Nasal cholesteatoma

This is another name for Rhinitis caseosa. The term “Rhinitis caseosa” was coined by Duplay in 1868. Eggston and Wolff after a detailed study in 1947 concluded that this condition could occur secondarily following pent up secretions in the sinus cavities. Their studies revealed that this condition is more common in patients with extensive bilateral ethmoidal polyposis. The presence of polypi in the nasal cavities caused obstruction to the normal drainage mechanism of the paranasal sinuses. This led to accumulation of secretions. Whitish to yellow cheesy material were found within the nasal cavities of these patients behind the nasal polypi. This cheesy material also caused expansion of sinus cavities, erosion of bone and extension into orbit.

Eggston used the term pseudocholesteatoma to describe this condition which resembled cholesteatoma only morphologically. Histologically squamous elements could not be identified in them. Histologically this tissue comprises of inflammatory tissue, granulation mixed with mucoid debris.

Presently allergic fungal sinusitis also resembles this condition and hence included under this category.

Clinical features:

1. Nasal obstruction
2. Presence of nasal polypi
3. Telecanthus
4. Swelling over medial canthal region
5. Proptosis with the eye being pushed downwards and laterally
6. These patients may present with loss of vision due to involvement of optic nerve
7. Intracranial extension due to erosion of anterior cranial fossa skull base is also seen

This disease could be considered to be end stage manifestion of sinus inflammation. Hence the use of the term “Rhinitis caseosa syndrome” makes lot of sense.

Pinus theory of nasal cholesteatoma:

According to Pinus a majority of patients suffering from nasal cholesteatoma also suffered from dental cysts which obliterated the entire maxillary sinus cavity.

Management:

Rhinitis caseosa can be managed by debridement followed by regular douching using normal saline.