Woody induration of rhinoscleroma is initially seen at which stage:

Ans. (c) Granulomatous stageRef: Dhingra's ENT 6th ed./156-57, 5th ed. /172B RHINOSCLEROMA* It is a chronic granulomatous disease caused by gram negative coccobacillus- Klebsiella Rhinoscleromatis.* It has 3 stages:# Catarrhal or atrophic stage: characterized by foul smelling purulent nasal discharge and crusting (causing obstruction). This stage resembles atrophic rhinitis.# Granulomatous stage: in this stage there are painless and non-ulcerative granulomatous nodules in nasal mucosa. There is also subdermal infiltration of lower part of external nose and upper lip giving a 'woody'feel.# Cicatricial stage: the last stage which causes adverse conditions like stenosis of nares, distortion of upper lip, adhesions in the nose, nasopharynx and oropharynx. There may be subglottic stenosis with respiratory distress.# Rhinoscleroma causes woody infiltration of nose, so it is also known as Woody Nose.# Characteristic cells upon biopsy are: Miculicz's cell and Russel Bodies.# Treatment: Streptomycin (lg/day) and tetracycline (2g/day) are given together for 4-6 weeks.