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Endoscopic-assisted laser therapy for extensive rhinoscleroma

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Abstract

Background

Scleroma is a granuloma affecting mainly the nose, and may extend to affect the pharynx, the larynx, the lacrimal apparatus, and many soft tissue structures surrounding the nose. In Egypt, as in many other Eastern countries, scleroma is the most common nasal granuloma diagnosed clinically and pathologically. Although it mainly affects the anterior part of the nose, it is not uncommon to find cases with extensive lesions that extend to occupy the entire nasal cavity, and also to the sinuses and the orbit. Active rhinoscleroma is usually treated medically, and surgical intervention is carried out in the fibrotic stage.

Theory

The aim of this study was to determine the role of CO2 laser in the management of extensive active rhinoscleroma.

Materials and methods

This is a prospective study that included 24 patients with extensive rhinoscleroma in the active phase, that is, patients had almost complete nasal obstruction with mouth breathing. Patients were divided into two groups: group A (12 cases), who were managed only with medical treatment, and group B (12 cases), who were managed with CO2 laser debulking, concurrently with medical treatment.

Results

Patients were followed up clinically for nasal blockage and histologically to assess the activity of the disease; group B showed earlier relief of nasal obstruction and needed less medical treatment to reach the inactive stage.

Conclusion

CO2 laser debulking is a good option in treating extensive rhinoscleroma, even in the active stage, as it provides rapid relief of nasal blockage and decreases the time needed for medical treatment, reducing the possible side effects of antibiotics.

References

  1. Hart CA, Rao SK. Rhinoscleroma. J Med Microbiol. 2000; 49: 395–396

    Article  Google Scholar 

  2. Von Hebra F. Rhinoscleroma: a new and unusual lesion at the nose in addition to histological findings by Dr M Khon. Wien Med Wochenschr. 1870; 20: 1–5

    Google Scholar 

  3. Van Renterghem L. Scleroma and rhinoscleroma, a diagnostic difficulty: review of literature with proposal of new observation. Cahier Otol Rhinol Laryngol. 1993; 10: 419–424

    Google Scholar 

  4. Von Frisch A. The aetiology of rhinoscleroma. Wien Med Wochenschr. 1882; 32: 969–972

    Google Scholar 

  5. Chan TV, Spiegel JH. Klebsiella rhinoscleromatis of the membranous nasal septum. J Laryngol Otol. 2007; 121: 998–1002

    Article  CAS  Google Scholar 

  6. Andraca R, Edson RS, Kern EB. Rhinoscleroma: a growing concern in the United States? Mayo Clinic experience. Mayo Clin Proc. 1993; 68: 1151–1157

    Article  CAS  Google Scholar 

  7. Hyams VJ. Rhinoscleroma. In: Binford CH, Cornor DH, editors Pathology of tropical and extraordinary diseases. Washington, DC: Armed Forces Institute of Pathology; 1976. pp. 187–189

  8. Alavi K, Kohout E, Dutz W. Two cases of scleroma in Iran. J Clin Pathol. 1971; 24: 360–362

    Article  CAS  Google Scholar 

  9. Berron P, Berron R, Ortiz Ortiz L. Alterations in the T-lymphocyte subpopulation in patients with rhinoscleroma. J Clin Microbiol. 1988; 26: 1031–1033

    Article  CAS  Google Scholar 

  10. Meyer PR, Shum TK, Becker TS, Taylor CR. Scleroma (rhinoscleroma). A histologic immunohistochemical study with bacteriologic correlates. Arch Pathol Lab Med. 1983; 107: 377–383

    CAS  PubMed  Google Scholar 

  11. El Mofty A. Histological examination of scleroma. Ann Otol Rhinol Laryngol. 1962; 71: 377–381

    Article  Google Scholar 

  12. Moraes MA, Magalhães AV, Marinho LC, Azevedo AE, Carneiro FP, Raymundo IT. Rhinoscleroma causing severe bilateral nasal obstruction. Braz J Infect Dis. 2010; 14: 190–192

    Article  Google Scholar 

  13. Avery RK, Salman SD, Baker AS. Rhinoscleroma treated with ciprofloxacin: a case report. Laryngoscope. 1995;105(8 I):854–856

    Article  CAS  Google Scholar 

  14. Gaafar HA, Gaafar AH, Nour YA. Rhinoscleroma: an updated experience through the last 10 years. Acta Otolaryngol. 2011; 131: 440–446

    Article  CAS  Google Scholar 

  15. N’Gattia KV, Kacouchia N, Koffi N’Guessan L, Mobio NM, Kouassi Ndjeundo J, Kouassi M, et al. Retrospective study of the rhinoscleroma about 14 cases in ENT departments of university hospitals (Côte d’Ivoire). Eur Ann Otorhinolaryngol Head Neck Dis. 2011;128:7–10

    Article  Google Scholar 

  16. Sun Y, Sun W, Lü X. Clinical analysis of 19 cases of scleroma respiratorium treated surgically. Lin Chuang Er Bi Yan Hou Ke Za Zhi. 1998; 12: 314–316

    CAS  PubMed  Google Scholar 

  17. Schwartz RA Rhinoscleroma treatment & management. 2011 Medscape

  18. Karpińska Kaczmarczyk K, Chosia M, Woyke S. Rhinoscleroma: a case report. Pol J Pathol. 2010;61:166–168

    PubMed  Google Scholar 

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Correspondence to Nassim Talaat Nassim MD.

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Nassim, N.T. Endoscopic-assisted laser therapy for extensive rhinoscleroma. Egypt J Otolaryngol 28, 89–94 (2012). https://doi.org/10.7123/01.EJO.0000413431.49513.c2

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  • DOI: https://doi.org/10.7123/01.EJO.0000413431.49513.c2

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