'Hebra' nose is caused by -

Ans. is 'a' i.e., Frisch bacillus Rhinoscleromao The causative organism is Klebsiella rhinoscleromatis or Frisch bacillus, which can be cultured from the biopsy material. The disease is endemic in several parts of world. In India, it is seen more often in northern than in the southern parts. Biopsy shows infiltration of submucosa with plasma cells, lymphocytes, eosinophils, Mikulicz cells & Russell bodies. The latter two are diagnostic features of the disease. The disease starts in the nose & extends to nasopharynx, oropharynx, larynx, trachea & bronchi. Mode of infection is unknown. Both sexes of any age may be affected.Clinical features of rhinoscleromao The disease runs through the following stagesa) Atrophic stage: It resembles atrophic rhinitis and is characterised by foul smelling purulent nasal discharge and crusting.b) Granulomatous stage: Granulomatous nodules form in nasal mucosa. There is also subdermal infiltration of lower part of external nose and upper lip giving a 'woody' feel. Nodules are painless and non-ulcerative.c) Cicatricial stage: This causes stenosis of nares, distortion of upper lip, adhesions in the nose, nasopharynx and oropharynx. There may be subglottic stenosis with respiratory distress.o Involvement of ulnar margin and nasal tip produces specific deformity - 'Hebra' nose or Tapir noseo Biopsy of rhinoscleroma shows infiltration of submucosa with plasma cells, lymphocytes, eosinophils, Mikulicz cells and Russell bodies. The latter two are the diagnostic features of the disease.Treatmento Both streptomycin & tetracycline are given together for minimum of 4-6 wks. Steroid can be combined to reduce fibrosis. Surgical treatment may be required to establish the airway and correct nasal deformity.