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What is Atrophic dry nasal mucosa, extensive encrustations with 'woody' hard external nose; is suggestive of and explain in detail?
Ans. b (Rhinoscleroma). (Ref. ENT PL Dhingra, 3rd ed., 194)In the granulomatous stage, painless and non-ulcerative nodules are formed in nasal mucosa, resulting in formation of so-called Woody Nose/ Hebry's Nose.RHINOSCLEROMA# Chronic granulomatous disease.# Caused by: a gram-negative bacterium Klebsiella rhinoscleromatis/Frisch bacillus- Atrophic stage--atrophic rhinitis--foul-smelling purulent nasal discharge & crusting.- Granulomatous stage--nodules in nasal mucosa, 'Woody' hard external nose & upper lip.- Cicatricial stage--stenosis of nares, distortion of upper parts in nose, nasopharynx & oropharynx.# It is common between 20 and 40y age and is found almost exclusively in lower socioeconomic class.# Mikulicz cells & Russel bodies are seen.- Mikulicz cells are large foam cells containing causative bacilli.# Rx: Streptomycin, tetracyclines, steroids, surgery.