Beruflich Dokumente
Kultur Dokumente
Ozena
Presentation Outlines
Definition
Pathophysiology
Clinical presentations
Differential diagnosis
Investigations
Treatment
Atrophic
rhinitis
(AR) is a chronic
and
degenerative
paranasal
mucosa
&
structures
other
Definition (Cont)
triad of characteristic fetor, greenish
crusts and roomy nasal cavities this
triad is diagnostic of the condition
Prevalence of Primary AR 0.3-1% in high
prevalence countries
High Prevalence countries are: India,
Pakistan, China, Philippines, Malaysia,
Saudi Arabia, Egypt and South america
Definition (Cont)
Primary AR: More common in females(*6), usually
bilateral, Prevalent in young and middle age adults
Often, no underlying etiology is discovered,
discovered
although inheritable or infectious causes (58.7%
K. ozena) are proposed mechanisms
there is however little evidence to suggest
bacterial organisms cause the disease, they may
be secondary invaders
Definition (Cont)
Secondary AR:
Complication of sinus surgery (89%)
1. FESS in CRS > FESS in Polypoid CRS
2. In Mayo clinic assay : Partial MT and/or IT
resection was the most common cause
Outlines
Definition
Pathophysiology
Clinical presentations
Differential diagnosis
Investigations
Treatment
Pathophysiology
Nl. Respiratory epithelium (Pseudostratified
Columnar) metaplastic changes
cuboidal/stratified squamous epithelium
Atrophy of cilia and the mucosal and
submucosal gland
Secondary bac. Infection produce a foetid
odour
Osteitis of inferior turbinates and ethmoid
turbinates
Vascular involvement (mainly endarteritis
obliterans)
Outlines
Definition
Pathophysiology
Clinical presentations
Differential diagnosis
Investigations
Treatment
Outlines
Definition
Pathophysiology
Clinical presentations
Differential diagnosis
Investigations
Treatment
Differential diagnosis
TB
Leprosy
Scleroma
Syphilis
Chronic sinus suppuration on its own
Suppurating adenoidal disease
Neglected FB / rhinoliths
Wegners disease
Chronic fungal rhinosinusitis
Empty nose syndrome (ENS)
Kern &
Stenkvist
at 1994
What is ENS?
Outlines
Definition
Pathophysiology
Clinical presentations
Differential diagnosis
Investigations
Treatment
Investigations
Outlines
Definition
Pathophysiology
Clinical presentations
Differential diagnosis
Investigations
Treatment
Treatment
(Medical)
Conservative management is the
mainstay
of the treatment
No cure available
Decongestants
or
antihistamines:
contraindicates
Nasal irrigation and douches:
With Alkaline douches (preferred)
With N/S or antibiotic+N/S douches
strongly
Treatment (Medical)
25g
2. Sodium biborate
25g
3. Sodium chloride
50g
Treatment (Medical)
Glucose-glycerine nose drops
1. Anhydrous Glucose 25% (~15 )
g
2. Glycerine 60cc
can
also
Chloramphenicol
douching, too
use
drops
Gentamicin
after
or
nasal
Treatment (Medical)
Antibiotics:
Rifampicin 600mg daily for 12wk (generic cap.
is 300mg take 2 every morning)
Recently: Cipro 500-750mg bid for 1-3mo
Treatment (Surgical)
1) Youngs Procedure
2) Modified Youngs procedures
3) Modification of modified Young
4) Implantation
5) Other approaches
Treatment (Surgical)
Youngs procedure
Circumferential flap elevation 1 cm cephalic to the
alar rim
Complete closure of nostril
Staged second side in 3-6 months
Difficult to elevate circumferential flap
Modified Young
Treatment (Surgical)
Modification of the modified youngs:
Treatment (Surgical)
Implantation:
Implantation
uses
Bone
Plastipore
Right
Left
Treatment (surgical)
Other approaches:
Transferring the Stensen duct to the maxillary
sinus antrum
Using a caldwell approach, translocating the
lateral nasal wall more medially
Silastic obturator
...
Presentation Conclusion
...Try to save nasal structures and mucosal layer as much as you can