Atrophic Rhinitis and Its Causes

Questions and Answers

What would be the expected finding in a transillumination test for a sinus affected by sinusitis?

The affected sinus has increased brightness.

The affected sinus shows normal illumination.

The affected sinus is opaque. (correct)

The affected sinus appears translucent.

Which imaging modality is considered the preferred method to investigate the sinuses?

MRI

X-rays

CT scan (correct)

Ultrasound

What medication should be used for pain relief in sinusitis treatment?

Codeine

Paracetamol (correct)

Ibuprofen

Aspirin

Which drug is specifically indicated for patients who are sensitive to penicillin?

Erythromycin Signup and view all the answers

What is a common symptom of acute frontal sinusitis?

Frontal headache with periodicity Signup and view all the answers

Which nasal decongestant drops are mentioned for use in sinusitis treatment?

Ephedrine Signup and view all the answers

What is the characteristic nature of the headache associated with frontal sinusitis?

Periodic and increasing throughout the day Signup and view all the answers

Which treatment is rarely necessary and is only done if medical treatment has failed?

Antral lavage Signup and view all the answers

What is a common result of adenoid enlargement in children?

Failure to thrive Signup and view all the answers

What symptom is commonly associated with chronic adenoiditis?

Nasal discharge Signup and view all the answers

What facial appearance is characterized by mouth breathing due to chronic nasal obstruction?

Adenoid facies Signup and view all the answers

What is a potential complication of an inflamed adenoid in terms of ear health?

Conductive hearing loss Signup and view all the answers

Which of the following can lead to the development of serous otitis media in children?

Infected adenoids Signup and view all the answers

Which infections are known to cause destruction of nasal structures leading to atrophic changes?

Syphilis and leprosy Signup and view all the answers

What is an effect of chronic nasal obstruction caused by enlarged adenoids?

Reduced efficience in speech articulation Signup and view all the answers

What is a common result of excessive surgical removal of turbinates?

Atrophic rhinitis Signup and view all the answers

Which type of rhinitis simulates nasal allergy but is nonallergic in nature?

Vasomotor rhinitis Signup and view all the answers

What is a clinical feature associated with pulmonary hypertension due to adenoid hypertrophy?

Long-standing nasal obstruction Signup and view all the answers

How can adenoid masses be evaluated in young children?

Nasopharyngoscopy Signup and view all the answers

What triggers the excessive secretion from the nasal glands in vasomotor rhinitis?

Parasympathetic stimulation Signup and view all the answers

What symptom often occurs first thing in the morning for individuals with vasomotor rhinitis?

Paroxysmal sneezing Signup and view all the answers

Which treatment is NOT recommended for vasomotor rhinitis?

Antibiotics Signup and view all the answers

What does sympathetic stimulation do to the nasal mucosa?

Leads to shrinkage and vasoconstriction Signup and view all the answers

What is a common non-specific stimulus that can trigger vasomotor rhinitis?

Sudden temperature changes Signup and view all the answers

What is the main method used for achieving haemostasis after adenoidectomy?

Electrocoagulation under vision Signup and view all the answers

What complication may result from hyperextension of the neck during an adenoidectomy?

Injury to the Eustachian tube opening Signup and view all the answers

Which condition is characterized by neck pain and torticollis following an adenoidectomy?

Grisel Syndrome Signup and view all the answers

Which of the following indicates a potential hemorrhage in the immediate postoperative period?

Vomiting of dark-colored blood Signup and view all the answers

What is a common indicator of ongoing bleeding after an adenoidectomy?

Rising pulse rate Signup and view all the answers

What should be checked for before removing adenoids to prevent velopharyngeal insufficiency?

Submucous cleft palate Signup and view all the answers

What is indicated for persistent bleeding that does not respond to initial measures after an adenoidectomy?

Postnasal pack left for 24 hours Signup and view all the answers

What should be utilized for more precise removal of adenoids during endoscopic adenoidectomy?

Debrider under endoscopic control Signup and view all the answers

What is the main characteristic of nasal polypi?

They are non-neoplastic masses of oedematous mucosa. Signup and view all the answers

Which of the following conditions is associated with nasal polypi?

Chronic Rhinosinusitis Signup and view all the answers

What percentage of asthma patients may show nasal polypi?

70% Signup and view all the answers

Which syndrome consists of nasal polypi, asthma, and aspirin intolerance?

Samter’s Triad Signup and view all the answers

From which location do multiple nasal polypi typically arise?

Lateral wall of nose Signup and view all the answers

What is the primary pathological change occurring in the nasal mucosa that leads to polyp formation?

Collection of extracellular fluid Signup and view all the answers

Which of the following conditions does NOT typically associate with nasal polypi?

Acute Sinusitis Signup and view all the answers

Which of the following best describes nasal mastocytosis?

It involves infiltration of nasal mucosa with mast cells and normal IgE levels. Signup and view all the answers

Study Notes

Secondary Atrophic Rhinitis

Caused by specific infections like syphilis, lupus, leprosy, and rhinoscleroma, leading to nasal structure destruction and atrophic changes.
Long-standing purulent sinusitis, radiotherapy to the nose, or excessive surgical removal of turbinates can also result in atrophic rhinitis.
Unilateral atrophic rhinitis may occur due to extreme deviation of the nasal septum, particularly on the wider side.

Vasomotor Rhinitis (VMR)

Nonallergic rhinitis that mimics nasal allergies with symptoms including nasal obstruction, rhinorrhea, and sneezing.
Pathogenesis involves rich blood supply in nasal mucosa; sympathetic stimulation causes vasoconstriction, while parasympathetic stimulation leads to vasodilation.
Overactive parasympathetic systems cause excessive secretion from nasal glands; autonomic nervous system instability due to emotional influences.
Symptoms include paroxysmal sneezing, excessive watery rhinorrhea, nasal obstruction, and postnasal drip.
Signs displayed in nasal mucosa include congestion and hypertrophy.

Treatment for Vasomotor Rhinitis

Medical: Antihistamines and oral decongestants relieve obstruction, sneezing, and rhinorrhea; topical steroids like Beclomethasone effectively control symptoms; systemic steroids for severe cases; tranquilizers may be needed.
Surgical: Reduction of nasal turbinates to relieve obstruction; potential evaluation through anterior rhinoscopy or nasal endoscopy.

Diagnosis of Sinus Diseases

Transillumination tests reveal opacity in affected sinuses; X-rays (Waters’ view) show opacity or fluid levels; CT scans are preferred for sinus investigation.

Treatment for Sinusitis

Medical: Antimicrobials like Ampicillin and Amoxicillin apply to a broad range of organisms; alternatives include Erythromycin or Doxycycline for penicillin-allergic patients.
Nasal decongestants, steam inhalation, and analgesics (Paracetamol) are also utilized.
Surgical: Antral lavage is rare but may be required if medical treatment fails.

Acute Frontal Sinusitis Characteristics

Symptoms include frontal headaches with periodicity, tenderness over the frontal sinus, upper eyelid edema, photophobia, and distinctive nasal discharge.
Diagnostic imaging includes X-rays showing sinus opacity or fluid levels and CT scans as the preferred modality.

Adenoid Hypertrophy in Children

Associated symptoms include nasal discharge leading to a wet bubbly nose, chronic maxillary sinusitis, and potential for epistaxis.
Adenoid facies results from chronic nasal obstruction, characterized by elongated face, open mouth, and pinched nose appearance.
Diagnosis can involve visual examination of the postnasal space, rigid or flexible nasopharyngoscope for detail inspection.

Treatment and Complications of Adenoidectomies

Endoscopic adenoidectomy enables more precise removal with immediate postoperative care similar to tonsillectomy.
Complications may include hemorrhage, injury to the Eustachian tube, pharyngeal musculature, Grisel syndrome (neck pain and torticollis), insufficiency of the velopharyngeal closure, nasopharyngeal stenosis, and recurrence due to regrowth of adenoid tissue.

Nasal Polyps

Non-neoplastic masses predominantly seen in bilateral ethmoidal and antrochoanal forms.
Etiologies include chronic rhinosinusitis, asthma, aspirin intolerance (Samter’s triad), cystic fibrosis, allergic fungal sinusitis, and several syndromes such as Kartagener Syndrome and Churg–Strauss Syndrome.
Pathogenesis involves inflammation leading to oedematous changes in the nasal mucosa, with polyps primarily arising from the lateral nasal wall, particularly in the middle meatus.

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Description

This quiz explores the various causes of secondary atrophic rhinitis, including specific infections such as syphilis and lupus, as well as factors like long-standing sinusitis and surgical interventions. Understand how these conditions lead to destruction of nasal structures and atrophic changes. Test your knowledge on this medical condition and its implications.