Antroscopy in rhinoscleroma

An Extensive Sinonasal Rhinoscleroma: A Rare Occurrence

Extensive involvement of the rhinoscleroma to the multiple paranasal sinuses, nasopharynx, and oropharynx is infrequent in clinical practice. Although pathology is diagnostic, other similar pathology should be ruled out in each case due to the nonspecific clinical symptoms of the patients. Radiology is always the key investigation in patients with sinonasal rhinoscleroma to find out the involvement of the disease and for proper surgical planning. Although majorities of the patients get benefited from prolonged medical treatment, surgery is warranted in cases of obstruction of the upper airway and significant nasal deformities. Preservation of the bony- cartilaginous framework is really a challenge in extensive sinonasal rhinoscleroma, especially in revision cases. A close follow-up is required in each case of sinonasal rhinoscleroma due to the high chance of its recurrence. In the present case, we have presented an extensive sinonasal rhinoscleroma which was successfully managed by surgery.

An unusual case of solitary scleroma of cheek

Scleroma is a disease of unwashed and occurs in people living in poor unhygienic conditions. Commonly it involves respiratory tract. We encountered a case of scleroma over cheek presenting as a solitary nodule without any sign of nasal scleroma.

Scleroma of the larynx

Twenty-two cases of rhinoscleroma were studied to determine the involvement of the larynx. The study revealed that scleroma affected the larynx in 40 per cent of cases. In the larynx, scleromatous lesions were found in the subglottic region and the disease was observed in stages i.e., atrophic, granulomatous (proliferative i.e., nodular) and a fibrotic or sclerotic (scarring) stage as found in the nose. The role of laryngological examination is established in the diagnosis of asymptomatic and early laryngeal lesions and in assessing response to initial treatment. Extensive granulomatous lesions were treated by open excision by the laryngofissure approach which was found to be the best method resulting in a quick recovery without any evidence of subglottic stenosis. The disease as a whole is discussed in the light of available literature.

Scleroma of the eustachian tube: salpingoscleroma

Rhinoscleroma is a chronic specific granulomatous inflammatory condition that has an affinity with the mucosa of the upper respiratory tract. Involvement of the eustachian tube is uncommon. In the present study nasopharyngoscopy was performed in 20 patients with rhinoscleroma to find out the type, nature and site of the lesion at the orifices of the eustachian tube. A lesion involving the eustachian tube was found in six cases (30 per cent). Lesions occurred in the form of atrophic changes with crusting, granuloma and fibrotic thick areas. Involvement of the eustachian tube was found to be associated with intranasal scleroma and was more common at the granulomatous stage. Eustachian tube scleroma had a possible association with subsequent changes in the tympanogram pattern. Nasopharyngoscopy was found to be of therapeutic value in removing the crust, discharge and granulations at the eustachian tube orifices.

Scleroma of the lower respiratory tract: a bronchoscopic study

Twenty cases suffering from rhinoscleroma were studied. Bronchoscopy was performed for detection of secondary involvement of the subglottic region, trachea and bronchus. The study revealed that the larynx was involved in 40 per cent, the trachea in 20 per cent and the bronchus in 10 per cent of cases. The intranasal lesion, endotracheal and endobroncheal lesions all occur in the form of an atrophic stage, granulomatous (proliferative) stage and finally a fibrotic or scarring stage. The role of bronchoscopy in early diagnosis, initial symptomatic treatment and in follow-up is discussed in the light of the available literature.