acuteandchronicrhinitis .powerpoint presentation

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2. ACUTE RHINITIS
0Acute Rhinitis can be –
0Viral
0Bacterial
0Irritative type

3. VIRAL RHINITIS
1) Common cold (Coryza)
0Aetiology :Several viruses (adeno virus, picorna
virus and its sub-groups sucha s rhinovirus,
coxsackie, and ECHO)
0Clinical features: Nasal stuffness, rhnorrhoea,
sneezing, low grade fever, secondary bacterial
invasion may occur.

4. Treatment : Bed rest,
Plenty of fluids,
Anthihistaminics,
Nasal decongestants,
Analgesics,
Antibiotics, when secondary infection
supervenes.
Complications:
0Sinusitis, pharyngitis, tonsillitis, bronchitis,
pneumonia and otitis media.

5. 2. Influenzal rhinitis
Influenza viruses A, B or C are responsible.
3. Rhinitis associated with
exanthemas.
Measles, rubell and chickenpox are often associated with
rhinitis which precedes exanthemas by 2–3 days.

6. BACTERIAL RHINITIS
0Non specific infections
0primary or secondary
0Primary bacterial rhinitis is seen in children and is usually the result of
infection with pneumococcus, streptococcus or staphylococcus.
0Secondary bacterial rhinitis is the result of bacterial infection
supervening acute viral rhinitis.
0Diphtheritic rhinitis :
0Primary
0Secondary to faucial diphtheria
0May occur in acute or chronic form
0Treatment -isolation of the patient, systemic penicillin and
diphtheria antitoxin.

7. IRRITATIVE RHINITIS
0acute rhinitis is caused by exposure to dust, smoke or
irritating gases such as ammonia, formaline, acid fumes,
etc.
0may result from trauma inflicted on the nasal mucosa
during intranasal manipulation,
0Symp -immediate catarrhal reaction with sneezing,
rhinorrhoea and nasal congestion.
0The symptoms may pass off rapidly with removal of the
offending agent

8. CHRONIC RHINITIS
0Chronic non-specific inflammations of nose
include :
1.Chronic simple rhinitis
2.Hypertrophic rhinitis
3.Atrophic rhinitis
4.Rhinitis sicca
5.Rhinitis caseosa.

9. 1) CHRONIC SIMPLE RHINITIS
0Aetiology:
0Predisposing factors
a.Persistence of nasal infection
b.Chronic irritation
c.Nasal obstruction.
d.Vasomotor rhinitis
e.Endocrinal or metabolic factors

10. 0Pathology:
0Hyperaemia and oedema of mucous membrane
0Hypertrophy of seromucinous glands
0increase in goblet cells.

11. 0Clinical features:
a.Nasal obstruction
b.Nasal discharge.
c.Headache
d.Swollen turbinates
e.Post-nasal discharge.

12. 0Treatment :
a.Treat the predisposing factor.
b.Nasal irrigations with alkaline solution.
c.Nasal decongestants.
d.Antibiotics help to clear nasal infection.

13. 2) HYPERTROPHIC RHINITIS
0Characterized by thickening of mucosa, submucosa,
seromucinous glands, periosteum and bone.
Aetiology :
0Recurrent nasal infections
0Chronic sinusitis
0Chronic irritation of nasal mucosa.
0Vasomotor and allergic rhinitis

14. Symptoms :
0Nasal obstruction
0Nasal discharge : thick and
sticky.
0Headache
0Heaviness of head
0Transient anosmia.
Signs :
0Hypertrophy of turbinates
0Turbinal mucosa is thick,
does not pit on pressure,
little shrinkage with
vasoconstrictor drugs due
to underlying fibrosis.
0Maximum changes in the
inferior turbiante.
0Mulberry appearance of
inferior turbiante.

17. Treatment :
0Discover the cause and remove it.
0Reduction in size of turbinates by
a.Liner cauterisation
b.Submucosal diathermy
c.Cryosurgeryof turbinates
d.Partial or total turbinectomy
e.Submucous resection of turbinates bone.
f.Lasers

21. Compensatory hypertrophic
rhinitis
0In cases of marked deviation of septum to
one side.
0Roomier side of the nose shows
hypertrophy of inferior and middle
turbinates.
0Reduction of turbinates may be required

22. 3) ATROPHIC RHINITIS (OZAENA)
0Chronic inflammation of nose characterized
by atrophy of nasal mucosa and turbinate
bones.
Primary atrophic rhinitis :
0Aetiology: Exact cause is not known,
Various theories regarding its causation are:
a.Hereditary factors
b.Endocrinal disturbances

23. c.Racial factors
d.Nutritional deficiency : Deficiency of vitamin
A, D or iron
e.Infective : Klebsiella ozaenae, (Perez
bacillus), diphtheroids, P.vulgaris, Esch. Coli,
Staphylococci and Streptococci but they are
all considered to be secondary invaders.
f.Autoimmune process : The body reacts by a
destructive process to the antigens released
from the nasal mucosa.

24. Pathology :
0Ciliated columnar epithelium is replaced by stratified
squamous type.
0Atrophy of seromucinous glands, venous sinusoids and
nerve elements.
0Obliterative endarteritis.
0The bone of turbinates undergoes resorption.
0Paranasal sinuses are small.

25. Clinical features :
0Commonly seen in females and starts around puberty.
0Foul smell from the nose.
0Marked anosmia (merciful anosmia)
0Nasal obstruction
0Epistaxis when the crusts are removed.

29. 0Nasal cavity full of greenish or greyish black dry crusts.
0Nasal cavities appear roomy.
0Nasal mucosa appear pale.
0Septal perforation and dermatitis of nasal vestibule.
0Nose shows saddle deformity.

30. Treatment :
1.Medical :
a.Nasal irrigation and removal of crusts-(
Sodium bicarbonate –1 part , sodium biborate –1
part, sodium chloride –2 parts in 280 ml
water)
a.25% glucose in glycerine. –Inhibits the growth
of proteolytic organisms which are responsible
for foul smell.

31. d.Local antibiotics –Kemicetine
TM
antiozaena solution
contains chloromycetin, oestradiol and vitamin D2.
e.Oestradiol spray –increase vascularity of nasal
mucosa and regeneration of seromucinous glands.
f.Placental extract injected submucosally.
g.Systemic use of streptomycin –Effective against
Klebsiella organisms.
h.Potassium iodide by mouth promotes and liquefies
nasal secretion.

32. Surgical
a.Young’s operation–Both the nostrils are closed
completely just within the nasal vestibule by
raising flaps. They are opened after 6 months or
later.
Modified young’s operation-Aims to partially close the
nostrils.

33. Surgical

35. 2.Surgical :
Narrowing the nasal cavities. Among the techniques
followed, some are:
0Submucosal injection to teflon paste.
0Insertion of fat, cartilage, bone or teflon strips under the
mucoperiosteum of the floor and lateral wall of nose and the
mucoperichondrium of the septum.
0Section and medial displacement of lateral wall of nose.

36. SECONDARY ATROPHIC RHINITIS :
0Specific infections like syphilis, lupus, leprosy and
rhinoscleroma.
0Longstanding purulent sinusitis, radiotherapy or nose or
excessive surgical removal of turbinates.
UNILATERAL ATROPHIC RHINITIS :
0Extreme deviation of nasal septum.
0Atrophic rhinitis on the wider side.

37. RHINITIS SICCA
0Crust-forming disease
0Seen in patients who work in hot, dry and dusty
surroundings.
0Confined to the anterior third of nose.
0The ciliated columnar epithelium undergoes
squamous metaplasia.
0Atrophy of seromucinous glands (Crusts, epistaxis,
septal perforation).
Treatment :
0Bland ointment or an antibiotic and steroid.
0Nasal douche.

38. RHINITIS CASEOSA
0Unilateral and mostly affecting males.
0Nose is filled with offensive purulent discharge and
cheesy material.
0Sinus mucosa becomes granulomatous. Bony walls
of sinus may be destroyed.
Treatment :
0Removal of debris and granulation tissue
0Free drainage of the affected sinus.