bubble_chart Overview

Caseous rhinitis (rhinitis caseosa) is characterized by foul-smelling caseous masses in the nasal cavity or sinuses, which can erode tissues and bones over time, potentially leading to nasal deformity in severe cases.

bubble_chart Etiology

In the past, this condition was referred to as a nasal sebaceous cyst, but histological evidence was lacking. In recent years, most scholars believe that the disease is caused by chronic purulent inflammation of the nasal cavity or sinuses, nasal obstruction, and poor drainage of secretions, leading to caseous necrosis of the mucosa and concentration of purulent secretions, ultimately resulting in the accumulation of caseous material in the nasal cavity or sinuses.

bubble_chart Pathological Changes

The caseous material is a pale yellow, unstructured semi-solid composed of amorphous debris such as pus cells, necrotic tissue, desquamated epithelium, stearin, small amounts of cholesterol, and calcium salt crystals. It may also contain fungi like Actinomyces and microorganisms such as diphtheroid bacilli, occasionally including foreign bodies, rhinoliths, or sequestra. The pathological changes in the nasal mucosa vary with the severity of the disease, ranging from inflammatory infiltration and hyperplasia in mild cases to mucosal degeneration, necrosis, and granulomatous proliferation in severe cases. In the most severe instances, bone destruction, nasal deformity, or fistula formation may occur.

bubble_chart Clinical Manifestations

The disease often occurs on one side and progresses slowly. The main symptoms include progressive nasal obstruction, foul-smelling purulent nasal discharge, minor epistaxis, decreased sense of smell, dizziness, headache, and loss of appetite. If the sphenoid sinus is invaded, it may impair vision and cause cranial nerve palsy.

Examination reveals accumulation of caseous material in the nasal cavity, perforation of the nasal septum, deformation of the external nose, displacement of the eyeball, and possible fistulas on the anterior wall of the maxillary sinus or hard palate. Early-stage X-rays show uniform blurring of the sinuses, while advanced stage imaging reveals sinus cavity enlargement and bone destruction. Biopsy only indicates chronic inflammation, which must be differentiated from malignant tumors.

bubble_chart Treatment Measures

Completely remove the caseous material from the nasal cavity or sinuses and perform nasal irrigation. If nasal polyps, granulation tissue, foreign bodies, or sequestra are found, they should also be removed. If the lesion involves the ethmoid sinus or maxillary sinus, ethmoidectomy or radical maxillary sinus surgery should be performed. Small local fistulas often heal naturally after the primary lesion is thoroughly cleared, but larger fistulas require curettage and suturing. The prognosis of this disease is favorable, and recurrence is rare after treatment.