Nasal Infections

Acute coryza:


The common cold is the result of viral infection but secondary bacterial infection may supervene. Its course is self-limiting and no treatment is required other than an antipyretic,such as aspirin.The prolonged use of vasoconstrictor nose drops should be discouraged,owing to their harmful effect on nasal mucosa (rhinitis medicamentosa).


Nasal vestibulitis:


Both children and adults may be carriers of pyogenic staphylococci, which can produce infection of the skin of the nasal vestibule. The site becomes sore and fissured and crusting will occur.Treatment,which needs to be prolonged, consists of topical antibiotic/antiseptic ointment and systemic flucloxacillin.Always take a swab for culture and sensitivity.


Furunculosis:


Abscess in a hair follicle is rare but must be treated seriously as it can lead to cavernous sinus thrombosis.The tip of the nose becomes red, tense and painful.Systemic antibiotics should be given without delay,preferably by in- jection.Drainage may be necessary but should be deferred until the patient has had adequate antibiotic treatment for 24h.In recurrent cases,diabetes must be excluded.


Chronic purulent rhinitis:


Chronic purulent nasal discharge may occur,especially in children.The dis- charge is thick, mucoid and incessant and often resistant to treatment. In such cases,a nasal swab may show the presence of Haemophilus influenzae, which should be treated with a prolonged course of antibiotics (amoxy- cillin,cotrimoxazole). It is necessary to exclude immunological deficiency, cystic fibrosis and
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ciliary abnormality in such cases of chronic rhinitis,as well as more obvious causes,such as enlarged adenoids,foreign body or allergic rhinitis.


Atrophic rhinitis (ozaena):


Fortunately now uncommon inWestern society,this disease is still seen oc- casionally.The nasal mucosa undergoes squamous metaplasia followed by atrophy,and the nose becomes filled with evil-smelling crusts,the stench of which is detectable even at a considerable distance. Such a patient will be ostracized and children will be abused by their peers. The aetiology of atrophic rhinitis is unknown.Various forms of treat- ment have been tried. In the early stages, meticulous attention to sinusitis and nasal hygiene may be helpful. In the more established case, the use of 50% glucose in glycerine as nasal drops seems to reduce the smell and crusting. Various surgical measures have been devised,the most reliable of which is closure of the nostrils,using a circumferential flap of vestibular skin.After a prolonged period of closure,recovery of the nasal mucosa may occur and the nose can be reopened (Young’s operation).