Acute & Chronic Rhinitis
Nur Adilah Binti Mohd Radzi
082012100027
Content
Acute rhinitis
Chronic rhinitis
Allergic rhinitis
Rhinitis
Acute rhinitis
Can either be:
Common
cold
(coryza)
1. Viral
Rhinitis
Influenza
Rhinitis
Rhinitis ass/
with
exanthemas
2.
Bacterial
Rhinitis
3.
Irritative
Rhinitis
Nonspecific
Infections
Diphtheritic
Rhinitis
1. Common cold (coryza)
Clinical Features
Caused by virus
Airborne droplets
IP : 1-4 days
Duration: 2-3
weeks
Adenovirus
Secondary
Infections:
Streptococcus
hemolyticus
PicornavirusPneumococcus
rhinovirus,
coxsackie
Staphylococcus
virus
H. Influenza
Enteric cytophatic
Klebsiella pneumoniae
human orphan virus
Morexella catarrhalis
Onset- Burning
sensation behind
nose nasal
stuffiness,
rhinorrhea,
sneezing
Nasal discharge :
watery, profuse.
(Mucopurulentsecondary
infection)
Chills, low grade
fever
1. Common cold (coryza)
Treatment
Bed rest
Plenty of fluids
Symptoms: Antistaminic, Nasal decongestant
Analgesic
Antibiotics
Complications
Usually self-limiting
Rarely:
Sinusitis, pharyngitis, tonsillitis, bronchitis, pneumonia and
otitis media
2. Influenzal Rhinitis
3. Rhinitis associated with
exnthemas
Caused by influenza
viruses A, B or C
Symptoms and signs
similar to those coryza
Complications due to
bacterial invasion are
common
Measles, Rubella and
chickenpox are often
associated with rhinitis
Precedes exanthemas
by 2-3 days
Secondary infection
and complications are
more frequent and
severe
Bacterial Rhinitis
1. Nonspecific Infections
. May be primary / secondary
. Primary - children ( Pneumococcus,
Streptococcus or Staphylococcus)
. A greyish white tenacious membrane
may form
. Removal attempt bleeding
. Secondary bacterial rhinitis
Bacterial Rhinitis
2. Diphtheritic Rhinitis
Rare
Primary or secondary to faucial diphtheria
Acute or chronic form
Greyish membrane seen covering the inferior turbinate
Removal bleeding
Excoriation of anterior nares and upper lip
Treatment
isolation
systemic penicillin
diphtheria antitoxin
Chronic Rhinitis
Chronic = long standing, persistent,
recurrent
1. Chronic Simple Rhinitis
2. Hypertrophic Rhinitis
3. Atrophic Rhinitis
4. Rhinitis Sicca
5. Rhinitis Caseosa
1. Chronic Simple Rhinitis
Aetiology:
Recurrent attacks of acute rhinitis in the presence of
predisposing factors such as :
Persistence of nasal infection
Chronic irritation from dust, smoke, snuff, etc.
Nasal obstruction due to DNS, synechiae
Vasomotor rhinitis
Endocrinal or metabolic factors (hypothyroidism, puberty, etc.)
Pathology:
Hyperaemia and oedema of mucous membrane
Hypertrophy of seromucinous glands
Increase in goblet cells
Blood sinusoids distended (particularly over the turbinates
area)
1. Chronic Simple Rhinitis
cont.
Clinical Features:
Nasal obstruction
Nasal discharge
Headache
Swollen turbinates (pit on pressure and shrink with application
of vasoconstrictor)
Postnasal discharge
Treatment:
Treat the cause
Nasal irrigation with alkaline solution
Nasal decongestant
Antibiotics
2. Hyperthrophic Rhinitis
Characterized by thickening of mucosa, submucosa,
seromucinous glands, periosteum and bone
Aetiology:
Recurrent nasal infections
Chronic sinusitis
Chronic irritation of nasal mucosa (smoking, industrial irritants, etc.)
Allergic and vasomotor rhinitis
Prolonged use of nasal drops
Symptoms:
Nasal obstruction
Nasal discharge (thick and sticky)
Headache, heaviness of head, transient anosmia
2. Hypertrophic Rhinitis
cont.
Signs:
Hypertrophy of turbinates
Turbinal mucosa is thick and does not pit on pressure
Little shrinkage with vasoconstrictor drugs underlying fibrosis
Mulberry appearance
COMPENSATORY
HYPERTROPHIC
RHINITIS
Treatment:
Linear cauterization
Submucosal diathermy
Cryosurgery of turbinates
Partial or total turbinectomy
Submucous resection of turbinate
Lasers
Seen in DNS to one side
Septoplasty + reduction of
hypertrophy turbinates
bone
3. ATROPHIC RHINITIS
(OZAENA)
Chronic inflammation characterized by atrophy of nasal mucosa
and turbinate bones
Nasal cavities roomy, full of foul-smelling crusts
Two types : Primary & Secondary
I. PRIMARY ATROPHIC RHINITIS
Aetiology:
Hereditary factors
Endocrinal disturbance
Racial factors
Nutritional deficiency
Infection (Klebsiella ozaenae, diphtheroids, Proteus vulgaris, [Link],
etc.)
Autoimmune process
3. ATROPHIC RHINITIS (OZAENA)
cont.
Pathology:
Ciliated columnar epithelium lost replaced by stratified squamous
type
Atrophy of seromucinous glands, blood sinusoids and nerve elements
Arteries obliterative endarteritis
Widening of nasal chambers (bone of turbinates undergoes
resorption)
Paranasal sinuses small (arrested development)
Greenish or
Merciful
Nasal
Epistaxis
greyish black
anosmia
obstruction
dry crusts
Posterior wall
of
nasopharynx
easily seen
Nasal mucosa
pale
Septal
perforation
and dermatitis
of nasal
vestibule
Atrophic
changes
(pharynx,
larynx)
3. ATROPHIC RHINITIS (OZAENA) cont.
Prognosis:
Disease persists for years but there is tendency to
recover spontaneously in middle age
Treatment (Medical & Surgical)
1. Nasal
2) 25% glucose
3) Local
SURGICAL
irrigation and
in glycerine
antibiotics
removal of
inhibits growth
(Kemicetine)
1) Youngs
Both nostrils
crusts (2- operation
proteolytic
eliminate 2
3x/days
organisms
infection
are
closed
completely
every 2-3d)
6) Systemic use
2) Modified Youngs operation
of streptomycin
Oestradiol
5) Placental
3) 4)Narrowing
the
nasal
cavities
(Klebsiella)
spray
extract
Submucosal injection of teflon paste
1g/day for 10d
Insertion of fat, cartilage, bone/Teflon strips
under mucoperiosteum
of the floor & lat.
7. Potassium
iodide
wall of nose & mucoperichondrium
of
promote &
septum
liquefies
nasal
Section & medial
displacement
lat. wall of
secretion
3. ATROPHIC RHINITIS (OZAENA)
cont.
SECONDARY ATROPHIC RHINITIS
Specific infections like syphilis, lupus, leprosy and
rhinoscleroma may cause destruction of the nasal
structures leading to atrophic changes
Long-standing purulent sinusitis, radiotherapy to
nose or excessive removal of turbinates may lead
to AR
Unilateral atrophic rhinitis
