Rinitis atrófica / Atrophic rhinitis

La rinitis atrófica es una enfermedad crónica y progresiva de etiología desconocida. Se caracteriza por atrofia de la mucosa nasal y hueso subyacente, dilatación anormal de las cavidades nasales, obstrucción nasal paradójica, y formación de secreciones viscosas y costras secas; produciendo fetidez. Sus manifestaciones clínicas más frecuentes son obstrucción nasal, secreción purulenta, costras nasales y mal olor nasal. Se ha separado en dos entidades: primaria y secundaria. El tratamiento es principalmente conservador, y se han propuesto diversas terapias farmacológicas y quirúrgicas. La rinitis atrófica unilateral es una condición infrecuente, con escasos reportes en la literatura científica. Se puede asociar a la desviación septal, por lo que su corrección quirúrgica es una alternativa terapéutica disponible.

Atrophic rhinitis is a chronic disease of unknown etiology. This condition is characterized by progressive nasal mucosal and underlyng bone atrophy, abnormal widening of the nasal cavities, paradoxical nasal congestion and formation of viscid secretions and dried crusts, leading to a characteristic fetor (ozaena). The main clinical manifestations include nasal obstruction, purulent discharge, daily nasal crusting, nasal dryness and foul smell. It has been divided into two separate entities; primary and secondary. Treatment is mostly conservative, although pharmacological and surgical therapies have been proposed. Unilateral atrophic rhinitis is an uncommon condition, with few reports in the scientific literature. It is associated with septum deviation, so surgical correction is one of the therapeutic options available.

Rinitis atrófica como causa del síndrome de nariz vacía: reporte de caso / Atrophic rhinitis as cause of the empty nose syndrome: case report

La rinitis atrófica es una de las causas del Síndrome de nariz vacía, la cual está relacionada con colonización por gérmenes, inflamación crónica y posterior atrofia progresiva de la mucosa nasal. Típicamente produce síntomas obstructivos nasales, rinorrea y costras fétidas. Se presenta el caso en imágenes endoscópicas, tomográficas y de cultivo en una paciente femenina en la cual por sus comorbilidades el manejo fue exclusivamente médico.

Atrophic rhinitis is one of the causes of the empty nose syndrome that is related to colonization by germs, chronic inflammation and subsequent progressive atrophy of the nasal mucosa. Typically produces nasal obstructive symptoms, runny nose and fetid crusts. Endoscopy, tomography and culture images of a female patient is presented in which by her co-morbidities associated the treatment was medical exclusively.

Modified surgical treatment of atrophic rhinitis

The aim of the study was to evaluate the role of alternate periods of surgical closure of the nostrils in treating patients with atrophic rhinitis. A descriptive study was conducted involving 11 patients clinically diagnosed as atrophic rhinitis who underwent surgical closure of the nostrils alternately. These patients were treated in the Department of ENT, Al-Jamhori Teaching Hospital, Mosul, Iraq during the period from April 1990 to December 2004. The parameters analyzed included age, sex, clinical presentation and residence. Moreover, evaluation of the result of alternative periodic surgical closure of the nostrils was evaluated. The study was conducted on 11 patients with atrophic rhinitis [10 females and 1 male]. The average age was 16.2 years with a range of 13.20 years. The peak age incidence was 18th year of life. The most frequent clinical presentation was nasal obstruction in spite of wide nasal cavities. There was improvement of symptoms with regeneration of the nasal mucosa in 10 [90.9%] patients. All of the patients accepted this operation as the other nostril was left open to allow for a relatively functional nasal airway. The results of this series suggest that this technique is useful in the treatment of atrophic rhinitis

Epistaxis: study of aetiology, site and side of bleeding.

The present study comprises 300 cases of epistaxis. The analysis of these cases revealed a higher incidence in young males. Unilateral bleeding was seen in almost 60% each of indoor and outdoor cases. Litte's area was the most common site responsible for epistaxis in 28.8% of the indoor and 26.2% of the outdoor patients. Hypertension was the most common systemic cause among indoor patients (62.2%) and sickle cell disorder among the outdoor patients (37.5%). Atrophic rhinitis with myiasis was the local cause of epistaxis in maximum (27%) of the indoor patients and traumatic epistaxis was the commonest cause (33%) among outdoor patients-fingernail trauma in 75.9% of them. Idiopathic epistaxis contributed for 16.5% indoor and 26.1% of outdoor cases. Intractable epistaxis was seen in one case following accidental facial trauma.

Investigations of the maxillary sinus in cases of primary atrophic rhinitis

Primary atrophic rhinitis is not uncommon disease in Egypt [Girgis, 1966]. Its exact aetiology is not yet well established [Barton and Sibert, 1980]. The condition of the maxillary sinus in cases of primary atrophic rhinitis is not clear. The aim of this work was to throw some light on the condition of the maxillary sinus in cases of primary atrophic rhinitis. This study included 30 patients, Sinoscopy was used to examine the mucous membrane of the sinus and to study the efficiency of its mucociliary transport mechanism. Radiological, Bacteriological and histopathological examinations of the nose and the maxillary sinus were also done. 22 patients [73%] showed thick bony walls during piercing by the sinoscope and the antrum was found to be small in size in almost all cases. The mucociliary function is only affected very late in the disease. The mucosa of the sinus shares the same histopathological changes as the nasal mucosa. However, in well established cases and before fibrosis the sinus mucosa showed compensatory hyperplasia of goblet cells. In 43.3% of cases the maxillary sinuses were found to be sterile and the commonest organism detected in both the nose and the sinus was staph. aureus and there was no relation between the type of the isolated organism and the atrophic changes. Opacification of the maxillary sinus by radiogical examination was found to be due to thickening of the walls and not due to infection

Serum alpha 1-antitrypsin level in patients with atrophic rhinitis

Serum alpha 1 antitrypsin [AIAT] level was determined in twenty four patients with primary atrophic rhinitis. It was found that serum alpha 1- antitrypsin levels were significantly lower in patients with primary atrophic rhinitis, while there was no change in patients with secondary atrophic rhinitis. We may conclude that AIAT deficiency is an aetiological factor of the primary atrophic rhinitis, and its determination may help to understand its pathogenesis and to differentiate it from secondary types