Caseous Sinusitis

Caseous rhinitis is the accumulation of foul-smelling caseous material in the nasal cavity or sinuses that erodes tissue and bone over time, causing nasal deformity in severe cases. It was formerly called nasal cholesteatoma, though lacking histological support. Most scholars now believe it results from chronic purulent nasal/sinus inflammation, nasal obstruction, poor drainage, leading to mucosal caseous necrosis and inspissated purulent secretions that accumulate as caseous material.

Common Symptoms

Rhinorrhea; nasal obstruction; fatigue; increased nasal discharge

Causes and Pathogenesis

Duplay (1868) proposed nasal erysipelas based on 2 cases, but no subsequent reports. Cozzollion (1889) found tubercle-like bacilli in caseous material, suggesting a link with pulmonary TB, but only 1 of 35 well-documented domestic cases had pulmonary TB. Some proposed syphilitic gummas, but only 2 of 16 had strongly positive Wassermann reactions. Tillaux (1889) proposed analogy to ear cholesteatoma, but Kelson (1900) found columnar/respiratory epithelium in most patients. Hill (1919-1920) found foreign bodies in 10 cases; 4 of 35 domestic cases had nasal stones or teeth. Sheicher proposed degenerated necrotic polyps forming caseous material; 12 of 35 domestic cases had polyps. Dental causes were proposed (50% in Soviet statistics) but only 1 of 13 domestic cases had a dental extraction history. Trauma was proposed but no domestic cases were traumatic. Most scholars accept that mechanical nasal obstruction (foreign body, structural anomaly like deviated septum/turbinate hypertrophy, or neoplasm) causes poor drainage, retained secretions, chronic purulent inflammation, mucosal caseous necrosis, and fatty degeneration of pus cells forming soft solid caseous material. However, chronic rhinitis/sinusitis with nasal deformity is common while caseous sinusitis is rare, suggesting additional biochemical changes.

Treatment

Drug therapy, supportive therapy

Preventive Measures

1. Exercise regularly, especially cold-tolerance training; breathe fresh outdoor air to improve nasal mucosal circulation. 2. Wash the nose frequently: inhale warm water or saline through the nose and expel through mouth or nose. Cold water nasal washing year-round, especially in the morning, improves circulation and resistance. 3. Correct bad habits: do not pick the nose or pluck nose hairs, which can cause purulent infection and intracranial/ear disease. 4. Nasal massage: press Yingxiang acupoints or rub the bridge of the nose to strengthen nasal function. 5. For nosebleeds: do not lie down or tilt the head back; spit out blood; pinch the alae nasi at the side of the nostrils for 3 minutes. 6. Diet: less spicy food; eat yin-nourishing foods in autumn/early winter; maintain regular bowel movements. 7. Keep nasal mucosa moist: ventilate rooms; use a little menthol oil or take vitamins C/A/D in dry weather.

Department to Visit

It is recommended to visit the ENT department; an appointment can be booked on this platform before the visit.

Warm reminder: The above information is for health science reference only and cannot replace professional medical diagnosis. If you have related symptoms, please seek medical attention at a regular hospital promptly.