Nose Treatment

RHINOSCLEROMA

Rhinoscleroma is a progressive granulomatous disease of the nose, extending into the nasopharynx, oropharynx, larynx and rarely the trachea.

Aetiology:
  • Age– It can occur in any age.
  • Sex– Both sexes are equally affected.
  • Race– It can affect people of any race.
  • Socioeconomic status– It affects the patients staying in rural areas, with poor domestic hygiene.
    • Causative Organism:
    • It is caused by the gram negative Frish bacillus, Klebsiella Rhinoscleromatis.
    Pathology:
    • Biopsy shows infiltration of submucosa with plasma cells, lymphocytes, eosinophils, Mikulicz cells and Russell bodies, latter two are diagnostic features of the disease.
    • Mikulicz cells are large foam cells with central nucleus and vacuolated cytoplasm containing causative bacilli.
  • 3 . Russell bodies are homogenous eosinophilic inclusion bodies found in the plasma cells, which occur due to accumulation of immunoglobulins secreted by the plasma cells.
Symptoms:
  • Nasal Blockage.
  • Nasal Discharges.
  • Externally visible woody shape and feel of nose.
Signs:
  • Nose is firm and woody.
  • Anterior Rhinoscopy- Stages
      • 1. Atrophic stage: Foul smelling discharge with changes in the mucous membrane.
      2. Granulation stage: Non ulcerative bluish red, and pale hard rubbery nodules develop.
      3. Cicatrizing stage: Adhesions and stenosis distort the normal anatomy.
Treatment:
  • Medical:
    • Once the diagnosis is confirmed by biopsy, high dosage of antibiotics like tetracycline, chloramphenicol and streptomycin are given for 4-6 weeks.
    • Local application of acriflavine solution over 6-8 weeks. Treatment is stopped only when two consecutive cultures from the biopsy material are negative. Steroids can be combined to reduce fibrosis.
  • Surgical:

    • Surgical treatment can be used to re-establish the airway without any further atrophic changes. CO2 laser debulking is a good option in treating extensive rhinoscleroma, even in the active stage, as it provides rapid relief of nasal blockage and decreases the time needed for medical treatment, reducing the possible side effects of antibiotics. Surgical treatment includes augmentation rhinoplasty. However, if left untreated the disease can lead to sepsis, bleeding, or other chronic conditions that can be fatal.

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