Rhinoscleroma

What is rhinoscleroma?

Rhinoscleroma is a chronic infection of the upper airway, in which hard stony growths develop, sometimes leading to marked deformity. Caused by infection with the Klebsiella rhinoscleromatis bacteria, the disease is spread by person to person transmission.

Rhinoscleroma goes through three phases. Initially, the individual experiences nasal congestion with persistent pus-filled nasal discharge. Next a painless mass develops. This mass, which usually begins at the front of the nose, may go on to involve the trachea, larynx, sinuses, bronchi, bone, cartilage, ear, or eye socket. Eventually the mass changes into fibrous tissue. Abnormal narrowing (strictures) with airway obstruction may result. This disease most commonly occurs in Egypt, Eastern Europe, and Central or South America.

How is it diagnosed?

History: Symptoms include a history of nasal obstruction or persistent nasal discharge. A painless mass may be present, usually in the nose. History should include information on individual's birthplace and residence.

Physical exam: The physical findings will depend on the stage of the disease. It may consist of crusting or an unusual amount of blood (hyperemia) in nasal mucous membranes. Occasionally, bony destruction or narrowing and deformity of the nasal septum may be present. The painless growth is hard and nodular with no tendency towards ulceration.

Tests: Microscopic examination of biopsied tissue, along with a culture to identify the infectious organism, is necessary for definitive diagnosis. An endoscope (a small, lighted magnification instrument used to examine the inside of a body cavity) may be inserted into the nasal passages to detect the presence of additional growths. A CT scan can also be used to locate additional growths.

How is rhinoscleroma treated?

Antibiotic drugs are used to combat the bacterial infection. An endoscope may be used to widen the passageway (dilatation), and the growth is removed by laser excision or surgery (rhinoplasty).

Medications

Noroxin (Norfloxacin)

What might complicate it?

Possible complications from rhinoscleroma include laryngeal or tracheal obstruction, constricting or narrowing (stenosis) of the airway passages, recurrence of airway obstruction, hemorrhage during or following surgery, internal scarring, or irregularities in the contour of the nose.

Predicted outcome

Although treatment is usually effective in removing the obstructive growths, individuals may have some residual deformity or irregularity in the contour of the nose.

Alternatives

Conditions with similar symptoms include leprosy, paracoccidioidomycosis, blastomycosis, histoplasmosis, sarcoid, basal cell carcinoma, Wegner's granulomatosis and mucocutaneous leishmaniasis.

Appropriate specialists

Otolaryngologist.

Last updated 21 June 2015