Shroff ENT Hospital

20/09/2026

Atrophic rhinitis is a condition where the inside lining of the nose becomes very thin, dry and shrunken.

Normally your nose lining makes mucus and has tiny hairs that clean and humidify air. In atrophic rhinitis, that lining gets destroyed, nasal cavity becomes abnormally wide, and thick, dry crusts form inside. Because of crusts, there is bad smell from nose, but the patient himself can't smell it due to loss of smell.

*2 Types:*

1. *Primary* - no clear reason, but more common in young females, poor nutrition, low iron, Vitamin A/D deficiency, chronic infection with Klebsiella, hormonal factors.
2. *Secondary* - after surgery (too much turbinate removal), radiation, chronic sinus infection, trauma, long nasal infection.

*Symptoms:*
- Nose feels blocked even though it's wide open (paradoxical obstruction)
- Thick, greenish-black dry crusts inside nose
- Bad foul smell from nose - called ozaena - others can feel it
- Loss of smell - anosmia
- Frequent nose bleeding when crusts come out
- Headache, dry throat
- The crusts keep coming back even after cleaning

*How ENT diagnoses:*
- Anterior rhinoscopy - wide roomy nasal cavities, atrophied turbinates, crusts
- Sometimes CT scan of nose/paranasal sinuses
- Blood tests for iron, vitamin deficiency

*Treatment - there is no permanent cure, but can be controlled well:*

1. *Nasal cleaning is main:*
- Daily nasal douching with normal saline, alkaline nasal wash
- Saline nasal drops / spray to keep moist
- Gentle crust removal at clinic, don't pick with fingers

2. *Moisturizing and drops:*
- Glucose in glycerin drops - keeps nose moist
- Liquid paraffin

3. *Treat deficiency/infection:*
- Iron, Vitamin A, D, B12 supplements
- Short course of antibiotics if infected crusts

4. *General care:*
- Lots of water, balanced diet
- Avoid dusty environment, smoking

5. *Surgery - in severe cases only:*
- Young's operation - to temporarily close nostril to heal
- Narrowing the wide cavity with implants, fat/graft
- Usually tried only when medical treatment fails for months

It takes long-term care - daily wash is the key. Crusts will reduce, smell goes away, but you need to continue washes.

If you are seeing such a patient, regular suction cleaning in OPD + home saline douching 2-3 times a day gives best relief.

20/09/2026

A vocal cord nodule is like a callus on your vocal cords.

Your vocal cords are 2 small bands of muscle in your voice box that vibrate to make sound. When you overuse them - shouting, singing loudly for long hours, speaking continuously - they get injured and swell.

With repeated injury, small, hard, bump-like swellings form on both cords, usually in the middle. That's a vocal nodule.

*Why it happens:*
- Voice overuse / misuse - teachers, singers, preachers, loud talkers, kids who scream a lot
- Shouting over noise
- Chronic cough, throat clearing
- Speaking in a very low or high pitch for long time
- Smoking, reflux can make it worse

*Symptoms:*
- Hoarseness, breathy or rough voice
- Voice tires quickly, need more effort to speak
- Pain or tightness while speaking
- Voice breaks, low pitch
- Feeling of something stuck in throat

*How ENT diagnoses it:*
- History + laryngoscopy / videostroboscopy - we look at cords with a small camera while you make sound. Nodules look like small symmetric white swellings on both sides.

*Treatment - depends on size and duration:*
1. *Voice rest and voice therapy* - This is first line. A speech therapist teaches correct voice use, breathing, avoiding shouting/throat clearing.
2. *Treat the cause* - treat acid reflux, allergy, stop smoking, hydrate well, avoid whispering (it strains more).
3. *Medicines* - no medicine directly removes nodule, but reflux meds, anti-allergy help if contributing.
4. *Surgery* - only if large nodule, not responding to 3-6 months of therapy, or very symptomatic professional voice user. Done by microlaryngoscopic excision, usually with laser/cold instruments.

Most small, recent nodules go away completely with voice therapy and rest.

*Prevention:*
- Don't shout, use mic if you need to address a crowd
- Take voice breaks, drink water
- Avoid frequent throat clearing - swallow or sip water instead
- Warm-up before long speaking/singing

If hoarseness lasts > 2-3 weeks, you should get a laryngoscopy done by an ENT.

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