rhinitis and its relation with homoeopathic miasms and its treatment

1. RHINITIS
DEPARTMENT OF SURGERY
By d.Gautam

2. contents
• Definition
• Classification
• Clinical features
• Signs
• Investigation
• Complication
• treatment

3. RHINITIS
• It is the inflammation of the nasal mucous
membrane

4. rhinitis
infected
Acute
bacterial viral
chroni
c
specific
Non
specific
Atrophic
rhinitis
Simple
chronic
rhinitis
Hypertroph
ic rhinitis
Rhinitis
sicca
Rhinitis
caseosa
Granuloma
tous rhiitis
Non
infected
allergic
seasonal perinial
vasomoto
r

5. specific
syphilis
leprosy
Tuberculosi
rhinosporidiosis
Rhino
scleroma
Fungal
infection
leishmaniosis

6. Coryza
• It is an acute non specific infective rhinitis.
• Also known as “common cold”.

7. Aetiology
• Causative organism: virus and may be either
influenza virus rhinovirus or adenovirus etc.
• Spread : is by air borne droplet infection or by
direct contact.
• Secondary infection by bacteria may occur
streptococcus staphylococcus pneumococcus
etc.

8. Pathology
• Viral infection of the nasal mucosa
• Acute generalised hyperaemia of the nasal
mucosa
• Engorgement of the secretory gland and
goblet cells
• Profuse secretion involvement of sinus

9. • sinusitis
• Involvement of Eustachian tube opening
• ASOM &SOM

10. CLINICAL FEATURES
• Incubation period:1-3 days
• Four stages
– Ischaemic stage
– Hyperaemic stage
– Stage of secondary inflammation
– Stage of resolution

11. ISCHAEMIC STAGE
• Raw sensation & irritation in the pharynx.
• Irritation & dryness in the nose.
• Sneezing attack.
• Malaise with chills.
•

12. HYPEREMIC STAGE
• Profuse watery rhinorrhea
• Anosmia
• Blocking of nose
• Fever and malaise with chills.
• Congested nasal mucosa
• Headache and otalgia

13. STAGE OF SECONDARY INFECTION
• Nasal discharge becomes thicker and
yellowish and greenish.
• Fever & malaise with chill.
• Headache
• Otalgia
• Congested nasal mucosa

14. COMPLICATION
• Sinusitis
• Acute otitis media.
• Pharyngitis.
• Pneumonia.
• Laryngitis.

15. STAGE OF RESOLUTION
• Resolution of uncomplicated cases occurs
within 6 -10 days.

16. Treatment
• Antibiotics
• Analgesics
• Antipyretics
• Antihistamine
• Vitamin C

17. • Rest and warm
• Give high protein diet
• Nasal decongestants locally
• Steam inhalation

18. CHRONIC SIMPLE RHINITIS
• Aetiology
• Predisposing factors
• Vasomotor rhinitis
• DNS
• Nasal polypi
• Tonsillitis
• Sinusitis
• Smoking and alcoholism

19. Clinical feature
• Rhinorrhoea-mucopurulent
• Headache
• Nasal obstruction
• Anosmia

20. SIGNS
• Hyperemic mucosa with oedema.
• Post nasal drip .
• Thick viscid mucopurulent nasal secreation.
• Pharyngitis.

21. TREATMENT
• Alkaline nasal douching.
• Treat the indisposing factors if present.
• Stop smoking &alcohol.

22. Chronic hypertrophic rhinitis
• Etiology
• Usually it result from recurrent attack from acute
rhinitis.
• Predisposing factors:
• sinusitis
• Pollution
• Dust
• Smoke
• Tonsilitis

23. • Nasal polyp
• Overuse of nasal drops
• Vitamin deficiency

24. CLINICAL FEATURE
• Nasal obstruction
• Rhinorrhoea
• Anosmia
• Dull headache
• Otalgia
• Sore throat due to pharyngitis

25. SIGNS
• Anterior rhinoscopy: Hypertrophy of inferior
nasal turbinates.
• Posterior rhinoscopy:Mullbery like appearance

26. TREATMENT
• Removal or treatment of predisposing factors
• Local nasal decongestants drops
• Antihistamine
• Surgical management for turbinate
hypertrophy
• Partial turbinectomy

27. ATROPHIC RHINITIS
• Synonym:ozeana
• It is a chronic inflammatory disease of the
nasal mucosa which characterised by
progressive atrophy of the mucosa and
turbinates', formation of crust and foul smell
from the nose known as ozaena.

28. CLASSIFICATION
• Unilateral or bilateral
• Primary or secondary

29. AETIOLOGY
• Primary:
• Exact aetiology not known but predisposing
factor include:
• Age : common between 15-40 yrs occurs
usually at puberty.
• Sex : more common in female.
• Heredity
• familial

30. • Environmental
• Nutritional
• Hormonal
• Vitamin a deficiency
• Infection
• Secondary :
• Chronic specific infection
• Extensive surgery
• Chronic sinusitis
• DNS

31. PATHOLOGY
• It is a condition characterised by atrophic
changes in all the nasal tissues.
• Mucosa undergoes atrophy and metaplasia
• Cilia and secretory glands also undergo
atrophy with a resultant pale , dry, thin
mucosa with thick scanty secretion dry to
form crust which may bleed on removal.
• Secondary infection usually results in foul
foetid smelling

32. • Turbinates' undergo atrophy resulting in loss
of anatomical landmarks on the nose and a
roomy nasal cavity.
• Blood vessels undergo periarteritis & endaritis
resulting in ischemia .
• Sensory nerves undergo atrophy and hence
the patients may complain of nasal
obstruction as he does not feels the air
passing through the nose.
• Atrophy of the olfactory nerve ending
resulting in anosmia

33. CLINICAL FEATURE
• Nasal obstruction :
– Crust in nasal cavity
– Atrophy of sensory nerves
• Crusting of nose(ozaena)
• Foul smell of nose
• Anosmia
• Epistaxis
• Headache
• dryness of nose and throat

34. SIGNS
• External nasal examination:
– Bridge of nose may be depressed ( saddle shaped)
• Anterior rhinoscopy
– Nasal cavity is roomy
– Causative factors like DNS
– Mucosa is pale shiny dry and atrophy
– Crust are seen

35. • Posterior rhinoscopy
– Diminished sensation of the mucosa due to the
atrophy of sensory nerve ending

36. COMPLICATION
• Sinusitis
• Middle ear infection
• Atrophic pharyngitis
• Maggots

37. INVESTIGATION
• X-ray of nose/sinus
• VDRL test
• Complete haemogram
• Dermatographical examination
• XRAY chest
• Nasal smear for leprosy and T.B
• Biopsy

38. TREATMENT
• Primary cause should be treated
• Nasal drops:
– 25% glycerine drops
– Chloramphenicol drops
– Streptomycin drops
• Placental extract
• Antibiotics
• Nutritional improvement vitamin A,B,B6
• vasodilators

39. Surgical treatment
• Narrowing of nasal cavity
• Submucosal grafting
• Partial closure
• Cervical sympathectomy

40. Rhinitis caseosa
• synonym;cholesteatoma.
It is a condition characterized by accumulation
of
a caseosa (cheesy) material in the nasal cavity
&maxillary sinus .

41. Aetiology
• The exact etiology is not known.
• Associated with inflammation and granulation
of the lining mucosa.
• There may be erosion of lateral nasal wall

42. Clinical feature
• Nasal obstruction
• Foul smell
• Headache
• Thick viscid rhinorrhoea

43. SIGNS
• Thick cheesy or caseous material
• Foetid odor
• Involvement of maxillary sinus

44. TREATMENT
• Caldwell luc operation

45. RHINITIS SICCA
• It is a disease of nose characterised by drying
and crusting affecting only the anterior
portion of the nasal cavity.

46. Aetiology
• Seen in person working dry hot dusty
environment like rubber factory worker bottle
factory workers.

47. CLINICAL FEATURE
• Crusting
• Drying
• Nasal obstruction
• Irritation
• Epistaxis
• Ulceration
• Septal perforation

48. SIGNS
• Anterior rhinoscopy: dry dark red mucosa
ulceration
• Posterior rhinoscopy: nasal mucosa normal
• No any crust or drying

49. TREATMENT
• Lubrication of nose-vaseline,oil
• Alkaline nasal douching
• Change of environment /job

50. DIPHTHERETIC RHINITIS
• Also known as nasal diptheria.
• It is a form of acute infective rhinitis.

51. Aetiology
• Causative organism: corynebacterium
diphtheria.
• Age :common in children.
• It is of two types
– Primary
– Secondary

52. Primary
• It may affect the nose first without
involvement of other tissues.
Secondary
• It may affect the nose secondary to faucial
diphtheria.

53. CLINICAL FEATURES
• Blood stained watery rhinorrhoea.
• Skin near the nasal vestibule may show
excoriation due to continuous nasal discharge.
• Nasal obstruction
• Greyish white membrane is seen on the
turbinate's or nasal septum, it is difficult to
remove.
• Constitutional symptoms such as fever
malaise etc.

54. Investigation
• Swab culture may show diphtheria bacilli

55. Treatment
• Patient is hospitalised and isolated.
• Antitoxin serum are given after a skin
sensitivity test.
• Penicillin and ampicillin.

56. ALLERGIC RHINITIS
• Allergic rhinitis is a common disorder which is
usually characterized by spasmodic attack of
severe sneezing and rhinorrhea.

57. Aetiology
• Age:all age
• Sex: both sex
• Predisposing factors:
• Hereditary
• Harmonasl
• Climate
• Emotional

58. • Precipatating factor(allergens)
• inhalents
• Ingestants
• Contactants
• Cosmetic powder
• Drugs
• Irritants
• Infection
• Intestinal helmenthis

59. TYPES
• Two types
• Seasonal
• Perinial

60. SYMPTOMS
• Irriritants
• Paroxysmal sneezing
• Rhinorrhoea
• Nasal obstruction
• Anosmia
• Headache

61. SIGNS
• Mucosa
–Acute stage :pale
Chronic stage :bluish purple
– Infection:present
– Polyp :present
– Allergic salute(tip of nose salute like)
– dorrer’s line (crease on dorsum of nose)

62. INVESTIGATION
• Nasal secretion : eosinophilia
• Haemogram
• Stool examination
• History about allergy
• Skin test by intradermal injection
• Inhalation of allergens
• Elimination test for food
• RAST (radio allergosorbant test)

63. TREATMENT
• Avoidance of allergen
• Desensitisation
• Symptomatic:
• antihistamine
• Steroids
• General:
• Vitamin c
• Calcium

64. LOCAL TREATMENT
• Hydrocortison injection
• Zinc ionisation
• Cryosurgery
• Laser therapy

65. SURGICAL
• Nasal obstruction
• Infection
• Vidian neurectomy

66. CORRELATION WITH MIASM
• Rhinitis covers all the three
miasm, psora and syphilis &
sycosis.

67. PSORA
• Psora-functional changes
• Rhinitis covers the psora miasm; psora leads
to functional disturbances; i.e. in rhinitis there
is inflammation of mucus membrane of nose
leading to ischemic conditions and burning,
irritation like symptoms.
• Sensation of dryness in the nose troublesome
even when the air passes freely.

68. • Epistaxis more or less profusely more or less
frequently.
• Ulcerated nostrils
• Nostrils as if it were stuffed up.
• Disagreeble sensation of dryness in the nose.

69. SYPHILIS
• It also covers the syphilis miasm because of
the nasal discharge.
• Loss of smell.
• Snuffle children.
• The bones of the nose are destroyed.
• Syphilis produce ulceration
• The crust of syphilis are dark greenish black or
brown,thick and not always offensive

70. SYCOTIC
• It also covers the sycotic miasm because t
leads to nasal destruction.
• Sense of smell loss.
• Sycotic has a red nose with prominent
cappilaries
• There is often nasal stoppage due thickening
of the membrane ,there is enlarged turbinated
bones.

71. • New babies of sycotic patient often get
snuffles nose dry stuffed up frequently in
Childs.
• Screams with anger in its attempt with
breathe with its mouth closed