Chronic catarrhal rhinitis

 Chronic catarrhal rhinitis

 develops as a result of repeated acute rhinitis.
Prolonged congestive hyperemia of the nasal
mucosa caused by alcoholism, chronic disease
of the cardiovascular system, and kidneys
predisposes to the development of chronic
rhinitis. In these diseases, hereditary
preconditions, developmental defects,
violations of normal anatomical relationships,
causing difficulty in nasal breathing, are
significant. Chronic rhinitis also develops as a
secondary disease in the pathology of the
nasopharynx and paranasal sinuses.
 Clinic
 The symptoms of chronic catarrhal rhinitis are

generally similar to those of acute rhinitis, but are

much less intense. The patient complains of nasal
discharge of a mucous or mucopurulent nature.
Difficulty in nasal breathing increases (as does nasal
discharge) in the cold. Often there is an alternating
congestion in one of the halves of the nose. With
rhinoscopy, diffuse hyperemia of the mucous
membrane is determined, often with a cyanotic
shade. The inferior turbinates are moderately
swollen, narrowing the lumen of the common nasal
passage. Chronic catarrhal rhinitis may be
accompanied by hyposmia. A possible transition of
catarrhal inflammation from the nasal cavity to the
mucous membrane of the auditory tube with the
subsequent development of tubo-otitis
 Diagnosis The diagnosis of the disease is established
on the basis of complaints, anamnesis, anterior and
posterior rhinoscopy. Differential diagnosis To
distinguish catarrhal chronic rhinitis from
hypertrophic, anemization of the mucous membrane is
performed with vasoconstrictor agents. A noticeable
contraction of the mucous membrane of the turbinates
indicates the absence of true hypertrophy
characteristic of hypertrophic rhinitis. Differential
diagnosis between false and true hypertrophy can be
performed using a bell-shaped probe.
 In the case of false hypertrophy, the probe more easily
bends the mucous membrane to the bone wall. With
true hypertrophy, compacted tissue is determined,
which does not lend itself well to pressure exerted on
it.
 Treatment
 It is necessary to eliminate the unfavorable
factors that cause the development of chronic
rhinitis. It is useful to stay in a dry warm climate,
hydro and balneotherapy is indicated. Local
treatment consists in the use of antibacterial and
astringent drugs in the form of a 3-5% solution
of protargol (collargol), 0.25 - 0.5% solution of
zinc sulfate, 2% salicylic ointment, etc. UHF is
prescribed to the area nose, endonasally UFO
(tube-quartz). The prognosis is usually good.
Chronic hypertrophic rhinitis
 The causes of hypertrophic rhinitis are the same as those
of catarrhal.
 Clinic
 Hypertrophic rhinitis is characterized by persistent nasal
congestion. Complicates nasal breathing and profuse
mucous and mucopurulent discharge. Due to obturation of
the olfactory gap, hyposmia occurs and then anosmia.
Subsequently, as a result of atrophy of the olfactory cells,
essential (irreversible) anosmia may occur. The timbre of
the voice in patients becomes nasal. As a result of the
compression of the lymph gaps by the fibrous tissue, the
lymph outflow from the cranial cavity is disrupted, which
causes the appearance of a feeling of heaviness in the
head, disability and sleep disturbance.
Treatment
 Treatment of hypertrophic rhinitis is
predominantly surgical. If there is bone
hypertrophy of the turbinates, one of the
options for submucosal intervention is
performed. With limited hypertrophy of the
anterior and posterior ends of the inferior
turbinates or their lower edge, these areas
are excised (conchotomy).
conchotomy
Atrophic rhinitis (Ozaena)

 Etiology
 Hereditary factors: the disease runs in families.
 Endocrine imbalance: the disease tends to start at

puberty and mostly involves females.

 Racial factors: whites are more susceptible than

natives of equatorial Africa.

 Nutritional deficiency: vitamins A or D, or iron.
 Infection: Klebsiella ozaena.
 Autoimmune factors: viral infection or some other

unidentified insult may trigger antigenicity of the

nasal mucosa.
Clinic
 Nasal obstruction despite the roomy nasal cavity,
which can be caused either by the obstruction
produced by the discharge in the nose, or as a result
of sensory loss due to atrophy of nerves in the nose,
so the patient is unaware of the air flow.
 Nasal discharge: greenish crusts with foul smelling,
though the patients may not be aware of this, because
the associated merciful anosmia.
 Epistaxis, may occur when the dried discharge (crusts)
are removed.
 Hyposmia. Atrophic nasal mucosa and turbinates.
 The nasal cavities become roomy and are filled with
foul smelling crusts.
treatment
 Medical treatment:
 Nasal irrigation and removal of crusts using alkaline
nasal solutions.
 25% glucose in glycerin can be applied to the nasal
mucosa to inhibit the growth of proteolytic organisms
which produce foul smell.
 Local antibiotic spray.
 Estradiol spray for regeneration of seromucinous
glands.
 Oral potassium iodide for liquefaction of secretion.
 Placental extract injected in the submucosa.
 Iron and vitamin A.
 Surgical interventions:
 Aims at narrowing of nasal cavity till the

mucosa regenerates.
 Young's operation: Closure of the nasal cavity

affected with atrophic rhinitis by creating

mucocutaneous flaps (6m-2y). (Obsolete)
 Submucosal augmentation using bone,

cartilage, or Teflon paste.