<prompt> Woody induration of rhinoscleroma is initially seen at which stage:Catarrhal stageStrophic stageGranulomatous stageCicatricial stage  <response>: Ans. c Granulomatous stageRef: Dhingras ENT 6th ed.156-57, 5th ed. 172B RHINOSCLEROMA It is a chronic granulomatous disease caused by gram negative coccobacillus- Klebsiella Rhinoscleromatis. It has 3 stages: Catarrhal or atrophic stage: characterized by foul smelling purulent nasal discharge and crusting causing obstruction. This stage resembles atrophic rhinitis. Granulomatous stage: in this stage there are painless and non-ulcerative granulomatous nodules in nasal mucosa. There is also subdermal infiltration of lower part of external nose and upper lip giving a woodyfeel. Cicatricial stage: the last stage which causes adverse conditions like stenosis of nares, distortion of upper lip, adhesions in the nose, nasopharynx and oropharynx. There may be subglottic stenosis with respiratory distress. Rhinoscleroma causes woody infiltration of nose, so it is also known as Woody Nose. Characteristic cells upon biopsy are: Miculiczs cell and Russel Bodies. Treatment: Streptomycin lgday and tetracycline 2gday are given together for 4-6 weeks. 