• It is a slow growing tumor due to hypertrophy of sebaceous glands of tip of nose.
• Rhinophyma  (an advanced type of rosacea) is characterized by an enlarged, bulbous, and red nose resulting from enlargement of the oil-producing glands beneath the surface of the skin on the nose.
• Often seen in long standing cases of Acne Rosacea. Rosacea is a chronic disease that affects the skin. The disease is characterized by redness, pimples, and, in advanced stages, thickened skin. When rosacea reaches this advanced stage, rhinophyma may develop.
  • Bulb-like shape of nose
  • Many oil glands, reddish color
  • Thickening of the skin

Symptoms and sign:

Presents as pink lobulated mass over the nose with superficial vascular dilation.Mostly affects men past middle age. The condition is more common in men than women.Patients seek advice due to unsightly appearance of the tumor, obstruction in breathing and vision due to large  size of the tumor.

Treatment:

Depending on the severity of rhinophyma, doctors may begin treatment with topical or oral rosacea treatment.

1. Paring down of the bulk of tumor with sharp knife or carbon dioxide laser and the area is allowed to re-epithelialize.
2. Excision and skin grafting.
3. Electrosurgery
4. Dermabrasion
5. Resculpturing

Prognosis- Rhinophyma can be corrected with surgery, but the condition may recur.

Rhinophyma is a big Cosmetic Issue. So treatment of this tumor is more important cosmetically than medically.

Source: Dhingra’s ENT, Lecture notes, Dermatology encyclopedia.

Maggots in the nose

• Myiasis narium
• Maggots in nose
• Larvae in nose

Myiasis is the infestation of tissue with fly larvae, commonly referred to as maggots. Maggots infest nose, nasopharynx and paranasal sinuses causing extensive destruction and obvious deformity.

Etiology or Cause:
Flies especially of genus Chrysomyia – Chrysomia bezianna(other common species are Lucilia hominivora or Sacrophaga Georginia) are attracted by the foul smelling discharge emanating from case of atrophic rhinitis, syphilis, leprosy or infected wounds and lay eggs about 200 at a time, which within 24 hours hatch into larvae.

The predisposing factors for Nasal Myiasis are:

• Poor nourishment with poor hygiene
• Atrophic rhinitis
• Leprosy in the nose
• Diabetes with purulent sinus infections
• Midline granulomatous lesions involving the nose
• Malignancy involving the nose
• Syphilitic disease involving the nose

Clinical features (Signs and Symptoms):

1st 3-4 days:

• intense irritation, sneezing, lacrimation
• headache
• blood-stained discharge from nostrils
• puffy eyelids and lips
• epistaxis

3rd or 4th day:

• maggots may crawl out of nose
• foul smelling serosanguinous discharge
• extensive destruction of nose, sinuses, soft tissue of face, palate and eyeball
• fistulae may form in the palate or around the nose
• death may occur from meningitis

Treatment:

• Visible maggots should be picked up with forceps
• Instillation of chloroform water/ether and oil (liquid paraffin) kills them
• Nasal docuhe with warm saline is used to remove slough, crusts and dead maggots
• Avoid contact of the patient with flies by use of mosquito nets
• Nasal hygiene for prevention

Two Types of Chr. Pharyngitis-

• Chronic Catarrhal Pharyngitis
• Chronic  Granular Pharyngitis ( Hypertrophic )

Causes ( Etiology ) Of Chronic Pharyngitis-

• Persistent infection in the surrounding structures of pharynx like sinus, tonsils, nose etc including dental sepsis.
• Mouth breathing exposes pharynx to air which has not been filtered ,humidified and adjusted. These are usually result of nasal polyp, rhinitis, turbinate hypertrophy,adenoids,tumors. It can also be due to protruded teeth or habitual mouth breathing.
• Environmental Pollution
• Faulty voice production as seen in certain professions like singers and over use of voice. Can also occur in case of pharyngeal neurosis

Symptoms-

• Discomfort or pain in the throat- prominent in the morning
• Foreign body sensation ( something stuck to throat ) sensation- patient has constant desire to clear his throat.
• Tiredness of Voice-  voice may lose quality and even crack.
• Cough-  irritable throat. Simply opening of mouth can cause retching and gagging

Signs-

Throat in Chr. pharyngitis

• Congestion of posterior wall of pharynx, engorgement of vessels, pillars may be thickened.
• Increased mucus secretion.
• Posterior pharyngeal wall may be studded with reddish nodules in case of Granular pharyngitis.
• Lateral pharyngeal  bands may enlarge and uvula may be elongated and hypertrophied.

Treatment:-

1. Etiological factor or causative agent must be eradicated for resolution of Pharyngitis. Eg. Stop smoking, abstain from alcohol and cold, irritant food.
2. Voice rest is essential
3. Speech therapy where faulty voice production is seen
4. Warm Saline gargles may be soothing  and even relieves pain and irritation.
5. Mandl’s paint can be applied to mucosa of pharynx

Surgical – Cautery of Lymphoid granules – Electrocautery  or Diathermy.

Source- Disease Of ENT, PL Dhingra and lecture notes