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, E.Coli,
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