Rhinoscleroma Treatment & Management

  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD   more...
 
Updated: May 13, 2011
 

Medical Care

Bronchoscopy has a role in the initial treatment of symptoms. Treatment should also include long-term antimicrobial therapy and surgical intervention in patients with symptoms of obstruction.

Bacterial overinfection responds to treatment with third-generation cephalosporins and clindamycin. Sclerotic lesions respond well to treatment with ciprofloxacin. Long-term antibiotic therapy often eradicates this infection.[16]

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Surgical Care

Surgery combined with antibiotic therapy is beneficial in patients with granulomatous disease and nasal or pharyngeal obstruction or nasal sinus involvement due to the proliferation of lesions.

Tracheotomy should be considered in patients with laryngeal obstruction of the second degree (granulomatous stage) and above (sclerotic stage).

Plastic surgery is necessary in patients with cicatricial stenosis or when imperforation remains in the nasal cavity, pharynx, larynx, or trachea.[17]

Extensive granulomatous lesions are treated by means of open excision by using the laryngofissure approach, which is the best method for a quick recovery in patients without evidence of subglottic stenosis.

Surgery and laser therapy are required to treat airway compromise and tissue deformity. Fiberoptic intubation[18] allows assessment of the pathology and subsequent passage of a cuffed tracheal tube to secure the airway. To overcome respiratory obstruction as the fiberscope passes through the opening in the membrane, either rapid intubation or a technique of preoxygenation and voluntary hyperventilation followed by breath holding during bronchoscopy is used. The thin caliber and maneuverability of the flexible fiberoptic bronchoscope makes fiberoptic intubation an excellent technique for airway management in cicatricial membranes of the pharynx.

Treatment of the advanced cicatrix with carbon dioxide laser vaporization yields excellent results. Obstructive lesions of the larynx and subglottic space are always a challenging problem for the endoscopist and anesthetist. At this level of the obstruction, the effectiveness and innocuous nature of carbon dioxide laser treatment are related to the degree of endoscopic exposure. Because of the transtracheal high-frequency jet ventilator, ensuring a free laryngeal endoscopic operative field is now possible.

The transtracheal catheter is introduced percutaneously through the cricothyroid membrane into the trachea under endoscopic control and connected to a high-frequency jet ventilator. Among many advantages of this technique, the most convincing include a clear operating field for the surgeon, complete relaxation of the patient, good respiratory gas exchange, elimination of the risk of igniting an endotracheal tube with the laser, decrease in the risk of aspiration of blood and debris, and the ability to provide oxygen and/or mechanical ventilation in the postoperative period.

Palatal symptoms may be relieved by means of uvulopalatopharyngoplasty.

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Consultations

Consultation with a plastic surgeon may be helpful in patients with cicatricial stenosis or in those with imperforation of the nasal cavity, pharynx, larynx, or trachea. An endoscopist and an anesthetist may be required to perform vaporization with a carbon dioxide laser.

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Contributor Information and Disclosures
Author

Robert A Schwartz, MD, MPH  Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi

Disclosure: Nothing to disclose.

Coauthor(s)

Egle Goriniene, MD  Staff Physician, Department of Infectious Diseases, New Jersey Medical School

Disclosure: Nothing to disclose.

Specialty Editor Board

Jacek C Szepietowski, MD, PhD  Professor, Vice-Head, Department of Dermatology, Venereology and Allergology, Wroclaw Medical University; Director of the Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Poland

Disclosure: Stiefel GSK Company Salary Employment; Orfagen Consulting fee Consulting; Maruho Consulting fee Consulting; Astellas Consulting fee Consulting; Abbott Consulting fee Consulting

David F Butler, MD  Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Jeffrey P Callen, MD  Professor of Medicine (Dermatology), Chief, Division of Dermatology, University of Louisville School of Medicine

Jeffrey P Callen, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and American College of Rheumatology

Disclosure: Amgen Honoraria Consulting; Abbott Honoraria Consulting; Electrical Optical Sciences Consulting fee Consulting; Celgene Honoraria Safety Monitoring Committee; GSK - Glaxo Smith Kline Consulting fee Consulting; TenXBioPharma Consulting fee Safety Monitoring Committee

Glen H Crawford, MD  Assistant Clinical Professor, Department of Dermatology, University of Pennsylvania School of Medicine; Chief, Division of Dermatology, The Pennsylvania Hospital

Glen H Crawford, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Phi Beta Kappa, and Society of USAF Flight Surgeons

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Department of Dermatology, Geisinger Medical Center

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

  1. de Pontual L, Ovetchkine P, Rodriguez D, et al. Rhinoscleroma: a French national retrospective study of epidemiological and clinical features. Clin Infect Dis. Dec 1 2008;47(11):1396-402. [Medline].

  2. De Champs C, Vellin JF, Diancourt L, et al. Laryngeal scleroma associated with Klebsiella pneumoniae subsp. ozaenae. J Clin Microbiol. Nov 2005;43(11):5811-3. [Medline].

  3. Sanchez-Marin LA, Bross-Soriano D, Arrieta J, et al. Association of HLA-DQA1*03011-DQB1*0301 haplotype with the development of respiratory scleroma. Otolaryngol Head Neck Surg. Mar 2007;136(3):481-3. [Medline].

  4. Abalkhail A, Satti MB, Uthman MA, Al Hilli F, Darwish A, Satir A. Rhinoscleroma: a clinicopathological study from the Gulf region. Singapore Med J. Feb 2007;48(2):148-51. [Medline].

  5. Azevedo-Bernarda R. Rhinoscleroma. Cent Afr J Med. Nov 1971;17(11):225-8. [Medline].

  6. Chan TV, Spiegel JH. Klebsiella rhinoscleromatis of the membranous nasal septum. J Laryngol Otol. Oct 2007;121(10):998-1002. [Medline].

  7. Navazo Eguia AI, Garcia Vicario F. [Rhinoscleroma]. Acta Otorrinolaringol Esp. Mar-Apr 2010;61(2):160-2. [Medline].

  8. Salima K, Samia S, Mounir T, Fethi J, et al. [Rhinoscleroma: a report of 2 cases]. Tunis Med. Sep 2005;83(9):568-71. [Medline].

  9. Botelho-Nevers E, Gouriet F, Lepidi H, et al. Chronic nasal infection caused by Klebsiella rhinoscleromatis or Klebsiella ozaenae: two forgotten infectious diseases. Int J Infect Dis. Sep 2007;11(5):423-9. [Medline].

  10. Ammar ME, Rosen A. Rhinoscleroma mimicking nasal polyposis. Ann Otol Rhinol Laryngol. Mar 2001;110(3):290-2. [Medline].

  11. Batsakis JG, el-Naggar AK. Rhinoscleroma and rhinosporidiosis. Ann Otol Rhinol Laryngol. Oct 1992;101(10):879-82. [Medline].

  12. Fuchs HA, Tanner SB. Granulomatous disorders of the nose and paranasal sinuses. Curr Opin Otolaryngol Head Neck Surg. Feb 2009;17(1):23-7. [Medline].

  13. Ingegnoli A, Corsi A, Verardo E, De Filippo M, Sverzellati N, Zompatori M. Uncommon causes of tracheobronchial stenosis and wall thickening: MDCT imaging. Radiol Med. Dec 2007;112(8):1132-41. [Medline].

  14. Maru YK, Munjal S, Gupta Y. Brush cytology and its comparison with histopathological examination in cases of diseases of the nose. J Laryngol Otol. Nov 1999;113(11):983-7. [Medline].

  15. Soni NK. Scleroma of the lower respiratory tract: a bronchoscopic study. J Laryngol Otol. Jun 1994;108(6):484-5. [Medline].

  16. Zhong Q, Guo W, Chen X, et al. Rhinoscleroma: a retrospective study of pathologic and clinical features. J Otolaryngol Head Neck Surg. Apr 2011;40(2):167-74. [Medline].

  17. Sun Y, Sun W, Lu X. [Clinical analysis of 19 cases of scleroma respiratorium treated surgically]. Lin Chuang Er Bi Yan Hou Ke Za Zhi. Jul 1998;12(7):314-6. [Medline].

  18. Divatia JV, Upadhye SM, Sareen R. Fibreoptic intubation in cicatricial membranes of the pharynx. Anaesthesia. Jun 1992;47(6):486-9. [Medline].

  19. Al Jahdali H, Bamefleh H, Memish Z, Al-Zuwayed M, Al Othman A. Upper airway obstruction due to rhinoscleroma: case report. J Chemother. Apr 2001;13 Suppl 1:69-72. [Medline].

  20. Busch RF. Rhinoscleroma occurring with airway obstruction. Otolaryngol Head Neck Surg. Nov 1993;109(5):933-6. [Medline].

  21. Munoz-Saavedra D, Olavarria-Leiva C. [Laryngeal stenosis as late manifestation of rhinoscleroma. Case report]. Acta Otorrinolaringol Esp. May-Jun 2010;61(3):241-3. [Medline].

  22. Gaafar HA, Gaafar AH, Nour YA. Rhinoscleroma: An updated experience through the last 10 years. Acta Otolaryngol. Apr 2011;131(4):440-6. [Medline].

 
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