Atrophic rhinitis and Allergic rhinitis-ENT 3rd MBBS
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Transcript of Atrophic rhinitis and Allergic rhinitis-ENT 3rd MBBS
ATROPHIC RHINITIS
By SREEJITH T
OZAENA Chronic inflammation of nose,
characterized by atrophy of nasal mucosa and turbinate bones.
nasal cavities are roomy ,filled with foul smelling crusts.
2 typesPrimary
Secondary
PRIMARY ATROPHIC RHINITIS
AETIOLOGY HERNIA
HEREDITARY FACTORS
ENDOCRINE DISTURBANCES
RACIAL FACTORS
NUTRITIONAL DEFICIENCY
INFECTIVE
AUTOIMMUNE PROCESS
PATHOLOGY
Ciliated columnar epithelium replaced by stratified squamous type.
Atrophy of seromucinous glands, venous blood sinusoids and nerve elements.
Arteries in the mucosa, periosteum and bone show obliterative endarteritis.
Bone of turbinates undergoes resorption causing widening of nasal chambers.
Paranasal sinuses are small due to arrested development.
CLINICAL FEATURES
MC females foul smell from the nose merciful anosmia nasal obstruction - crust formation. greenish or greyish black dry crusts
covering the turbinates and septum. Epistaxis – on removal of crust. nasal cavities appear roomy atrophy of turbinates
nasal mucosa –pale septal perforation dermatitis of nasal vestibule saddle deformity of nose atrophic pharyngitis – Pharyngeal mucosa
appear dry and glazed with crusts atrophic laryngitis – cough, hoarseness of
voice hearing impairment X-ray paranasal sinus - opaque
TREATMENT
MedicalNasal irrigation and removal of crusts
25% glucose in glycerine
Local antibiotics
Oestradiol therapy
Placental extract
Systemic use of streptomycin
Potassium iodide
Surgical
YOUNG’S OPERATION
• Modified Young’s operation
NARROWING THE NASAL CAVITIES• Submucosal injection of teflon paste• Insertion of fat, cartilage or teflon strips
under the mucoperiosteum of the floor, lateral wall of nose, mucoperichondrium of the septum.
• Section and medial displacement of lateral wall of nose
SECONDARY ATROPHIC RHINITIS
Syphilis Lupus Leprosy Rhinoscleroma Long standing purulent sinusitis Radiotherapy to nose Excessive surgical removal of turbinates
UNILATERAL ATROPHIC RHINITIS Extreme deviation of nasal septum accompanied
by atrophic rhinitis on the wider side
ALLERGIC RHINITIS
IgE mediated immunologic response of nasal mucosa to airborne allergens and is characterized by Watery nasal discharge Nasal obstruction Sneezing Itching in the nose
2 TypesSeasonal
Perennial
ETIOLOGY
Inhalent allergensSeasonal allergens – pollensPerennial allergens – molds, dust mite,
dander from animals
Genetic predisposition
PATHOGENESIS
Inhaled allergens IgE blood basophil / mast cell
Subsequent exposure Ag +IgE degranulation of mast cells release preformed & newly formed chemical mediators vasodilatation, mucosal edema, infiltration of eosinophils, excessive secretion from nasal glands, smooth muscle contraction.
PRIMING EFFECT - mucosa earlier sensitized to an allergen will react to smaller doses of subsequent specific allergen and also get primed to other nonspecific antigens to which patient was not exposed cause nonspecific nasal hyper -reactivity
• ALLERGIC RESPONSE- 2 phases
Acute or early phase
• Within 5–30 min after exposure
• Sneezing, rhinorrhoea, nasal blockage, bronchospasm
• Due to release of vasoactive amines
Late or delayed phase
• 2-8 hour after exposure
• Swelling, congestion, thick secretion
• Due to infiltration of inflammatory cells at the site of antigen deposition
CLINICAL FEATURES
Seasonal nasal allergy
Paroxysmal sneezing(10-20 sneezes at a time)
Nasal obstruction
Watery nasal discharge
Itching of eyes, palate or pharynx
Perennial allergy
Frequent colds
Persistently stuffy nose
Anosmia due to mucosal edema
Postnasal drip
Chronic cough
Hearing impairment
SIGNS OF ALLERGY
Nasal signs Transverse nasal crease Pale and edematous nasal mucosa: bluish Swollen turbinates Thin, watery or mucoid discharge
Ocular signs Edema of the lids Congestion and cobblestone appearance of the
conjunctiva Dark circles under the eyes(allergic shiners)
Otologic signs Retracted tympanic membrane Otitis media
Pharyngeal signs Granular pharyngitis
Laryngeal signs Hoarseness Edema of the vocal cords
NEW ALLERGIC RHINITIS AND ITS IMPACT ON ASTHMA (ARIA) CLASSIFICATION
Duration of disease
INTERMITTENT (symptoms are
present for)
• Less than 4 days a week OR
• For less than 4 weeks
PERSISTENT (symptoms are
present for)
• More than 4 days a week OR
• For more than 4 weeks
Severity of disease
MILD: None of the following symptoms are present• Sleep disturbances• Impairment of daily activities, leisure and
sport• Impairment of school or work• Troublesome symptoms
MODERATE TO SEVERE
• One or more of the above symptoms are present
INVESTIGATIONS Total and differential count
Peripheral eosinophilia Nasal smear
taken at the time of clinically active disease or after challenge test
shows large number of eosinophils present in non allergic rhinitis also eg:NARES
Skin test: helps to identify specific allergen Skin prick test: drop of conc. allergen solution volar
surface of forearm introduce to the dermis central wheal and surrounding zone of erythema within 10-15 min +ve test
Specific IgE measurement: in vitro test to find specific allergen
Radioallergosorbent test (RAST) invitro test measures specific IgE antibody concentration in serum
Nasal provocation test
COMPLICATIONS
Recurrent sinusitis Nasal polypi Serous otitis media Orthodontic problems Bronchial asthma
TREATMENT
Avoidance of allergen. Treatment with drugs
Antihistaminics Sympathomimetics (oral & topical) Corticosteroids Sodium cromoglycate Anticholinergics Leukotriene receptor antagonist Anti IgE
Immunotherapy allergen is given in gradually increasing doses till the
maintenance dose is reached suppresses IgE formation raise the titre of specific IgG antibody subcutaneous, nasal, sublingual routes
STEP CARE APPROACH RECOMMENDED BY ARIA
Mild intermittent disease oral antihistamines, intranasal cromolyn sodium
Moderate / persistent disease intranasal corticosteroids
Severe combination therapy (oral nonsedating antihistamines + intranasal steroids)
Severe and persistent combination therapy + short course of oral steroids & immunotherapy
Persistent nasal obstruction intranasal decongestants OR (oral decongestants + antihistamines)
Avoid allergens and irritants in all forms of disease.
THANK YOU !!!