Abstract

A CASE OF SECONDARY ATROPHIC RHINITIS WITH HANSEN???S DISEASE

Author(s): Nowsheen Hamdani, M. Vijaya Kumar

Atrophic rhinitis is an uncommon disorder in modern societies and its incidence varies from 0.3-7.8% of the population.1 It can be classified as primary atrophic rhinitis which arises de novo or secondary atrophic rhinitis which may occur as a sequela of granulomatous diseases such as leprosy, syphilis, etc., comprises only 1% of the cases.2 Thus such cases are of clinical importance and rarity. Atrophic rhinitis (AR) is a debilitating chronic nasal mucosal disease of unknown aetiology. The condition is characterized by progressive nasal mucosal atrophy, progressive atrophy of the underlying bone of the turbinates, abnormal widening (roomy) / patency of the nasal cavities (with paradoxical congestion) and viscid secretions and dried crusts leading to a characteristic fetor (ozaena).3,4,5 On the basis of causes AR can be classified as; Primary Atrophic rhinitis which has decreased markedly in incidence (0.3-1%) and the aetiology is unknown2,3,6 and secondary atrophic rhinitis is mostly common in developed countries. The most common cause is sinus surgery, it alone comprises of 90% of secondary atrophic rhinitis, common procedures include partial and total turbinectomy (80%), without turbinectomy (10%) and partial maxillectomy (10%), followed by radiation (2.5%), trauma (1%) and granulomatous or infectious diseases (1%).2,7 The malady of “empty nose syndrome is associated with extensive turbinate surgeries causing secondary Atrophic Rhinitis”.8 Little is known about this secondary form and it remains incompletely characterized. It has occurred in association with chronic granulomatous diseases of the nose including leprosy, sarcoidosis, rhinoscleroma, Wegener’s granulomatosis and infectious diseases like TB and syphilis. The onset after treatment with antiangiogenic drug underlines the role of the microvasculature in the pathogenesis.2,9 While these causes were once common, now only comprise of 1-2% cases, thus rare.2 Secondary atrophic rhinitis is typically seen in older population.