This document discusses ozaena and allergic rhinitis. It defines ozaena as a chronic inflammation of the nose characterized by nasal mucosa atrophy. It describes the primary atrophic and secondary causes. It also discusses the clinical features, investigations, and treatments for allergic rhinitis including antihistamines, corticosteroids, immunotherapy, and the ARIA classification system for intermittent vs persistent and mild vs moderate to severe disease.
2. OZAENA
Chronic inflammation of nose,
characterized by atrophy of nasal mucosa
and turbinate bones.
nasal cavities are roomy ,filled with foul
smelling crusts.
2 types
Primary
Secondary
5. PATHOLOGY
Ciliated columnar epithelium replaced by
stratified squamous type.
Atrophy of seromucinous glands, venous
blood sinusoids and nerve elements.
Arteries in the mucosa, periosteum and
bone show obliterative endarteritis.
Bone of turbinates undergoes resorption
causing widening of nasal chambers.
Paranasal sinuses are small due to
arrested development.
6. CLINICAL FEATURES
MC females
foul smell from the nose
merciful anosmia
nasal obstruction - crust formation.
greenish or greyish black dry crusts
covering the turbinates and septum.
Epistaxis – on removal of crust.
nasal cavities appear roomy
atrophy of turbinates
7. nasal mucosa –pale
septal perforation
dermatitis of nasal vestibule
saddle deformity of nose
atrophic pharyngitis – Pharyngeal mucosa
appear dry and glazed with crusts
atrophic laryngitis – cough, hoarseness of
voice
hearing impairment
X-ray paranasal sinus - opaque
8. TREATMENT
Medical
Nasal irrigation and removal of crusts
25% glucose in glycerine
Local antibiotics
Oestradiol therapy
Placental extract
Systemic use of streptomycin
Potassium iodide
9. Surgical
YOUNG’S OPERATION
• Modified Young’s operation
NARROWING THE NASAL
CAVITIES
• Submucosal injection of teflon paste
• Insertion of fat, cartilage or teflon strips
under the mucoperiosteum of the floor,
lateral wall of nose, mucoperichondrium
of the septum.
• Section and medial displacement of
lateral wall of nose
12. IgE mediated immunologic response of nasal
mucosa to airborne allergens and is characterized
by
Watery nasal discharge
Nasal obstruction
Sneezing
Itching in the nose
2 Types
Seasonal
Perennial
15. PATHOGENESIS
Inhaled allergens IgE blood basophil / mast
cell
Subsequent exposure Ag +IgE
degranulation of mast cells release preformed
& newly formed chemical mediators
vasodilatation, mucosal edema, infiltration of
eosinophils, excessive secretion from nasal
glands, smooth muscle contraction.
16. PRIMING EFFECT - mucosa earlier sensitized to
an allergen will react to smaller doses of
subsequent specific allergen and also get primed
to other nonspecific antigens to which patient was
not exposed cause nonspecific nasal hyper -
reactivity
17. •ALLERGIC RESPONSE- 2 phases
Acute or early
phase
• Within 5–30 min
after exposure
• Sneezing,
rhinorrhoea, nasal
blockage,
bronchospasm
• Due to release of
vasoactive amines
Late or
delayed phase
• 2-8 hour after
exposure
• Swelling, congestion,
thick secretion
• Due to infiltration of
inflammatory cells at
the site of antigen
deposition
18. CLINICAL FEATURES
Seasonal nasal allergy
Paroxysmal sneezing(10-20
sneezes at a time)
Nasal obstruction
Watery nasal discharge
Itching of eyes, palate or pharynx
20. SIGNS OF ALLERGY
Nasal signs
Transverse nasal crease
Pale and edematous nasal mucosa: bluish
Swollen turbinates
Thin, watery or mucoid discharge
Ocular signs
Edema of the lids
Congestion and cobblestone appearance of the
conjunctiva
Dark circles under the eyes(allergic shiners)
21.
22. Otologic signs
Retracted tympanic membrane
Otitis media
Pharyngeal signs
Granular pharyngitis
Laryngeal signs
Hoarseness
Edema of the vocal cords
23. NEW ALLERGIC RHINITIS AND
ITS IMPACT ON ASTHMA (ARIA)
CLASSIFICATION
Duration of disease
INTERMITTENT
(symptoms are
present for)
• Less than 4 days
a week OR
• For less than 4
weeks
PERSISTENT
(symptoms are
present for)
• More than 4
days a week OR
• For more than 4
weeks
24. Severity of disease
MILD: None of the following
symptoms are present
• Sleep disturbances
• Impairment of daily activities, leisure and
sport
• Impairment of school or work
• Troublesome symptoms
MODERATE TO SEVERE
• One or more of the above symptoms are
present
25. INVESTIGATIONS
Total and differential count
Peripheral eosinophilia
Nasal smear
taken at the time of clinically active disease or after
challenge test
shows large number of eosinophils
present in non allergic rhinitis also eg:NARES
Skin test: helps to identify specific allergen
Skin prick test: drop of conc. allergen solution volar
surface of forearm introduce to the dermis central
wheal and surrounding zone of erythema within 10-15 min
+ve test
Specific IgE measurement: in vitro test to find specific
allergen
28. TREATMENT
Avoidance of allergen.
Treatment with drugs
Antihistaminics
Sympathomimetics (oral & topical)
Corticosteroids
Sodium cromoglycate
Anticholinergics
Leukotriene receptor antagonist
Anti IgE
29. Immunotherapy
allergen is given in gradually increasing doses till the
maintenance dose is reached
suppresses IgE formation
raise the titre of specific IgG antibody
subcutaneous, nasal, sublingual routes
30. STEP CARE APPROACH
RECOMMENDED BY ARIA
Mild intermittent disease oral antihistamines,
intranasal cromolyn sodium
Moderate / persistent disease intranasal
corticosteroids
Severe combination therapy (oral nonsedating
antihistamines + intranasal steroids)
Severe and persistent combination therapy + short
course of oral steroids & immunotherapy
Persistent nasal obstruction intranasal
decongestants OR (oral decongestants +
antihistamines)
Avoid allergens and irritants in all forms of disease.