02-03-2013, 02:40 PM
AETIOPATHOGENESIS OF ATROPHIC RHINITIS
AETIOPATHOGENESIS.ppt (Size: 79 KB / Downloads: 21)
INTRODUCTION
Defn: A chronic inflammatory condition of the nose marked by wasting of the mucous membrane & the glands. It is usually associated with crusting & foul- smelling discharge.
It is an uncommon condition in modern societies. Found more in the arid climates or developing world, but now becoming more common as a sequelae of medical intervention.
Described in 1876 by Dr Bernhard Fraenkel as a triad of fetor crusting & atrophy of nasal structures.
- The breath is often so penetrating as to render the near presence of the sufferer not only unpleasant but almost unendurable.
Synonyms: rhinitis sicca, open-nose syndrome, dry rhinitis, Ozaena.
RELEVANT ANATOMY & PHYSIOLOGY
Normal nasal mucosa is made up of pseudostratified columnar epithelium, & has abundant goblet cells, mucous & serous glands. Their secretions form a continuous sheet –mucous blanket (MB).
MB - sf mucous layer, deeper serous layer, floating on top of cilia wch are constantly beating to carry it like a ‘‘conveyer belt’’ toward the nasopharynx.
Speed :5-10mm/min.
Clearance of a complete sheet of mucus into nasopharynx takes 10-20 minutes.
CLASSIFICATION
Primary
Secondary.
Primary AR is the classic form of the dx, & is felt to arise de-novo. In modern societies, it is often a Dg of exclusion, any precipitating factors such as sinus surgery, nasal trauma or radiation are considered exclusions. The “causative” agent in almost all cases of primary AR is Klebsiella ozaenae.
Secondary AR is the most common form of the dx in developed countries. The most common cause is sinus surgery.
AETIOLOGY
PRIMARY AR:
The exact cause is unknown. Various theories have been advanced regarding its causation; based on experimental studies or isolated case studies.
1.Infectious:
S.Sali reported dvpt of AR in 7 children of one family following contact with a known case of AR.
Primary AR is almost always associated with a single organism, Klebsiella ozaenae.
CONCLUSION
A clear understanding of the aetio- pathogenesis of AR is essential for appropriate mgt of the condition.