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    Atrophic rhinitis is a debiliting nasal mucosal disease & a chronic inflammatory condition of nose associated with progressive atrophy of the nasal mucosa, characterized by greenish yellow crust formation, roominess of nasal cavity with characteristic feature of paradoxical nasal congestion.

PRIMARY ATROPHIC RHINITIS:

1.       HEREDITORY FACTORS.

2.       ENDOCRINAL DISTURBANCE- More in females. Starts at puberty.

3.       RACIAL FACTORS: More in white & yellow.

4.       NUTRITIONAL DEFICIENCY: Vit. A, D & Iron deficiency.

5.       INFECTIVE: KLEBSIELLA: Ozaena, Diptherioids, Proteus vulgaris, E. coli, Staphylococci, Streptococci.

6.       AUTOIMMUNE PROCESS: Destructive process to the antigen released from nasal mucosa.

7.       SURFACTANT DEFICIENCY: Significant change in phosphor lipid profile in nasal aspirate.

SECONDARY ATROPHIC RHINITIS:

1.       Trauma- DNS (unilateral).

2.       Surgery.

3.       Granulomatous disease- TB, Leprosy, Syphilis.

4.       Infection- Chronic sinusitis, Rhinoscleroma, Wegner’s Granulomatosis.

5.       Radiation exposure.

PATHOLOGY:

1.       Squamous metaplasia.

2.       Atrophy of the glands & nerves.

3.       Dilated capillaries (Type-2) / Endarteritis & periarteritis (Type-1)

                                                         

                            ↑ Alkaline phosphate activity

                                                         

       Bone resorption & roominess of nasal cavity & crusting.

CLINICAL FEATURES:

1.       Offensive smell (ozaena) [Merciful anosmia]

2.       Anosmia/ hyponosmia- Due to atrophy of olfactory receptor.

3.       Nasal obstruction- Due to the crusts through the nasal cavities are roomy.

4.       Discharge of greenish yellow thick crust.

5.       Epistaxis- Due to dislodgement of crust.

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