Atrophic Rhinitis
ENT তে Written এবং Viva তে খুবই কমনলি ধরা হয় এটা। চলুন একটু গ্যাঞ্জাম করা যাক।
Atrophic rhinitis (AR) is a chronic condition characterized by progressive atrophy of the nasal mucosa and underlying bone, leading to a foul-smelling nasal discharge and nasal crusting.
2 Types হইতে পারে
– Primary (idiopathic) atrophic rhinitis
– Secondary atrophic rhinitis ( due to various underlying conditions)
Etiology
Primary Atrophic Rhinitis (Idiopathic)
Unknown cause, but factors like hereditary predisposition, endocrine imbalance, and nutritional deficiencies have been suggested.
Associated with infection by Klebsiella ozaenae (Important)
Secondary Atrophic Rhinitis
Infections: Tuberculosis, leprosy, syphilis
Surgical causes: Excessive nasal surgery (e.g., turbinectomy)
Radiation exposure
Endocrine Cause
Chronic granulomatous diseases
Pathophysiology
1. Mucosal Atrophy → Loss of ciliated epithelium → Accumulation of thick, foul-smelling crusts.
2. Osteitis & Bone Resorption → Widening of nasal cavities (paradoxical nasal obstruction).
3. Vascular Changes → Decreased blood supply to nasal mucosa.
Clinical Features
Symptoms কি কি পাইতে পারি
Foul-smelling nasal discharge (ozaena)
Crusting inside the nasal cavity
Nasal obstruction (despite a roomy nasal cavity)
Epistaxis (bleeding from the crusts)
Anosmia (loss of smell) এইটাকে বলা হয় Merciful Anosmia কারণ এত মারাত্মক দুর্গন্ধ হয় এইটায় কিন্তু রুগী কোন গন্ধ পায়না।রুগী গন্ধ পাইলে বিনাশ হয়ে যাইতো।
Headache & nasal discomfort
Sign কি কি পাবো
Roomy nasal cavities due to mucosal and bony atrophy
Thick greenish or yellowish crusts গুরুত্বপূর্ণ
Crusting over turbinates (which appear small and atrophic)
Absent or reduced nasal secretions
Investigations কি কি করবো?
1.X-ray PNS
2.CTreatment
3. Nasal Swab
4. Nasal Biopsy
Treatment কিভাবে করবো?
Medical Management
1. Nasal irrigation with alkaline solutions: Removes crusts.
( Sodium Bicarbonate এবং Sodium Biburate 1:1 মিশ্রণ করে Higginson Syringe দিয়ে কাম সাড়বো)
2. 25% Glucose in Glycerin মারতে পারি
3. KI দিয়ে Painting করতে পারি
4. Antibiotics
5. Placental Extracts Injection if Endocrine Cause
6. Vitamin A & D supplements: Help in mucosal regeneration.
Surgical Treatment
Young’s operation: Closure of nasal cavities to reduce crust formation ( Complete Close করে দেই 6 month এর জন্য)
Modified Young’s Operation – nasal closure procedures Reduce nasal space and improve humidity ( Partial Close করি 1-2 years এর জন্য)
Raiyyan Tahsan Date:-3-3-2025 Monday Time:-11-16-37 Pm
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