Rhinitis

rhinitis and its relation with homoeopathic miasms and its treatment

1. RHINITIS DEPARTMENT OF SURGERY By d.Gautam

2. contents Definition Classification Clinical features Signs Investigation Complication treatment

3. RHINITIS It is the inflammation of the nasal mucous membrane

4. Coryza It is an acute non specific infective rhinitis. Also known as “common cold”.

5. Aetiology Causative organism: virus and may be either influenza virus rhinovirus or adenovirus etc. Spread : is by air borne droplet infection or by direct contact. Secondary infection by bacteria may occur streptococcus staphylococcus pneumococcus etc.

6. Pathology Viral infection of the nasal mucosa Acute generalised hyperaemia of the nasal mucosa Engorgement of the secretory gland and goblet cells Profuse secretion involvement of sinus

7. sinusitis Involvement of Eustachian tube opening ASOM &SOM

8. CLINICAL FEATURES Incubation period:1-3 days Four stages Ischaemic stage Hyperaemic stage Stage of secondary inflammation Stage of resolution

9. ISCHAEMIC STAGE Raw sensation & irritation in the pharynx. Irritation & dryness in the nose. Sneezing attack. Malaise with chills.

10. HYPEREMIC STAGE Profuse watery rhinorrhea Anosmia Blocking of nose Fever and malaise with chills. Congested nasal mucosa Headache and otalgia

11. STAGE OF SECONDARY INFECTION Nasal discharge becomes thicker and yellowish and greenish. Fever & malaise with chill. Headache Otalgia Congested nasal mucosa

12. COMPLICATION Sinusitis Acute otitis media. Pharyngitis. Pneumonia. Laryngitis.

13. STAGE OF RESOLUTION Resolution of uncomplicated cases occurs within 6 -10 days.

14. Treatment Antibiotics Analgesics Antipyretics Antihistamine Vitamin C

15. Rest and warm Give high protein diet Nasal decongestants locally Steam inhalation

16. CHRONIC SIMPLE RHINITIS Aetiology Predisposing factors Vasomotor rhinitis DNS Nasal polypi Tonsillitis Sinusitis Smoking and alcoholism

17. Clinical feature Rhinorrhoea-mucopurulent Headache Nasal obstruction Anosmia

18. SIGNS Hyperemic mucosa with oedema . Post nasal drip . Thick viscid mucopurulent nasal secreation . Pharyngitis.

19. TREATMENT Alkaline nasal douching. Treat the indisposing factors if present. Stop smoking &alcohol.

20. Chronic hypertrophic rhinitis Etiology Usually it result from recurrent attack from acute rhinitis. Predisposing factors: sinusitis Pollution Dust Smoke Tonsilitis

21. Nasal polyp Overuse of nasal drops Vitamin deficiency

22. CLINICAL FEATURE Nasal obstruction Rhinorrhoea Anosmia Dull headache Otalgia Sore throat due to pharyngitis

23. SIGNS Anterior rhinoscopy : Hypertrophy of inferior nasal turbinates . Posterior rhinoscopy:Mullbery like appearance

24. TREATMENT Removal or treatment of predisposing factors Local nasal decongestants drops Antihistamine Surgical management for turbinate hypertrophy Partial turbinectomy

25. ATROPHIC RHINITIS Synonym:ozeana It is a chronic inflammatory disease of the nasal mucosa which characterised by progressive atrophy of the mucosa and turbinates ', formation of crust and foul smell from the nose known as ozaena.

26. CLASSIFICATION Unilateral or bilateral Primary or secondary

27. AETIOLOGY Primary: Exact aetiology not known but predisposing factor include: Age : common between 15-40 yrs occurs usually at puberty. Sex : more common in female. Heredity familial

28. Environmental Nutritional Hormonal Vitamin a deficiency Infection Secondary : Chronic specific infection Extensive surgery Chronic sinusitis DNS

29. PATHOLOGY It is a condition characterised by atrophic changes in all the nasal tissues. Mucosa undergoes atrophy and metaplasia Cilia and secretory glands also undergo atrophy with a resultant pale , dry, thin mucosa with thick scanty secretion dry to form crust which may bleed on removal. Secondary infection usually results in foul foetid smelling

30. Turbinates' undergo atrophy resulting in loss of anatomical landmarks on the nose and a roomy nasal cavity. Blood vessels undergo periarteritis & endaritis resulting in ischemia . Sensory nerves undergo atrophy and hence the patients may complain of nasal obstruction as he does not feels the air passing through the nose. Atrophy of the olfactory nerve ending resulting in anosmia

31. CLINICAL FEATURE Nasal obstruction : Crust in nasal cavity Atrophy of sensory nerves Crusting of nose(ozaena) Foul smell of nose Anosmia Epistaxis Headache dryness of nose and throat

32. SIGNS External nasal examination: Bridge of nose may be depressed ( saddle shaped) Anterior rhinoscopy Nasal cavity is roomy Causative factors like DNS Mucosa is pale shiny dry and atrophy Crust are seen

33. Posterior rhinoscopy Diminished sensation of the mucosa due to the atrophy of sensory nerve ending

34. COMPLICATION Sinusitis Middle ear infection Atrophic pharyngitis Maggots

35. INVESTIGATION X-ray of nose/sinus VDRL test Complete haemogram Dermatographical examination XRAY chest Nasal smear for leprosy and T.B Biopsy

36. TREATMENT Primary cause should be treated Nasal drops: 25% glycerine drops Chloramphenicol drops Streptomycin drops Placental extract Antibiotics Nutritional improvement vitamin A,B,B6 vasodilators

37. Surgical treatment Narrowing of nasal cavity Submucosal grafting Partial closure Cervical sympathectomy

38. Rhinitis caseosa synonym;cholesteatoma. It is a condition characterized by accumulation of a caseosa (cheesy) material in the nasal cavity &maxillary sinus .

39. Aetiology The exact etiology is not known. Associated with inflammation and granulation of the lining mucosa. There may be erosion of lateral nasal wall

40. Clinical feature Nasal obstruction Foul smell Headache Thick viscid rhinorrhoea

41. SIGNS Thick cheesy or caseous material Foetid odor Involvement of maxillary sinus

42. TREATMENT Caldwell luc operation

43. RHINITIS SICCA It is a disease of nose characterised by drying and crusting affecting only the anterior portion of the nasal cavity.

44. Aetiology Seen in person working dry hot dusty environment like rubber factory worker bottle factory workers.

45. CLINICAL FEATURE Crusting Drying Nasal obstruction Irritation Epistaxis Ulceration Septal perforation

46. SIGNS Anterior rhinoscopy : dry dark red mucosa ulceration Posterior rhinoscopy : nasal mucosa normal No any crust or drying

47. TREATMENT Lubrication of nose- vaseline,oil Alkaline nasal douching Change of environment /job

48. DIPHTHERETIC RHINITIS Also known as nasal diptheria . It is a form of acute infective rhinitis.

49. Aetiology Causative organism: corynebacterium diphtheria. Age :common in children. It is of two types Primary Secondary

50. Primary It may affect the nose first without involvement of other tissues. Secondary It may affect the nose secondary to faucial diphtheria.

51. CLINICAL FEATURES Blood stained watery rhinorrhoea. Skin near the nasal vestibule may show excoriation due to continuous nasal discharge. Nasal obstruction Greyish white membrane is seen on the turbinate's or nasal septum, it is difficult to remove. Constitutional symptoms such as fever malaise etc.

52. Investigation Swab culture may show diphtheria bacilli

53. Treatment Patient is hospitalised and isolated. Antitoxin serum are given after a skin sensitivity test. Penicillin and ampicillin.

54. ALLERGIC RHINITIS Allergic rhinitis is a common disorder which is usually characterized by spasmodic attack of severe sneezing and rhinorrhea.

55. Aetiology Age:all age Sex: both sex Predisposing factors: Hereditary Harmonasl Climate Emotional

56. Precipatating factor(allergens) inhalents Ingestants Contactants Cosmetic powder Drugs Irritants Infection Intestinal helmenthis

57. TYPES Two types Seasonal Perinial

58. SYMPTOMS Irriritants Paroxysmal sneezing Rhinorrhoea Nasal obstruction Anosmia Headache

59. SIGNS Mucosa –Acute stage :pale Chronic stage :bluish purple Infection:present Polyp :present Allergic salute(tip of nose salute like) dorrer’s line (crease on dorsum of nose)

60. INVESTIGATION Nasal secretion : eosinophilia Haemogram Stool examination History about allergy Skin test by intradermal injection Inhalation of allergens Elimination test for food RAST (radio allergosorbant test)

61. TREATMENT Avoidance of allergen Desensitisation Symptomatic: antihistamine Steroids General: Vitamin c Calcium

62. LOCAL TREATMENT Hydrocortison injection Zinc ionisation Cryosurgery Laser therapy

63. SURGICAL Nasal obstruction Infection Vidian neurectomy

64. CORRELATION WITH MIASM Rhinitis covers all the three miasm, psora and syphilis & sycosis.

65. PSORA Psora-functional changes Rhinitis covers the psora miasm; psora leads to functional disturbances; i.e. in rhinitis there is inflammation of mucus membrane of nose leading to ischemic conditions and burning, irritation like symptoms. Sensation of dryness in the nose troublesome even when the air passes freely.

66. Epistaxis more or less profusely more or less frequently. Ulcerated nostrils Nostrils as if it were stuffed up. Disagreeble sensation of dryness in the nose.

67. SYPHILIS It also covers the syphilis miasm because of the nasal discharge. Loss of smell. Snuffle children. The bones of the nose are destroyed. Syphilis produce ulceration The crust of syphilis are dark greenish black or brown,thick and not always offensive

68. SYCOTIC It also covers the sycotic miasm because t leads to nasal destruction. Sense of smell loss. Sycotic has a red nose with prominent cappilaries There is often nasal stoppage due thickening of the membrane ,there is enlarged turbinated bones.

69. New babies of sycotic patient often get snuffles nose dry stuffed up frequently in Childs. Screams with anger in its attempt with breathe with its mouth closed