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Posts: 1120
Mar 29 16 5:44 PM
religiousnessa wrote:Not trying to answer a specific question. I'm just trying to make sense of why some people might improve or get worse, and also to give us a better sense of what we can expect about the likely progression of the disease based on our individual case.
religiousnessa wrote:I disagree with your distinction between "pure atrophic rhinitis" and "secondary atrophic rhinitis." I think the right distinction is between "primary atrophic rhinitis" (which is indeed rare) and "secondary atrophic rhinitis."
religiousnessa wrote:The key thing to realize is that, according to the largest review of atrophic rhinitis cases (Kern and Moore), the only real distinction between primary and secondary AR is *cause.* In the former, it's usually an unknown cause, although it seems to have something to do with growing up in a really unhygenic environment (e.g., bathing on a daily basis in a dirty river), whereas in latter it usually has a very specific cause (surgery, granulotomous disease, etc.) But other than cause, primary and secondary AR are very very similar: similar symptoms (obstruction, crusting, bleeding, lost sense of smell), similar objective findings (ct scans and histological findings are usually indistinguishable), and similar course of the disease. Now even if there are some other small differences between primary and secondary AR (e.g., it's more likely that there's something bacterial going on with primary AR), you still get the sense from the literature that primary and secondary AR are 90% the same.
religiousnessa wrote:I think the confusion is probably more over the first category (pure ENS) than the third category (mixed ENS and AR). I think the third category is by far the largest category of ENS suffers, and it's the one that most of us think of when we think of ENS. But I think there are also a few pure ENS people out there: they only had a small amount of their turbinates removed (e.g., maybe 10 percent) and don't have a lot of crusting, bleeding, etc., but they do expierience breathing problems and pain because of the nerve damage.I totally agree with your point about the amount of turbinates remaining being pretty important to prognosis. Your body is going to do a much better job of regenerating an organ if it has something to work with. That actually brings up a good point about the "pure ENS" group: if there are people who just have nerve damage because they didn't have much turbinate removed, they might be likely to recover somewhat as their remaining turbinates help them to regenerate.
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