Know rhinitis atrophy

Preliminary

Atrophic rhinitis are often present in people with low socioeconomic, environmental & poor in developing countries. Etiology & pathogenesis of atrophic rhinitis has yet to be explained clearly, so that there is no standard treatment.

Atrophic rhinitis is a chronic nasal infection, characterized by progressive atrophy of the mucosa & bone Konka & crust formation. Clinically, nasal mucosa produce thick secretions & quickly dries to form crust that smells foul. The disease is more often about ladies, at the age of puberty.

Often present in people with low socioeconomic level & in a bad surroundings & in developing countries. Etiology & pathogenesis of atrophic rhinitis as yet to be explained satisfactorily.

Therefore, the etiology is uncertain, then there is no standard treatment. Treatment is aimed at eliminating the causes & to relieve signs. Conservative treatment can be administered or if it does not help, surgical procedure.

Synonym

Frequency

Ozaena, fetida rhinitis, rhinitis krustosa.

A number of the literature written that atrophic rhinitis is more often about ladies, at the age of puberty. Baser et al get ten ladies & five men, & Jiang et al get 15 ladies & 12 men. Samiadi get two female & three male patients.

But in terms of age, some authors get different results. Baser et al get the age between 26-50 years, Jiang et al ranged 13-68 years, Samiadi get between 15-49 years of age.

The disease is often found among people with low socioeconomic level & poor environments & in developing countries. H Adam Malik Hospital from January 1999 to December 2000 found 6 patients with atrophic rhinitis, two ladies & one men, ages ranging from 10-37 years.

Etiology

Etiology of atrophic rhinitis as yet to be explained satisfactorily. A number of the theories put forward include:

  * Infection with specific chronic

  * Fe Deficiency
  * Chronic Sinusitis
  * Estrogen hormone imbalance
  * Collagen diseases including autoimmune diseases
  * Mechanical theory of Zaufal
  * Autonomic imbalance.
  * Reflex Sympathetic Dystrophy Variations of the Syndrome (RSDS)
  * Hereditary
  * Supurasi in the nose & paranasal sinuses
  * Blood type.

   ozaena Klebsiella bacteria. These germs normally sillia cease activity in human nasal mucosa. Germs are Staphylococcal, Strep, & Pseudomonas aeruginosa, Kokobasilus, Bacillus mucosus, Diphteroid bacilli, Cocobacillus ozaena foetidus.

Pathology & Pategenesis


In addition to the above factors, atrophic rhinitis may even be classified above: that the reason for primary atrophic rhinitis is unknown & secondary atrophic rhinitis, nasal trauma (major surgical procedure on the nose or radiotherapy) & chronic nasal infection caused by syphilis, leprosy, midline granuloma , rinoskleroma & tbc.

Some authors said that there metaplasi ciliated columnar epithelium in to squamous epithelium or atrophic, & fibrosis of the tunica propria. There is a reduction in alveolar glands in both number & size & the presence of endarteritis & periarteritis of the terminal arteriole. Therefore, the pathology, atrophy rhinitis can be divided in to:

  * Type I: presence of endarteritis & periarteritis of the terminal arteriole due to chronic infection; improved with vasodilator effects of estrogen therapy.
  * Type II: There capillary vasodilation, which increases bad with estrogen therapy.

Taylor & Young get endothelial cells react positively with alkaline phosphatase which showed active bone absorption.


Most cases are type I. Endarteritis in the arteriole will cause a reduction in blood flow to the mucosa. Also you will discover a round cell infiltration in submucosal.

Ciliated epithelium & glandular atrophy seromusinus cause the formation of a thick crust which is attached. Konka atrophy causes airways to be roomy.

It is also connected with the theory of an autoimmune process; Dobbie detect antibodies against the surfactant protein A. Deficiency of surfactant is the main cause of decreasing nasal resistance to infection.

Abnormal surfactant function caused reduced efficiency of mucus clearance & have a bad effect on the frequency of cilia movement. This will cause the buildup of mucus & also exacerbated by dryness of the nasal mucosa & loss of cilia. Mucus will dry up along with terkelupasnya epithelial cells, forming a crust which is an excellent medium for bacterial growth.

Clinical signs & examination

On examination found: nasal cavity filled with green crust, sometimes yellow or black; if the crust is removed, looks roomy nasal cavity, atrophy Konka, purulent secretions & green, narrow & dry nasal mucosa. May even be found caterpillar / larva eggs (because of the stench arising).

Complaints usually include: nasal congestion, weakened olfaction (anosmi), thick green snot, the crust (crust), green, headache, epistaxis & nose feel dry.

  * Level I: nasal mucosal atrophy, mucosal looks reddish & slimy, crusting a bit.
  * Level II: increasingly clear nasal mucosal atrophy, mucosal increasingly dry, the color faded, much crusting, anosmia complaint is not clear.
  * Grade III: extreme mucosal atrophy & bone so that Konka appear as lines, nasal cavity looks wide, can be found crusting in the nasopharynx, there is a clear anosmia.

Sutomo & Samsudin ozaena clinically divide in to levels:


Diagnosis

The diagnosis can be established based on: anamnesis, process blood tests, x-ray images of paranasal sinuses, the examination of serum Fe, Mantoux check, histopathological examination & serological check (VDRL check & the Wasserman check) to get rid of syphilis.

Differential Diagnosis

Tbc chronic rhinitis, chronic rhinitis leprosy, syphilis, chronic rhinitis & rhinitis physics.

Complication

Can be: perforated septum, pharyngitis, sinusitis, miasis nose, saddle nose.

Management

The aim of treatment is to: eliminate the etiologic factors & eliminate the signs. Conservative treatment can be administered or if no help is surgical procedure.

Conservative
one) Broad spectrum antibiotics according to bacterial resistance check, with adequate doses until signs of infection disappear. Qizilbash & Darf reported nice ends in treatment with oral Rifampicin 600 mg one x every day for 12 weeks.

one) Drug nasal wash, to cleanse the nasal cavity of crusting & secretions & eliminate odor.
Among others:
a. Betadin solution in 100 ml of warm water or,
b. Mixture: NaCl, NH4Cl, NaHCO3 aaa 9 & Aqua commercial 300 c => one tablespoon mixed with 9 tablespoons warm water.
c. Salt solution.
d. Mixture: 28.4 g Na bicarbonate, Na diborat 28.4 g, 56.7 g NaCl => mixed with 280 ml of warm water.
Solution is inhaled in to the nasal cavity & out again with a blow hard, the water released in to the nasopharynx through the mouth, completed once a day.

three) nasal drops, after the crust was appointed, given, among others: glucose 25% in glycerin to dampen the mucosa, oestradiol in Arachis oil ten 000 U / ml, anti ozaena kemisetin streptomycin solution & one g NaCl + 30 ml. Given times a day each drops.

two) Vitamin A three x ten.000 U for one weeks.

6) Moreover, if there is sinusitis, treated to completion.

five) Fe preparations.

Sinha, Sardana & Rjvanski reported systemic human placental extract gave 80% improvement in one years & intranasal submucosal injection of placental extract gave 93.3% improvement simultaneously period. This helps the regeneration of epithelial & glandular tissue.

Samiadi in the document provide: trisulfa three x one tablets every day for one weeks, sodium bicarbonate, washing the nose with a physiological Na Cl three times a day, blood & urine controls three times a week to see the side effects of medications, cleaning the nose at the clinic every one weeks, wash nose continued until 2-3 months later & obtained satisfactory ends in 6 of 7 patients.

The purpose of the operation, among other things: the airy narrow nasal cavity, reduce drying & crusting & the formation of resting mucosa thus allowing the occurrence of regeneration.

Operation

one) Modified Young's operation
Closure of the nostrils with the left three mm openings.

Some operations performed techniques include:
one) Young's operation
Total closure of the nasal cavity with a flap. Sinha reported nice results with the closure of the nostrils in part or entirely by sewing one's nose turns each over a period of years.

three) Lautenschlager operation
By mobilizing the medial wall of the antrum & part of etmoid, then moved to the nostril.

two) with submucosal implantation of cartilage, bone, dermofit, synthetic materials such as Teflon, a mix Triosite & fibrin Glue.

Mewengkang N reported koana closing operation using a pharyngeal flap in patients ozaena child succeed satisfactorily.

five) Transplantation of parotid duct in to the maxillary sinus (Wittmack's operation) for the purpose of wetting the nasal mucosa.

With the expected improvement of mucosa & the operation state of the disease.

Prognosis

Conclusion

Atrophic rhinitis is a chronic nasal infection, characterized by progressive mucosal atrophy & bone formation accompanied by crusting Konka.

Etiology & pathogenesis of atrophic rhinitis as yet to be explained satisfactorily. Therefore, the etiology is uncertain, then there is no standard treatment. Treatment is aimed at eliminating the causes & to relieve signs. Treatment can be conservative or operative.