Secondary Atrophic Rhinitis Research Articles

Tissue specific stem cell therapy for airway regeneration.

Secondary atrophic rhinitis (AR), a consequence of mucosal damage during nasal surgeries, significantly impairs patient quality of life. The lack of effective, lasting treatments underscores the need for alternative therapeutic strategies. A major impediment in advancing research is the scarcity of studies focused on secondary AR. Our study addresses this gap by developing an animal model that closely mirrors the histopathological changes observed in patients with secondary AR. These changes include squamous metaplasia, goblet cell hyperplasia, submucosal fibrosis, and glandular atrophy. Upon administering human nasal turbinate stem cells embedded in collagen type I hydrogel in these models, we observed ciliary regeneration. This finding suggests the potential therapeutic benefit of this approach. Our animal models not only emulate the clinical manifestations of secondary AR but also serve as valuable tools for evaluating the efficacy of cell-based biotechnological interventions.

Remodeling and Reverse Repositioning of the Septal Cartilage in Cases of Secondary Atrophic Rhinitis Due to Deviated Nasal Septum

Background: Atrophic Rhinitis is sometimes referred to as coryza foetida is a chronic disease of the nose which is characterized by progressive atrophy of the nasal mucosa and underlying bone of the turbinates and the presence of a viscid secretion which emits a characteristic foul odor sometimes called ozaena (a stench). A special condition of secondary atrophic rhinitis is gross deviation of nasal septum which causes excessive airflow on the opposite side of the deviation resulting in unilateral Atrophic Rhinitis is being discussed in the present study. Method: In the present study a new method of treatment was used in which the removed cartilage after doing mucosal resection operation of the nasal septum was remodeled and repositioned in the nose. Results: The standard line of therapy in such cases is to do the Sub mucosal resection operation of the nasal septum and follow up the patients with standard postoperative medical therapy of Atrophic Rhinitis. The postoperative rehabilitation time is significantly large (more than a year) which is sometimes not possible due to compliance and the disease persists even after surgery. We remodeled and placed the cartilage back in the septum in reverse position (convexity to opposite side) and found good results in recovery of regeneration of the mucosa. Conclusion: Removal of the septal cartilage after doing mucosal resection operation of the nasal septum, remodeling and repositioned in the nose improves results of the operation and helps in recovery of secondary Atrophic Rhinitis faster than if not done so.

Incidence of secondary atrophic rhinitis following endoscopic sinonasal tumour surgery: a retrospective review

Incidence of secondary atrophic rhinitis following endoscopic sinonasal tumour surgery: a retrospective review

Computational Fluid Dynamics (CFD) Investigation of Aerodynamic Characters inside Nasal Cavity towards Surgical Treatments for Secondary Atrophic Rhinitis

Purpose. To use computational fluid dynamics (CFD) technology to fundamentally understand (1) the effect of surgical treatments on nasal physiology for secondary atrophic rhinitis and (2) the priority of operations. Subjects and Methods: With the aid of medical imaging and CFD modeling, three virtual operations (nasoseptal perforation repair, cavity narrowing, and a combination of both) were performed to analyze airflow, nasal resistance, and wall shear stress. Results. Compared with the cavity‐narrowing virtual operation, nasal resistance was not significantly altered by septal perforation repair virtual operation. Airflow allocation changed with more air flowing through the olfactory area and less though the nasal floor after all operations, especially the cavity‐narrowing operation. Wall shear stress at the original epistaxis area and the nasal floor was reduced after the cavity‐narrowing operation. Conclusions. Simulation results suggest that the cavity‐narrowing operation takes priority over septal perforation repair if a staged surgery approach is adopted. If only one operation can be chosen, the cavity‐narrowing operation is better than the septal perforation repair. This work shows that CFD‐based modeling may aid precision medicine.

Primary and secondary atrophic rhinitis: a microbiological and histopathological study

<p class="abstract"><strong>Background:</strong> Atrophic rhinitis is a distressing chronic nasal pathology characterized by progressive nasal mucosal atrophy, formation of thick crusts and a distinct foul odor. The etiology of this condition is still controvertible. The present study was undertaken to evaluate the microbiological flora and histopathological changes in primary and secondary atrophic rhinitis patients.</p><p class="abstract"><strong>Methods:</strong> A total 50 atrophic rhinitis patients (15 males & 35 females) were considered, all patients were undergone for complete haemogram, microbiological examination of nasal pus and histopathological examination for biopsied material. </p><p class="abstract"><strong>Results:</strong> A total 82% patients were shown primary atrophic rhinitis and 18% cases were secondary atrophic rhinitis. <em>Pseudomonas aeruginosa</em> was commonly isolated bacteria in 72%, followed by <em>Staphylococcus aureus</em> (12%) and other bacteria were <em>E. coli</em> (8%) and <em>Proteus mirabilus</em> (6%) and sterile swab in 2% cases. Squamous metaplasia was found in 78% cases, while transitional metaplasia in 16% cases. The incidence of dilated blood vessels, endarteritis, and periarteritis in lamina propria is 44%, 30% and 16% respectively.</p><p><strong>Conclusions:</strong> <em>Pseudomonas<strong> </strong>aeruginosa</em> was most commonly isolated bacteria. The most important pathological change is squamous cell metaplasia in atrophic rhinitis patients.</p>

Clinical profile of patients with atrophic rhinitis: descriptive study

<p class="abstract"><strong>Background:</strong> Atrophic rhinitis is a chronic nasal disease, characterized by a triad of symptoms, namely foul odour, atrophy of nasal mucosa and crusts formation. The understanding of the pathophysiology and the management of atrophic rhinitis has long been a vexing problem for the treating clinician<span lang="EN-IN">. Hence some authors have recommended adopting a capsular dissection technique in order to avoid these complications. </span></p><p class="abstract"><strong>Methods:</strong> This present study was conducted in the Department of E.N.T, in which all the cases diagnosed as primary atrophic rhinitis and who were willing to undergo this surgery during the study period were taken for the study. Totally 20 patients were included for the study. Patients with secondary atrophic rhinitis were excluded<span lang="EN-IN">. </span></p><p class="abstract"><strong>Results:</strong> In our study foul smelling nasal discharge and falling of crusts were the most commonest presenting symptoms which were present in all 20 patients (100%). The other presenting complaints were loss of sense of smell in 19 patients (95%), nasal obstruction in 16 patients (80%), bleeding from nose in 9 patients (45%), headache in 9 patients (45%) and maggots in 2 patients (10%)<span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> The incidence of atrophic rhinitis is more in low, less in middle and nil in high socio economic status group of patients and smelling nasal discharge and falling of crusts were the most commonest presenting symptoms<span lang="EN-IN">.</span></p>

A study of Prevalence of primary and secondary atrophic rhinitis at tertiary health care centre

A study of Prevalence of primary and secondary atrophic rhinitis at tertiary health care centre

Surgery of the turbinates and "empty nose" syndrome.

Surgical therapy of the inferior and/or middle turbinate is indicated when conservative treatment options have failed. The desired goal is a reduction of the soft tissue volume of the turbinates regarding the individual anatomic findings, whilst simultaneously conserving as much mucosa as possible. As the turbinates serve as a functional entity within the nose, they ensure climatisation, humidification and cleaning of the inhaled air. Thus free nasal breathing means a decent quality of life, as well.Regarding the multitude of different surgical techniques, we confirm that no ideal standard technique for turbinate reduction has been developed so far. Moreover, there is a lack of prospective and comparable long-term studies, which makes it difficult to recommend evidence-based surgical techniques. However, the anterior turbinoplasty seems to fulfil the preconditions of limited tissue reduction and mucosa-preservation, and therefore it is the method of choice today.Radical resection of the turbinates may lead to severe functional disturbances developing a secondary atrophic rhinitis. The “empty nose” syndrome is a specific entity within the secondary atrophic rhinitis where intranasal changes in airflow result in disturbed climatisation and also interfere with pulmonary function. Results deriving from an actual in vivo study of climatisation and airflow in “empty nose” patients are presented.

Atrophic rhinosinusitis: progress toward explanation of an unsolved medical mystery

Atrophic rhinosinusitis is a chronic condition associated with considerable morbidity and decreased quality of life. This review describes progress in the characterization of primary and secondary atrophic rhinosinusitis and the development of diagnostic criteria for both syndromes. Primary atrophic rhinitis usually develops as a consequence of an acute febrile illness in members of lower socioeconomic groups in developing areas of the world. The clinical setting and presence of culturable Klebsialla ozenae in the purulent, foul-smelling, nasal discharge of these patients forms the basis for diagnosis. An animal model for the disease exists in swine in which case an effective vaccine has been developed. Secondary atrophic rhinosinusitis is a condition that follows destruction of the nasal mucosa by any of a number of inflammatory processes including inflammatory diseases nasal/sinus surgery, and antiangiogenic therapy. Diagnostic criteria include patient reported recurrent epistaxis or episodic anosmia; or physician documented nasal purulence, nasal crusting, chronic inflammatory disease involving the upper airway (e.g. sarcoidosis, Wegener's granulomatosis, etc.) or two or more sinus surgeries. Patients with two more of these have secondary atrophic rhinitis with a sensitivity of 0.95 and a specificity of 0.77. Atrophic rhinosinusitis results from destruction of the normal respiratory epithelium and transition to a nonciliated squamous epithelium, loss of mucociliary clearance, accumulation of stagnant mucous. That milieu facilitates acute and chronic infection (wet phase), and eventual sclerosis with epistaxis and chronic bloody crusts (dry phase).

Endoscopic Views of Choanal Stenosis in Secondary Atrophic Rhinitis

Endoscopic Views of Choanal Stenosis in Secondary Atrophic Rhinitis

A simplified technique for treatment of atrophic and hypotrophic rhinitis

Although primary atrophic rhinitis is a rare disease in this country, atrophic rhinitis secondary to surgical removal of all or major portions of the inferior turbinate is extremely common. The morbidity of excessively reduced inferior turbinates may not be evident for many years after surgery. The true incidence of secondary atrophic rhinitis has never been studied, but is clearly increasing. This trend is likely to continue as the frequency of turbinate-reduction procedures increases. Ten patients with primary or secondary atrophic rhinitis were treated surgically with a submucosal dermal graft (Alloderm, Lifecell, Branchburg, NJ) implanted into the remaining inferior turbinate or to the lateral nasal wall when no inferior turbinate was present. Subsequent augmentation was accomplished with micronized acellular dermal graft (Cymetra, Lifecell, Branchburg, NJ) injected on an outpatient basis. Results were clearly different for those patients (seven) who had remaining turbinate and those (three) who had no residual turbinate. Five of the seven patients who had augmentation of residual turbinate had objective evidence of an enlarged inferior turbinate and subjective improvement in their symptoms. The three patients who underwent dermal augmentation of their lateral nasal wall had no improvement in symptoms. This is a pilot study on a small number of patients to assess the feasibility of using Alloderm to augment an excessively reduced inferior turbinate. The surgical technique is relatively simple and the donor material is readily available. Morbidity is minimal and results are good if residual turbinate is present.

Atrophic Rhinitis: A Review of 242 Cases

Atrophic rhinitis is a debilitating nasal mucosal disease of unknown etiology. It is characterized by progressive nasal mucosal atrophy, nasal crusting, fetor, and enlargement of the nasal space with paradoxical nasal congestion. Primary atrophic rhinitis has decreased markedly in incidence in the last century. This probably relates to the increased use of antibiotics for chronic nasal infection. Secondary atrophic rhinitis resulting from trauma, surgery granulomatous diseases, infection, and radiation exposure accounts for the majority of cases encountered by the rhinologist today. Excessive turbinate surgery has been both acquitted and accused in the literature as an etiology for secondary atrophic rhinitis. We saw 242 patients with the diagnosis of atrophic rhinitis between 1982 and 1999. The diagnosis was confirmed by physical examination, biopsy, and imaging studies. Patients were diagnosed with primary atrophic rhinitis if their condition developed in a previously healthy nose and secondary atrophic rhinitis if their condition developed after sinonasal surgery, trauma, or chronic granulomatous disease. Prevention and treatment of the disease is discussed.

Triosite implants and fibrin glue in the treatment of atrophic rhinitis: technique and results.

Nine patients with primary or secondary atrophic rhinitis were treated by narrowing of the nasal fossae using a new surgical technique (derived from the Eryes procedure) in which a Triosite and fibrin glue mixture is implanted via the labial vestibule route. The results were good or excellent in seven patients. No rejections occurred. Osseocoalescence, as evaluated by computed axial tomography at 6 months, was good. Inspiratory intrasnasal pain in patients with postsurgical atrophic rhinitis improved following the operation. The surgical technique, which is quick and easy to perform, avoids the discomfort of nostril closure or the implantation of grafts from other parts of the body. Complicated flap procedures are also avoided.

RATIONALE OF ESTROGEN THERAPY OF PRIMARY ATROPHIC RHINITIS (OZENA) RELATIONSHIP OF THE PHARYNGEAL PITUITARY TO OZENA

The establishment of the differential diagnosis of ozena as primary atrophic rhinitis of vascular origin and secondary atrophic rhinitis of infective source and the presentation of a definite pathologic picture for each condition have made possible a scientific approach to the therapy. At the Third International Rhinolaryngological Congress, held in Madrid in 1932, I had the privilege of demonstrating a series of pathologic photomicrographs on the basis of which the heterogeneous group of conditions characterized by shrinkage of the expansile tissues of the nose, with increase in the nasal space, associated with fetid crusts, and commonly called synonymously atrophic rhinitis and ozena, could be separated pathologically into two subtypes. One of these (atrophic rhinitis, or secondary atrophic rhinitis) presented the pathologic picture of inflammatory reaction to infection that had invaded the tunica propria of the mucosa; the other, ozena, or primary atrophic rhinitis, was due to changes in the blood