusts

Posterior wall of nasopharynx  easily seen

Nasal mucosa  pale

Septal perforation and dermatitis of nasal vestibule

Atrophic changes (pharynx, larynx)

3. ATROPHIC RHINITIS (OZAENA) cont. Prognosis: • Disease persists for years but there is tendency to recover spontaneously in middle age Treatment (Medical & Surgical) 1. Nasal 2) 25% glucose 3) Local SURGICAL irrigation and in glycerine – antibiotics removal of inhibits growth (Kemicetine) – 1) Young’s – Both nostrils crusts (2- operation proteolytic eliminate 2’ 3x/days organisms infection are closed completely every 2-3d) 6) Systemic use 2) Modified Young’s operation of streptomycin Oestradiol 5) Placental 3) 4)Narrowing the nasal cavities (Klebsiella) spray extract • Submucosal injection of teflon paste • 1g/day for 10d

• Insertion of fat, cartilage, bone/Teflon strips under mucoperiosteum of the floor & lat. 7. Potassium iodide – wall of nose & mucoperichondrium of promote & septum liquefies nasal • Section & medial displacement lat. wall of secretion

3. ATROPHIC RHINITIS (OZAENA) cont. SECONDARY ATROPHIC RHINITIS • Specific infections like syphilis, lupus, leprosy and rhinoscleroma may cause destruction of the nasal structures leading to atrophic changes • Long-standing purulent sinusitis, radiotherapy to nose or excessive removal of turbinates may lead to AR • Unilateral atrophic rhinitis