Chronic Rhinitis

Slide 1 · Chronic rhinitis

Recurrent nasal inflammation, mucosal injury, and impaired secretion drainage

Dr Abu Suraih Sakhri

MBBS, MD (Pathology)

www.abusuraihsakhri.com

Slide 2 · Learning objectives

Trace repeated microbial or allergic attacks to chronic rhinitis and bacterial superinfection.

Identify epithelial injury and the three inflammatory cell types described in the source.

Connect nasal obstruction with polyps, impaired drainage, and sinusitis.

Slide 3 · The upper-airway framework

Sinus cavity

Nasal space

Schematic — not a clinical or histologic specimen

The upper airway includes the nose, pharynx, and larynx.

Nasal inflammation is an important group of upper-airway disorders.

The nose and accessory sinuses share interconnected drainage pathways.

Slide 4 · Infectious, allergic, and chronic processes

Microbial rhinitis

Allergic rhinitis

Repeated mucosal inflammation

Slide 5 · Chronic rhinitis: The defining sequence

Repeated microbial or allergic rhinitis provides the antecedent history.

Superimposed bacterial infection can complicate the recurrent process.

The mucosa develops surface injury and an inflammatory-cell infiltrate.

Slide 6 · A recurrent process differs from one cold

Acute episode

Acute infectious rhinitis often clears rapidly.

Chronic process

Chronic rhinitis follows repeated episodes of inflammation.

Time course and preceding episodes alter clinicopathologic interpretation.

Slide 7 · Distinct starting mechanisms

Allergic

Allergen exposure initiates an IgE-mediated mucosal reaction.

Microbial

Viral respiratory infection initiates microbial rhinitis.

Both pathways can recur and precede chronic inflammation.

Slide 8 · Allergic rhinitis: Common triggers

Relevant allergens include plant pollens, fungi, animal allergens, and dust mites.

The inflammatory process is an IgE-mediated hypersensitivity reaction.

Early and late phases occur in the accompanying immune response.

Slide 9 · Allergic mucosal response

Allergen exposure

IgE-mediated immune response

Edema, mucus secretion, eosinophils

Slide 10 · Infectious rhinitis: Acute mucosal effects

Rhinoviruses, echoviruses, and adenoviruses are described as viral causes.

Acute mucosal edema and thickening narrow the nasal cavity.

Secondary bacterial infection can produce mucopurulent or suppurative exudate.

Slide 11 · Two initiating pathways can converge

Repeated microbial rhinitis

Repeated allergic rhinitis

Inflamed nasal mucosa

Slide 12 · Superimposed bacterial infection

Bacterial superinfection is explicitly described in the course of chronic rhinitis.

This process adds infection to an already repeatedly inflamed mucosa.

An allergic episode alone must not be equated with bacterial infection.

Slide 13 · Core pathogenic sequence

Recurrent episodes

Bacterial superinfection

Mucosal inflammatory injury

Slide 14 · Drainage modifies disease progression

Septal deviation or polyps

Impaired secretion drainage

Greater microbial susceptibility

Slide 15 · Septal deviation is a structural risk

Schematic — not a clinical or histologic specimen

An altered septal contour can impede normal secretion drainage.

The key effect is impaired passage of nasal secretions.

Poor clearance predisposes the mucosa to microbial invasion.

Slide 16 · Nasal polyps provide a second obstruction

Schematic — not a clinical or histologic specimen

Recurrent rhinitis may produce focal mucosal protrusions.

When large or multiple, polyps may encroach on the airway.

Polyp-associated obstruction can impede sinus drainage.

Slide 17 · Obstructions share a functional consequence

Deviated nasal septum

Mucosal polyps

Impaired drainage of secretions

Slide 18 · The inflammation–obstruction relationship

Repeated mucosal inflammation

Nasal obstruction or swelling

Reduced secretion drainage

Slide 19 · Extension beyond the nasal cavity

Sinus cavity

Nasal space

Schematic — not a clinical or histologic specimen

Infection associated with chronic rhinitis may spread into sinuses.

Nasal and sinus spaces communicate through drainage routes.

Rhinitis and sinusitis therefore can form a connected disease process.

Slide 20 · Integrated pathogenesis

Repeated inflammation

Mucosal injury

Impaired drainage

Bacterial superinfection

Possible sinusitis

Slide 21 · Histology has two complementary compartments

Schematic — not a clinical or histologic specimen

Inspect the mucosal surface for epithelial integrity or loss.

Inspect the underlying tissue for inflammatory-cell infiltrates.

The stated inflammatory response includes neutrophils, lymphocytes and plasma cells.

Slide 22 · Superficial epithelial desquamation

Schematic — not a clinical or histologic specimen

Desquamation refers to shedding or loss of the lining epithelial cells.

Superficial mucosal injury is a common change in chronic rhinitis.

Evaluate epithelial changes separately from inflammatory-cell composition.

Slide 23 · Superficial mucosal ulceration

Schematic — not a clinical or histologic specimen

Ulceration produces a defect in the mucosal surface.

The source permits superficial mucosal ulceration in chronic rhinitis.

Surface ulceration is not equivalent to an intact reactive epithelium.

Slide 24 · Intact and injured mucosal surfaces

Intact surface

The intact surface maintains a continuous epithelial lining.

Injured surface

An injured surface may demonstrate desquamation or ulceration.

The adjacent inflammatory infiltrate helps characterize the process.

Slide 25 · Chronic rhinitis contains a mixed infiltrate

Neutrophil

Lymphocyte

Plasma cell

Schematic — not a clinical or histologic specimen

Variable neutrophils may be present.

Lymphocytes are also described in the inflammatory infiltrate.

Plasma cells complete the listed chronic-rhinitis cell spectrum.

Slide 26 · Neutrophils in chronic rhinitis

Neutrophil

Lymphocyte

Plasma cell

Schematic — not a clinical or histologic specimen

Neutrophils are one component of the mixed inflammatory response.

Their proportion may vary across lesions.

Neutrophils alone do not establish a single specific cause.

Slide 27 · Lymphocytes in chronic rhinitis

Neutrophil

Lymphocyte

Plasma cell

Schematic — not a clinical or histologic specimen

Lymphocytes can infiltrate the mucosa in chronic rhinitis.

They coexist with other cell types in the source description.

Interpret them alongside epithelial injury and clinical context.

Slide 28 · Plasma cells in chronic rhinitis

Neutrophil

Lymphocyte

Plasma cell

Schematic — not a clinical or histologic specimen

Plasma cells are named in the source inflammatory-cell spectrum.

Relative abundance varies within this mixed infiltrate.

No numerical plasma-cell threshold is supplied for this entity.

Slide 29 · The inflammatory mixture is variable

Neutrophils

A lesion may show a conspicuous neutrophil component.

Mononuclear cells

Another lesion may contain more lymphocytes and plasma cells.

There is no mandatory fixed ratio among these three populations.

Slide 30 · Allergic and chronic patterns are distinct

Allergic rhinitis

Allergic rhinitis has an eosinophil-rich infiltrate in the neighboring text.

Chronic rhinitis

Chronic rhinitis includes variable neutrophils, lymphocytes, and plasma cells.

Do not require eosinophilia in every chronic-rhinitis specimen.

Slide 31 · Edema contributes to tissue and airway change

Schematic — not a clinical or histologic specimen

Allergic mucosal reactions can produce edema and mucus secretion.

Nasal-polyps stroma may be markedly edematous.

Swelling and protrusions can reduce available airway and drainage space.

Slide 32 · A structured mucosal review

Surface epithelium

Stromal edema and architecture

Inflammatory cell populations

Slide 33 · Morphology synthesis: Chronic rhinitis

Superficial epithelial desquamation or ulceration is typical.

Neutrophils, lymphocytes, and plasma cells occur in variable proportions.

Interpret these findings in recurrent inflammation with possible superinfection.

Slide 34 · How polyps arise from recurrent rhinitis

Schematic — not a clinical or histologic specimen

Repeated rhinitis can produce focal protrusions of mucosal tissue.

A polyp is a localized expansion rather than diffuse flat mucosal swelling.

Its significance increases when it impairs the airway or drainage.

Slide 35 · Polyp size and encroachment

Schematic — not a clinical or histologic specimen

Nasal polyps may attain lengths of 3–4 cm.

Large or multiple lesions can encroach on the airway.

Sinus drainage can be disrupted by extensive polyposis.

Slide 36 · The polyp contains loose edematous stroma

Schematic — not a clinical or histologic specimen

The polyp core is edematous mucosa with loose stromal architecture.

The expanded stroma forms the substance of the mucosal protrusion.

This is inflammatory polyp architecture, not tumor staging.

Slide 37 · Glandular changes within nasal polyps

Schematic — not a clinical or histologic specimen

Hyperplastic mucus glands can be identified.

Cystic gland changes are another described finding.

These glands coexist with stromal edema and inflammation.

Slide 38 · Polyps have their own cell spectrum

Neutrophil

Eosinophil

Plasma cell

Schematic — not a clinical or histologic specimen

Polyp infiltrates can contain neutrophils.

Eosinophils are often important in the described inflammatory mixture.

Plasma cells are also listed in the adjacent pathology description.

Slide 39 · Polyp surface: Intact versus ulcerated

Intact surface

Without bacterial infection the polyp surface may remain intact.

Ulcerated surface

With infection the mucosal surface may become ulcerated.

Surface integrity helps interpret superimposed inflammation.

Slide 40 · A polyp does not always signify atopy

Most people with nasal polyps are not atopic discussion.

An eosinophil-rich polyp does not independently establish systemic atopy.

Interpret morphology together with clinical inflammatory context.

Slide 41 · Polyps link chronic inflammation to obstruction

Recurrent nasal inflammation

Polypoid mucosal expansion

Obstructed airway and sinus drainage

Slide 42 · Compare three related nasal entities

Process

Characteristic morphology

Functional effect

Infectious rhinitis

Acute swollen mucosa, catarrh

Possible bacterial exudate

Chronic rhinitis

Epithelial injury, mixed infiltrate

Repeated inflammation and superinfection

Inflammatory polyp

Edematous protruding mucosa, glands

Potential airway and outflow obstruction

Slide 43 · The nasal–sinus relationship

Sinus cavity

Nasal space

Schematic — not a clinical or histologic specimen

Chronic nasal infection can extend into the sinuses.

Rhinitis often precedes acute sinusitis.

Edema and obstruction connect nasal and sinus inflammation.

Slide 44 · Rhinitis commonly precedes sinusitis

Rhinitis

Mucosal edema

Impaired sinus outflow

Slide 45 · An alternative origin: Dental infection

Rhinitis route

Most acute sinusitis cases are preceded by rhinitis.

Odontogenic route

A periapical infection may extend through the maxillary sinus floor.

These represent different anatomic routes into sinus inflammation.

Slide 46 · Outflow obstruction retains sinus contents

Sinus cavity

Nasal space

Schematic — not a clinical or histologic specimen

An inflamed sinus develops edematous mucosa.

Edema obstructs drainage from the cavity.

Trapped secretions can accumulate behind the narrowing.

Slide 47 · Empyema develops in an infected sinus

Mucosal inflammation

Impaired outflow

Purulent retention: Empyema

Slide 48 · Mucocele and empyema are distinct

Mucocele

A mucocele results from accumulation of retained mucus.

Empyema

Empyema involves purulent material retained in an infected sinus.

Both implicate impaired drainage, but the contents differ.

Slide 49 · Anatomic sites of outflow obstruction

Sinus cavity

Nasal space

Schematic — not a clinical or histologic specimen

Frontal sinus drainage is most often affected in the source account.

Anterior ethmoid outflow obstruction is another less common site.

These blockages can permit abnormal accumulation of secretions.

Slide 50 · Acute sinusitis can progress to chronic disease

Acute sinusitis

Persistent drainage impairment

Chronic sinusitis

Slide 51 · Polymicrobial chronic sinusitis

Most chronic sinus infections in the source are polymicrobial.

Microbes often include members of the normal oral microbial community.

This is different from assuming a single named pathogen in every patient.

Slide 52 · Inherited ciliary dysfunction is another cause

Impaired ciliary action

Poor mucociliary clearance

Sinusitis in Kartagener syndrome

Slide 53 · Kartagener syndrome: Associated features

Sinusitis can be an uncommon manifestation of Kartagener syndrome.

Bronchiectasis is also part of the described syndrome.

Situs inversus occurs in the classic syndromic constellation.

Slide 54 · Severe fungal sinus infection

Fungal causes can produce severe chronic sinus infection.

Mucormycosis is specifically highlighted in the source.

Diabetes is a relevant predisposing clinical context.

Slide 55 · Spread from sinus to the orbit

Sinus cavity

Nasal space

Schematic — not a clinical or histologic specimen

Sinus infection can occasionally extend into the orbital region.

This represents extension beyond the local mucosal compartment.

Orbital spread is a serious but uncommon consequence.

Slide 56 · Spread into bone: Osteomyelitis

Sinus infection

Extension through adjacent bone

Osteomyelitis

Slide 57 · Intracranial venous complication

Severe sinus infection

Extension into cranial vault

Septic dural venous thrombophlebitis

Slide 58 · Complications follow a severity hierarchy

Localized mucosal sinusitis

Obstruction and retained contents

Occasional orbital, bone, or intracranial spread

Slide 59 · Case 1: Septal obstruction

A patient experiences repeated inflammatory episodes of rhinitis.

A deviated septum impedes the normal flow of secretions.

Question: Which functional change increases microbial susceptibility?

Slide 60 · Case 1: The relevant intermediate step

Deviated septum

Impaired secretion drainage

Increased likelihood of invasion

Slide 61 · Case 2: A nasal mucosal specimen

Histology shows superficial desquamation of nasal epithelium.

Neutrophils, lymphocytes and plasma cells are found in the mucosa.

Question: Which elements match the chronic-rhinitis description?

Slide 62 · Case 2: Morphological interpretation

Schematic — not a clinical or histologic specimen

Surface epithelial injury corresponds to desquamation or ulceration.

The infiltrate matches the described variable inflammatory-cell mixture.

These findings alone do not identify an individual organism.

Slide 63 · Case 3: Obstruction by nasal polyps

Repeated rhinitis is followed by formation of multiple large polyps.

The sinus outflow tract becomes obstructed.

Question: What two different types of sinus retention may occur?

Slide 64 · Case 3: Retained mucus versus pus

Mucocele

Mucocele denotes mucus accumulation behind obstruction.

Empyema

Empyema denotes accumulation of purulent material.

Both connect to impaired outflow but describe different contents.

Slide 65 · Unified clinicopathologic model

Repeated microbial or allergic rhinitis

Mucosal injury

Polyps or septal obstruction

Impaired drainage

Sinus extension may occur

Slide 66 · Teaching synthesis

Repeated microbial or allergic rhinitis can precede chronic mucosal inflammation.

The principal histologic findings are epithelial injury and a mixed cellular infiltrate.

Drainage impairment links nasal disease to bacterial infection and sinusitis.

Slide 67 · References

Robbins, Cotran & Kumar. Pathologic Basis of Disease. Eleventh edition. Elsevier, 2026.

Relevant contiguous sections: Infectious Rhinitis; Allergic Rhinitis; Nasal Polyps; Chronic Rhinitis; Sinusitis.