Juvenile nasopharyngeal angiofibroma| aetiology, diagnosis, treatment

Synonyms: dry rhinitis, rhinitis sicca, empty-nose syndrome, or ozaena.

Definition: chronic non-specific rhinitis characterized by progressive atrophy of the nasal mucosa along with the underlying bones of turbinates.

Etiology (Causes):

Primary atrophic rhinitis: (HERNIA)

• Hereditary factors: the disease runs in families.
• Endocrine imbalance: the disease tends to start at puberty and mostly involves females.
  
• Racial factors: whites are more susceptible than natives of equatorial Africa.
• Nutritional deficiency: vitamins A or D, or iron.
• Infection: Klebsiella ozaena.
• Autoimmune factors: viral infection or some other unidentified insult may trigger antigenicity of the nasal mucosa.

Secondary atrophic rhinitis: most frequent type nowadays.

• Specific infections (granulomas) such as syphilis (Treponema), and rhinoscleroma.
• Radiotherapy of the nose
• Complication of surgery of the Turbinates.

Pathology:

• Squamous metaplasia of the epithelium of nasal mucosa.
• Atrophy of mucosa, turbinal bones and seromucinous glands due to obliterative endarteritis.

Incidence: more common in females at the age of puberty.

Symptoms:

• Nasal obstruction despite the roomy nasal cavity, which can be caused either by the obstruction produced by the discharge in the nose, or as a result of sensory loss due to atrophy of nerves in the nose, so the patient is unaware of the air flow.
• Nasal discharge: greenish crusts with foul smelling, though the patients may not be aware of this, because the associated merciful anosmia.
• Epistaxis, may occur when the dried discharge (crusts) are removed.
• Hyposmia.

Signs:

• Atrophic nasal mucosa and turbinates.
• The nasal cavities become roomy and are filled with foul smelling crusts.

Treatment of atrophic rhinitis:

First, treatment of the cause: e.g., nasal granulomas, then:

Medical treatment:

• Nasal irrigation and removal of crusts using alkaline nasal solutions.
• 25% glucose in glycerin can be applied to the nasal mucosa to inhibit the growth of proteolytic organisms which produce foul smell.
• Local antibiotic spray.
• Estradiol spray for regeneration of seromucinous glands.
• Oral potassium iodide for liquefaction of secretion.
• Placental extract injected in the submucosa.
• Iron and vitamin A.

Surgical interventions:

• Aims at narrowing of nasal cavity till the mucosa regenerates.
• Young's operation: Closure of the nasal cavity affected with atrophic rhinitis by creating mucocutaneous flaps (6m-2y). (Obsolete)
• Submucosal augmentation using bone, cartilage, or Teflon paste.

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