1) VIRAL RHINITIS

CLINICAL FEATURES:

Burning sensation of nose followed by nasal

stuffiness , rhinorrhoea and sneezing.

Low grade fever.
Nasal discharge is initially watery and profuse but
may become mucopurulent due to sec. bacterial
invasion.
TREATMENT:
Bed rest
Plenty of fluids.
Antihistamine and nasal decongestant.
Analgesics to relieve headache and antibiotics if

secondary infection.

COMPLICATIONS:
Disease is usually self limiting and resolves
spontaneously after 2to 3 weeks.
Occasionally sinusitis, bronchitis, pharyngitis
may occur.
INFLUENZAL RHINITIS:
Caused by influenza viruses A , B or C .
RHINITIS ASSOCIATED WITH EXANTHEMAS:
Measles, rubella, chickenpox, are often
associated with rhinitis which precedes
exanthemas by 2-3 days.

2) BACTERIAL RHINITIS
A)Non-specific infections:
It may be primary or secondary.
Primary bacterial rhinitis is seen in child usually
infected by pneumococcus , streptococcus or
staphylococcus.
A greyish white membrane may form in the
nose , which with attempted removal, cause
bleeding.
B)Secondary bacterial rhinitis is result of bacterial
infection supervening acute viral rhinitis.

3) IRRITATIVE RHINITIS
Caused by exposure to dust, smoke and

irritating gases like ammonia, formalin etc.

May result from trauma on nasal mucosa
during intranasal manipulation.
CLINICAL FEATURES:
Immediate catarrhal reaction with sneezing,
rhinorrhoea and nasal congestion.
Symptoms may pass off rapidly with removal
of offending agent .

CHRONIC SIMPLE RHINITIS

Aetiology:
Recurrent attacks of acute rhinitis in presence
of predisposing factors leads to chronicity.
Predisposing factors:
Persistence of nasal infection due to sinusitis ,
tonsillitis and adenoids.
Chronic irritation from dust, smoke etc
Nasal obstruction due to DNS, synechia
leading to persistence of discharge.

PATHOLOGY:
There is hyperaemia and edema of mucous
membrane with hypertrophy of seromucinous
glands and increase in goblet cells.
Blood sinusoids over turbinates are distended.
CLINICAL FEATURES:
Nasal obstruction
Nasal discharge
Headache
Swollen turbinates- pit on pressure ,shrink with
decongestant.
Post nasal discharge.

TREATMEN
T:
Treatment of

causative agent.
Nasal irrigation with alkaline solution .
Nasal decongestant help to relieve nasal
obstruction and improves sinus ventilation.
A short course of systemic steroids helps to
wean patient already addicted to excessive
use of decongestant drops or sprays.
Antibiotics.

ATROPHIC
RHINITIS(OZAENA)
It is the chronic inflammation of nose

characterised by atrophy of nasal mucosa and

turbinate bones . The nasal cavities are roomy
and full of foul-smelling crusts.
Two types
Primary atrophic rhinitis
Secondary atrophic rhinitis.

PRIMARY ATROPHIC RHINITIS

AETIOLOGY: (HERNIA)
Hereditary factors.
Endocrinal disturbance.
Racial factors .
Nutritional deficiency.
Infective.
Autoimmune process.

PATHOLOGY:
Ciliated columnar epithelium is lost and is

replaced by stratified squamous type.

Atrophy of seromucinous glands, venous
blood sinusoids and nerve element.
Turbinate undergoes resorption causing
widening of nasal chambers.

CLINICAL FEATURES
SIGN & SYMPTOMS
Common in females during puberty.
Foul smell from nose , but patient remains
unware.
Marked anosmia(merciful anosmia)
Nasal obstruction inspite of wide nasal
chambers due to large crust formation.
Epistaxis.

EXAMINATION shows nasal cavity to be full of

greenish or greyish black dry crusts covering the

turbinates & septum.
Attempt to remove my cause bleeding. If removed ,
nasal cavities appear roomy with atrophy of
turbinates so much so that the posterior wall of
nasopharynx can be easily seen .
Nasal turbinates may be reduced to mere ridges.
Nasal mucosa appears pale .
Nasal vestibule may be present shows saddle
defromity
Atrophic changes may be seen in pharyngeal
mucosa larynx with cough and hoarseness of voice.

Radiographic Findings
1. Mucoperiosteal thickening of the paranasal sinuses.
2. Loss of definition of the OMC secondary to

resorption of the ethmoid bulla and uncinate

process.

3. Hypoplasia of the maxillary sinuses.

4. Enlargement of the nasal cavities with

erosion and bowing of the lateral nasal wall.

5. Bony resorption and mucosal

atrophy of the inferior and

middle turbinates.

PROGNOSIS
The disease persists for years but there is a

tendency to recover spontaneously in middle age.

Current Therapies
Goals of therapy
Restore nasal hydration
Minimize crusting and debris

Therapy options
Topical therapy
Saline irrigations
Antibiotic irrigations
Systemic antibiotics
Implants to fill nasal volume
Closure of the nostrils

Local therapy
Irrigations
Saline
Mixtures

Sodium bicarbonate
Shehata: Sodium Carbonate 25g, Sodium Biborate 25g, and
Sodium Chloride 50g in 250ml water.

Antibiotic solution

Moore: Gentamycin solution 80mg/L

Anti-drying agents
Glycerine
Mineral Oil
Paraffin with 2% Menthol

Other
Acetylcholine
Pilocarpine

Systemic therapy

SURGICAL:
A) Youngs operation:
Both the nostrils are closed completely just within

the nasal vestibule by raising flaps. They are

opened after 6 months or later. In these cases,
mucosa may revert to normal and crusting
reduced.
Youngs procedure
Circumferential flap elevation 1 cm cephalic to the alar rim.
Sutures placed in center of elevated flap to close the nostril

Advantages
Often provided relief of symptoms

Disadvantages
Difficult to elevate circumferential flap
Breakdown of central suture area common
Does not allow for cleaning
Did not allow for periodic examination
Recurrence after flap takedown

Modified youngs operation:

To avoid discomfort of B/L nasal obstruction ,
modified youngs operation aims to partially close
the nostrils. It is also claimed to give the same
benefit as youngs.
Modified Youngs
Elevation of extended perichondrial flap through contralateral

hemitransfixion incision.
Short skin flap elevated from the intercartilaginous line on the
ipsilateral side.
Suture lateral and medial flaps with vicryl.
Staged second side with first side takedown in 6 mon.

Advantages
Technically easier than Young procedure
No suture line breakdown
No vestibular stenosis on takedown

Disadvantages
Not possible with large septal defects
Does not allow for cleaning
Does not allow for periodic examination
Recurrence after flap takedown

Modified Young

B) Narrowing of nasal cavities:

Nasal chanbers are very wide in atrophic rhinitis

and air currents dry up secretion leading to

crusting . Narrowing the size of nasal helps
relieve the symptoms.
i. submosal injection of teflon paste.
ii.insertion of fat, cartilage, bone or teflon strips
under the mucoperiosteumof the floor and
lateral wall of nose and mucoperichondrium of
the septum
iii. Section and medial displacement lateral wall
of nose.