You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information.
What is Woody induration of rhinoscleroma is initially seen at which stage: and explain in detail?
Ans. (c) Granulomatous stageRef: Dhingra's 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 'woody'feel.# 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: Miculicz's cell and Russel Bodies.# Treatment: Streptomycin (lg/day) and tetracycline (2g/day) are given together for 4-6 weeks.