--- title: "Rhinoscleroma" description: "An overview of Rhinoscleroma, covering its etiology, pathogenesis, pathology, stages, diagnosis, management, and complications." source: "The ENT Resident" author: "Dr. Mausumi Das" canonical_url: "https://www.theentresident.com/ent-notes-lectures/rhinoscleroma" categories: ["Rhinology"] video: "https://www.youtube.com/watch?v=wiYJIK7QEPk" image: "https://media.theentresident.com/og-images/rhinoscleroma.png" --- # Rhinoscleroma An overview of Rhinoscleroma, covering its etiology, pathogenesis, pathology, stages, diagnosis, management, and complications. Watch the full video lecture on YouTube: https://www.youtube.com/watch?v=wiYJIK7QEPk ## Rhinoscleroma : Chronic Granulomatous Disease of Nose ### 🌬 What is Rhinoscleroma? Rhinoscleroma is a **chronic, progressive granulomatous disease** typically starting in the nose and spreading to other parts of the respiratory tract. --- ### 🦠 Causative Agent of Rhinoscleroma: It is caused by a **Gram-negative encapsulated bacillus** called **Klebsiella rhinoscleromatis**. >What is another name of Klebsiella rhinoscleromatis? --- ### 🌍 Epidemiology of Rhinoscleroma: - Named by **Von Hebra**, giving rise to the term "Hebra nose" for a characteristic appearance. - Common in parts of Eastern Europe, Africa, and Latin America. - In India, it is more common in the **northern states of India** compared to the southern states. >Which disease of nose is common in Southern states of India? - Occurs at **any age**, but most common in the **2nd to 3rd decade** of life. - Slight **female preponderance**. - Often associated with **lower socioeconomic status**, poor nutrition, and poor hygiene. --- ### 🔬 Pathogenesis of Rhinoscleroma: - Exact mode of infection is unclear, but suspected to be **airborne** (inhalation of droplets or contaminated material). - Patients are usually **immunologically normal**. --- ### 🦠 Pathology of Rhinoscleroma Pathological findings can be described grossly and microscopically. #### **Gross Features:** - Involved tissues become indurated, resulting in a characteristic **hard, "woody" feel** on palpation (also known as a **"woody nose"**). >What is the first site affected in Rhinoscleroma? >Why is Rhinoscleroma also called as **Scleroma Respiratorium**? #### **Microscopic Features (Histology):** Histological examination is diagnostic and reveals two key features: 1. Mikulicz Cells 2. Russell Bodies Other microscopic features include dense infiltration of the submucosa by plasma cells, lymphocytes, and eosinophils. >What are Mikulicz cells and Russell Bodies? --- ### 🦠 Microbiology of Rhinoscleroma: - Klebsiella rhinoscleromatis is a Gram-negative, encapsulated, non-motile **diplobacillus**. - Microbiological diagnosis can be made by finding a **positive culture** on **MacConkey Agar**. --- ### 🚶 Clinical Features (Stages) of Rhinoscleroma Rhinoscleroma is a progressive disease typically described in four stages: 1. Prodromal or Catarrhal Stage 2. Atrophic Stage 3. Granulomatous (Hypertrophic) Stage 4. Fibrotic (Cicatricial) Stage >What are the characteristic symptoms and signs of each stage of Rhinoscleroma? --- ### 🔬 Investigations of Rhinoscleroma - **Clinical Presentation:** The classical appearance (especially in the granulomatous stage with woody feel and Hebra nose) is highly suggestive. - **Biopsy & Histopathology:** The **definitive diagnostic method**. Biopsy of the nasal lesion confirms the diagnosis by identifying **Mikulicz cells** and **Russell bodies**. - **Diagnostic Nasal Endoscopy:** To visualize the extent of the disease and involved structures. - **Imaging (X-ray, CT Scan)** >What are the Radiological findings of Rhinoscleroma? - **Microbiological Culture:** Culture of nasal discharge or biopsy material on MacConkey agar to isolate K. rhinoscleromatis. --- ### 🏥 Management of Rhinoscleroma Management involves medical treatment to eradicate the bacteria and surgical intervention to address obstruction and deformities. #### **Medical Treatment:** - **Antibiotics:** The cornerstone of treatment. - Tetracycline **(Drug of choice)** - Streptomycin - Other options: Ciprofloxacin, Rifampicin. >What is the dose and duration of treatment of Tetracycline and Streptomycin? >What is the Criterion for stopping Antibiotics? - **Steroids** >What is the role of Steroids in the treatment of Rhinoscleroma? - **Radiotherapy** >What is the dose of Radiotherapy used in Rhinoscleroma? >What is the indication of Radiotherapy in Rhinoscleroma? #### **Surgical Treatment:** Aimed at removing granulation tissue, improving airway obstruction, and correcting deformities. - Removal of granulomatous tissue with cautery or laser. - **Dilation of strictures** in the fibrotic stage (e.g., subglottic stenosis). Placement of polythene tubes or spacers to maintain airway patency. - **Plastic surgery:** Considered in the late cicatricial stage for cosmetic correction of deformities (Hebra nose, Tapir nose), only after confirming the disease is inactive (e.g., three consecutive negative biopsies). --- ### 💊 Complications of Rhinoscleroma - External nose deformity - Vestibular stenosis - Strictures of soft palate, pharynx, larynx, trachea, bronchi - Nasal regurgitation - Anosmia - Otitis Media with Effusion - Malignant changes >What are some external nose deformities seen in Rhinoscleroma? --- ## 🤔 Differential Diagnosis of Rhinoscleroma Consider the following conditions that can present with nasal/respiratory granulomas or similar features: - Other **Chronic Granulomatous Diseases** involving the nose: - Tuberculosis - Leprosy - Lupus vulgaris - Syphilis (Gumma) - Rhinosporidiosis (friable, red, strawberry-like mass with sporangia) - Wegener's Granulomatosis (destructive) - Sarcoidosis (strawberry skin appearance) - Leishmaniasis - Eosinophilic Granuloma - Stewart's Granuloma (Midline Destructive Granuloma) - **Atrophic Rhinitis:** Can resemble the atrophic stage of Rhinoscleroma (wide nasal cavities, crusts, atrophy), but lacks the characteristic induration, nodules, Mikulicz cells, and Russell bodies. - **Benign and Malignant Tumors** presenting as nasal masses. --- ## About This Note This free ENT note on Rhinoscleroma was written by Dr. Mausumi Das and is paired with a corresponding video lecture. Canonical page of this note: https://www.theentresident.com/ent-notes-lectures/rhinoscleroma When citing or referencing this content, please credit The ENT Resident and link to the canonical page above. ## Related Notes by Category - Rhinology: https://www.theentresident.com/ent-notes-lectures/category/rhinology.md ## About The ENT Resident The ENT Resident is an educational website and resource library created by Dr. Mausumi Das (MS ENT) for ENT residents, ENT postgraduates preparing for exams, and MBBS students. Dr. Mausumi Das writes the notes, draws the diagrams, and records the lectures herself. Browse all ENT notes and lectures on The ENT Resident: https://www.theentresident.com/ent-notes-lectures.md ## Medical-use Boundary The ENT Resident provides educational material for medical learning and revision. It does not provide patient-specific medical advice, diagnosis, or emergency care, and it is not a substitute for evaluation by a qualified healthcare professional. ## More Resources - Learn about the Premium ENT Notes, preview a complete sample, and find purchase options: https://www.theentresident.com/premium.md - Premium note for this topic, Rhinoscleroma: https://theentresident.gumroad.com/l/czrfw - Read student testimonials: https://www.theentresident.com/testimonials.md - Contact The ENT Resident: https://www.theentresident.com/contact.md --- A complete index of all pages on this site, with descriptions and markdown links can be found here: https://www.theentresident.com/llms.txt