Chronic atrophic rhinitis

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Chronic atrophic rhinitis
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Chronic atrophic rhinitis, or simply atrophic rhinitis, is a chronic inflammation of the nose characterised by atrophy of nasal mucosa, including the glands, turbinate bones and the nerve elements supplying the nose. Chronic atrophic rhinitis may be primary and secondary. Special forms of chronic atrophic rhinitis are rhinitis sicca anterior and ozaena. It can also be described as the empty nose syndrome.

Contents

Signs and symptoms

Etiology

Causes can be remembered by the mnemonic HERNIA:

Secondary atrophic rhinitis

Specific infections, such as syphilis, leprosy and rhinoscleroma, may cause destruction of the nasal structures leading to atrophic changes. Atrophic rhinitis can also result from long-standing purulent sinusitis or radiotherapy of the nose, or as a complication of surgery of the turbinates. [3] The United Kingdom National Health Service has stated that "Most cases of atrophic rhinitis in the UK occur when the turbinates are damaged or removed during surgery". [4] Some authors refer to as Atrophic rhinitis secondary to sinus surgery as the empty nose syndrome. [3]

Unilateral atrophic rhinitis

Extreme deviation of nasal septum may be accompanied by atrophic rhinitis on the wider side.

Pathology

Diagnosis

Diagnosis is based on clinical history and examination. Examination is clinical, via anterior rhinoscopy and fibreoptic, using nasendoscopy. A CT scan can be used to confirm the diagnosis and review disease extent.

Treatment

Treatment of atrophic rhinitis can be either medical or surgical.

Medical measures include:

Surgical interventions include:

History

This disorder was known since the time of ancient Egypt, almost 4,000 years ago, and descriptions of it are found in the historical medical papyri. In the Edwin Smith Papyrus (1700 BC) it was prescribed a treatment based on wine and breast milk to cure this disease. [3] The ancient Greek and Indian civilizations were aware of atrophic rhinitis. [7]

See also

Related Research Articles

<span class="mw-page-title-main">Otorhinolaryngology</span> Medical specialty

Otorhinolaryngology ( oh-toh-RY-noh-LARR-in-GOL-ə-jee, abbreviated ORL and also known as otolaryngology, otolaryngology  head and neck surgery, or ear, nose, and throat is a surgical subspeciality within medicine that deals with the surgical and medical management of conditions of the head and neck. Doctors who specialize in this area are called otorhinolaryngologists, otolaryngologists, head and neck surgeons, or ENT surgeons or physicians. Patients seek treatment from an otorhinolaryngologist for diseases of the ear, nose, throat, base of the skull, head, and neck. These commonly include functional diseases that affect the senses and activities of eating, drinking, speaking, breathing, swallowing, and hearing. In addition, ENT surgery encompasses the surgical management of cancers and benign tumors and reconstruction of the head and neck as well as plastic surgery of the face and neck.

<span class="mw-page-title-main">Nasal cavity</span> Large, air-filled space above and behind the nose in the middle of the face

The nasal cavity is a large, air-filled space above and behind the nose in the middle of the face. The nasal septum divides the cavity into two cavities, also known as fossae. Each cavity is the continuation of one of the two nostrils. The nasal cavity is the uppermost part of the respiratory system and provides the nasal passage for inhaled air from the nostrils to the nasopharynx and rest of the respiratory tract.

<span class="mw-page-title-main">Rhinitis</span> Irritation and inflammation of the mucous membrane inside the nose

Rhinitis, also known as coryza, is irritation and inflammation of the mucous membrane inside the nose. Common symptoms are a stuffy nose, runny nose, sneezing, and post-nasal drip.

<span class="mw-page-title-main">Nasal concha</span> Piece of bone in the breathing passage of humans and other animals

In anatomy, a nasal concha, plural conchae, also called a nasal turbinate or turbinal, is a long, narrow, curled shelf of bone that protrudes into the breathing passage of the nose in humans and various animals. The conchae are shaped like an elongated seashell, which gave them their name. A concha is any of the scrolled spongy bones of the nasal passages in vertebrates.

<span class="mw-page-title-main">Nasal polyp</span> Noncancerous growths within the nose or sinuses

Nasal polyps (NP) are noncancerous growths within the nose or sinuses. Symptoms include trouble breathing through the nose, loss of smell, decreased taste, post nasal drip, and a runny nose. The growths are sac-like, movable, and nontender, though face pain may occasionally occur. They typically occur in both nostrils in those who are affected. Complications may include sinusitis and broadening of the nose.

<span class="mw-page-title-main">Septoplasty</span> Corrective surgical procedure

Septoplasty [ˈsɛp.toˌplæ.sti] (Etymology: L, saeptum, septum; Gk, πλάσσειν plassein – to shape), or alternatively submucous septal resection and septal reconstruction, is a corrective surgical procedure done to straighten a deviated nasal septum – the nasal septum being the partition between the two nasal cavities. Ideally, the septum should run down the center of the nose. When it deviates into one of the cavities, it narrows that cavity and impedes airflow. Deviated nasal septum or “crooked” internal nose can occur at childbirth or as the result of an injury or other trauma. If the wall that functions as a separator of both sides of the nose is tilted towards one side at a degree greater than 50%, it might cause difficulty breathing. Often the inferior turbinate on the opposite side enlarges, which is termed compensatory hypertrophy. Deviations of the septum can lead to nasal obstruction. Most surgeries are completed in 60 minutes or less, while the recovery time could be up to several weeks. Put simply, septoplasty is a surgery that helps repair the passageways in the nose making it easier to breathe. This surgery is usually performed on patients with a deviated septum, recurrent rhinitis, or sinus issues.

<span class="mw-page-title-main">Rhinoscleroma</span> Medical condition

Rhinoscleroma, is a chronic granulomatous bacterial disease of the nose that can sometimes infect the upper respiratory tract. It most commonly affects the nasal cavity—the nose is involved in 95–100 per cent of cases—however, it can also affect the nasopharynx, larynx, trachea, and bronchi. Slightly more females than males are affected and patients are usually 10 to 30 years of age. Rhinoscleroma is considered a tropical disease and is mostly endemic to North Africa, South Asia and Central America, less common in the United States.

<span class="mw-page-title-main">Nasal septum perforation</span> Medical condition

A nasal septum perforation is a medical condition in which the nasal septum, the bony/cartilaginous wall dividing the nasal cavities, develops a hole or fissure.

Nasal congestion is the partial or complete blockage of nasal passages, leading to impaired nasal breathing, usually due to membranes lining the nose becoming swollen from inflammation of blood vessels.

<span class="mw-page-title-main">Post-nasal drip</span> Medical condition

Post-nasal drip (PND), also known as upper airway cough syndrome (UACS), occurs when excessive mucus is produced by the nasal mucosa. The excess mucus accumulates in the back of the nose, and eventually in the throat once it drips down the back of the throat. It can be caused by rhinitis, sinusitis, gastroesophageal reflux disease (GERD), or by a disorder of swallowing. Other causes can be allergy, cold, flu, and side effects from medications.

Rhinitis medicamentosa is a condition of rebound nasal congestion suspected to be brought on by extended use of topical decongestants and certain oral medications that constrict blood vessels in the lining of the nose, although evidence has been contradictory.

<span class="mw-page-title-main">Empty nose syndrome</span> Medical condition

Empty nose syndrome (ENS) is a clinical syndrome, the hallmark symptom of which is a sensation of suffocation despite a clear airway. This syndrome is often referred to as a form of secondary atrophic rhinitis. ENS is a potential complication of nasal turbinate surgery or injury. Patients have usually undergone a turbinectomy or other surgical procedures that injure the nasal turbinates.

<span class="mw-page-title-main">Dacryocystorhinostomy</span>

Dacryocystorhinostomy (DCR) is a surgical procedure to restore the flow of tears into the nose from the lacrimal sac when the nasolacrimal duct does not function.

<span class="mw-page-title-main">Functional endoscopic sinus surgery</span> Surgery to enlarge the paranasal sinus drainage pathways

Functional endoscopic sinus surgery (FESS) is a procedure that is used to treat sinusitis and other conditions that affect the sinuses. Sinusitis is an inflammation of the sinuses that can cause symptoms such as congestion, headaches, and difficulty breathing through the nose.

<span class="mw-page-title-main">Human nose</span> Feature of the face

The human nose is the most protruding part of the face. It bears the nostrils and is the first organ of the respiratory system. It is also the principal organ in the olfactory system. The shape of the nose is determined by the nasal bones and the nasal cartilages, including the nasal septum which separates the nostrils and divides the nasal cavity into two. On average the nose of a male is larger than that of a female.

Young's operation is a surgery designed for the treatment of atrophic rhinitis, first described by Austen Young in 1967.

<span class="mw-page-title-main">Turbinectomy</span>

A turbinectomy or turbinoplasty is a surgical procedure, that removes tissue, and sometimes bone, of the turbinates in the nasal passage, particularly the inferior nasal concha. The procedure is usually performed to relieve nasal obstructions. In most cases, turbinate hypertrophy is accompanied by some septum deviation, so the surgery is done along with septoplasty.

Merciful anosmia is a condition in which the person is unaware of a foul smell emanating from his own nose. This condition is seen in atrophic rhinitis. In atrophic rhinitis, the turbinates, venous sinusoids, seromucinous glands and nerves undergo atrophy, resulting in a foul smelling discharge. As the nerve fibres sensing smell are also atrophied, the patient is unable to appreciate the foul smell.

Caldwell-Luc surgery, Caldwell-Luc operation, also known as Caldwell-Luc antrostomy, and Radical antrostomy, is an operation to remove irreversibly damaged mucosa of the maxillary sinus. It is done when maxillary sinusitis is not cured by medication or other non-invasive technique. The approach is mainly from the anterior wall of the maxilla bone. It was introduced by George Caldwell(1893)and Henry Luc(1897). The maxillary sinus is entered from two separate openings, one in the canine fossa to gain access to the antrum and other in the naso antral wall for drainage.

Nonallergic rhinitis is rhinitis—inflammation of the inner part of the nose—not caused by an allergy. Nonallergic rhinitis displays symptoms including chronic sneezing or having a congested, drippy nose, without an identified allergic reaction. Other common terms for nonallergic rhinitis are vasomotor rhinitis and perennial rhinitis. The prevalence of nonallergic rhinitis in otolaryngology is 40%. Allergic rhinitis is more common than nonallergic rhinitis; however, both conditions have similar presentation, manifestation and treatment. Nasal itching and paroxysmal sneezing are usually associated with nonallergic rhinitis rather than allergic rhinitis.

References

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  2. Bunnag C, Jareoncharsri P, Tansuriyawong P, Bhothisuwan W, Chantarakul N (September 1999). "Characteristics of atrophic rhinitis in Thai patients at the Siriraj Hospital". Rhinology. 37 (3): 125–30. PMID   10567992.
  3. 1 2 3 4 deShazo, Richard D.; Stringer, Scott P. (2011-02-01). "Atrophic rhinosinusitis: progress toward explanation of an unsolved medical mystery". Current Opinion in Allergy and Clinical Immunology. 11 (1): 1–7. doi:10.1097/ACI.0b013e328342333e. ISSN   1473-6322. PMID   21157302. S2CID   27205163.
  4. Choices, NHS. "Non-allergic rhinitis - Causes - NHS Choices". www.nhs.uk. Retrieved 2017-08-12.
  5. 1 2 Gleeson, Michael; Clarke, Ray (2008-04-25). Scott-Brown's Otorhinolaryngology: Head and Neck Surgery 7Ed: 3 volume set. CRC Press. ISBN   9781444109832.
  6. Gleeson, Michael; Clarke, Ray (2008-04-25). Scott-Brown's Otorhinolaryngology: Head and Neck Surgery 7Ed: 3 volume set. CRC Press. ISBN   9781444109832.
  7. Shehata MA (1996). "Atrophic rhinitis". Am J Otolaryngol. 17 (2): 81–6. doi:10.1016/s0196-0709(96)90000-9. PMID   8820180.