2Acute Infective Rhinitis SPECIFIC NON-SPECIFICAcute diphtheritic Common coldAcute syphilitic InfluenzaErysipelasExanthematous rhinitis
3Common cold (coryza)Highly contagious, viral infectious disease of upper respiratory system. Caused by rhino-virus, coronavirus, human parainfluenza virus, human respiratory syncytial virus, adenovirus.Transmission:Aerosol generated by coughing, sneezingContact with saliva or nasal secretions
4Symptoms: sore throat, runny nose, nasal congestion, sneezing, cough; pink eye, muscle aches, fatigue, malaise, headaches, muscle weakness, loss of appetite. Symptoms resolve after 1-2 week.Opportunistic super infections: acute bronchitis, croup, pneumonia, sinusitis, otitis media, sore throat.
5Treatment Bed rest. Avoid exposure to cold weather. Plenty of fluids. Avoid cola & alcoholic drinks.Avoid tea & coffee (they cause dehydration)Antihistamines + nasal decongestantsNon-aspirin analgesicsAntibiotics for secondary infectionDoubtful role: Vitamin C, Zinc, chicken soup, ginger, garlic, herbal tea, steam inhalation.
9History Dr. Spencer Watson, 1875: Used the term “Ozaena” Dr. Bernhard Fraenkel, 1876:Described triad of:1. Fetor2. Crusting3. Atrophy of nasal structures
10IntroductionChronic inflammation of nose with progressive atrophy of nasal mucosa & turbinate bonesFormation of scanty viscid secretion & green crusts which emit a foul odour (ozaena)Removal of crusts reveals roomy nasal cavityTypes: 1. Primary 2. Secondary
13DevelopmentalCongenitally spacious nasal cavityPoor pneumatization of maxillary antrumHereditary: 30% cases autosomal inheritence67% = Dominant, 33% = RecessiveEndocrine: Seen during puberty, menopause,menstruation. Symptoms aggravateddue to oestrogen deficiency.
14Racial: More in American Negroes & Latin races (yellow race)Nutritional deficiency: Iron deficiency,Vitamin A deficiency, Vitamin D deficiencyInfection: Klebsiella ozaenae (Perez & Abelbacillus), Coccobacillus foetides ozaena,Bacillus mucosus, Diphtheroids,Haemophilus influenzae
15Autoimmune: viral infection / malnutrition / immune deficiency trigger destructive autoimmune process on nasal mucosaAutonomic Imbalance: Reflex Sympathetic Dystrophy Syndrome (R.S.D.S.) causes vasodilatation & hyperaemic decalcification of turbinates followed by vasoconstrictionSurfactant deficiency in nasal secretion: ciliary dysfunction + stasis of nasal secretions
17Symptoms Nasal obstruction Greenish-yellow nasal discharge Offensive smell (ozaena) due to anaerobic infection, experienced by relativesMerciful anosmia present in the patientEpistaxis on crust removal
18Signs Roomy nasal cavity with atrophy of mucosa & turbinates Greenish-yellow nasal discharge with crust formation (begins posteriorly)Foul smell (foetor)Nasal septum perforationNasal myiasis
23D/D for ozaena D/D for dry nose 1. Atrophic rhinitis 1. Atrophic rhinitis2. Purulent sinusitis 2. Rhinitis sicca3. Nasal foreign body 3. Radiotherapy4. Rhinitis caseosa 4. Sjogren’s syndrome5. Malignancy
24Causes of nasal obstruction Causes of Anosmia1. Loss of olfactory neural elements2. Thick secretion & crusts over olfactory area3. Degeneration of secretory glands scanty mucous for dissolving odoriferous materialsCauses of nasal obstruction1. Blunting of sensory nerve endings2. Crust formation3. Lack of eddy current formation in roomy cavity
25Pathology: Accumulation of lymphocytes & plasma cells. Squamous metaplasia from ciliated columnar Ciliary destruction & decrease in nasal glands Bone resorptionType I: Endarteritis & periarteritis of terminalarterioles. Benefit from estrogen therapyType II: Dilated capillaries worsened by estrogen
32Alkaline Nasal DoucheSodium bicarbonate (28.4g) loosens nasal crustsSodium biborate (28.4g) AntisepticSodium chloride (56.7g) makes solution isotonicMixed in 280 ml of warm water to make the solution.20 ml plastic syringe with 6” long rubber tubing taken.Syringe nasal cavity while pt bends forward & keepssaying K, K, K … to close nasopharyngeal isthmus.Done B.D. till all crusts disappear.
33Action of Placental extract Progesterone leads to hyperplasia of nasal mucosa & glandular secretionOestrogen leads to vasodilatationBiogenic stimulator of metabolic & regenerative processIntra-placental serum boosts up immunityMechanical narrowing of nasal passage
35Young’s operation: Only 1 nostril closed completely by raising 2 circumferentialflaps (inner mucosal & outer cutaneous) in nasalvestibule & suturing them in midline.Modified Young’s operation done by similarway but keeping a 3 mm opening on both sides.Recannalisation done after month with atri-radiate (Mercedes Benz) incision.
43Advantages of Modified Young Progress of disease can be monitored with 2.7 mm nasal endoscopeGlucose in glycerine drops can be instilledBoth nostrils can be operated at one sittingNasal breathing preservedNo complaints of de-nasal voiceBetter cosmetic result
44Lautenslager’s operation: Fracture & medial displacement of lateral nasal wallWilson’s operation: submucosal injectionof Teflon pasteAntral mucosal transplantation into nasal cavitythrough intranasal antrostomy: Raghav SharanVestibuloplasty: raising a lateral shelf fromnasal vestibular flap to cover turbinates
53Types of surgery Nasal closure: Young Modified Young Volume reduction: Lautenslager Wilson Sublabial implants VestibuloplastyDenervation: Cervical sympathectomy Stellate ganglion block Sphenopalatine ganglion blockSalivary irrigation: Parotid duct implantation
54Aim of Surgery Decrease trauma of air turbulence: Nasal closure Volume reductionIncrease nasal secretions: Parotid duct implantation into maxillary sinusIncrease vascularity of nasal mucosa: Denervation procedures Nasal implantation of maxillary sinus mucosa
55Surgical Treatment Modified Young Young Lautenslager Lady Wilson Was Vestibuloplasty VerySublabial implantation SweetAntral mucosal transplantation AndParotid duct implantation Pretty