DEFINITION
This chronic inflammation of the nose is characterized by roomy nasal cavities and foul-smelling large crusts in the posterior nasal cavity.
There occurs atrophy of nasal mucosa and turbinate bones.
TYPES
Atrophic rhinitis can be of two types —
- PRIMARY, and
- SECONDARY.
The primary atrophic rhinitis is more common and will be described in more detail.
Primary Atrophic Rhinitis
Etiology
The exact cause of primary atrophic rhinitis is NOT KNOWN, but various theories and predisposing factors, which have been proposed, are the following —
a. HEREDITARY: More than one family member can be affected.
b. HORMONAL: It usually starts at puberty.
Females are affected more than males. Spontaneous regression of symptoms occurs after menopause.
c. RACIAL: White and yellow races are more affected than natives of equatorial Africa.
d. DIETARY: Deficiency of vitamin A, D or iron, or other dietary factors are seen. Patients are usually from low socioeconomic levels.
e. INFECTIVE: The various organisms cultured from cases of atrophic rhinitis are —
- Klebsiella ozaenae (Perez bacillus),
- Diphtheroids,
- Proteus vulgaris,
- Escherichia coli,
- Staphylococci and
- Streptococci
They are not considered primary causative organisms but are said to be secondary invaders, which are responsible for foul smell.
f. AUTOIMMUNE: Some unspecified agents are said to trigger antigenicity of the nasal mucosa that leads to the production of antibodies that destruct nasal mucosa.
Clinical Features
1. Patients are usually females around puberty.
They emit foul smell from the nose, which make them social outcasts.
Patients themselves are not aware of this foul smell because of marked anosmia (merciful anosmia).
2. Nasal obstruction
Due to large crusts filling the nose is present in spite of unduly wide nasal chambers.
3. Epistaxis (NASAL BLEED)
Usually occurs when the crusts are removed.
4. Greenish or grayish black dry crusts.
5. Roomy nasal cavities
Atrophy of turbinates allows easy visibility of the posterior wall of the nasopharynx and ostium of the sinuses.
6. Nasal mucosa looks pale.
7. Septal perforation and nasal saddle deformity are not uncommon.
8. Atrophic pharyngitis
Atrophic changes also start involving the pharyngeal mucosa, which looks dry and glazed with crusts.
9. Eustachian tube Obstruction
This may result in middle ear effusion, which presents with deafness.
10. Atrophic Laryngitis
Atrophic changes may occur in the larynx also leading to cough and hoarseness of voice.
11. X-ray of paranasal sinuses
This shows small, underdeveloped, and thick-walled sinuses, which appear opaque.
Due to arrested development, paranasal sinuses remain small.
Antral puncture becomes difficult due to thick sinus walls.
Treatment
A complete cure is not yet possible. Treatment consists of both medical and surgical management.
A. Medical
It aims to maintain nasal hygiene and remove crusts, which take care of putrefying smell and further crust formation.
a) Warm normal saline or alkaline nasal irrigation:
It facilitates the removal of crusts.
One teaspoonful of alkaline powder (sodium bicarbonate 1 part, sodium biborate 1 part, and sodium chloride 2 parts) is dissolved in 280 ml of water.
It is used for irrigating the nasal cavities 2 or 3 times a day.
Later on, just once every 2 or 3 days is sufficient.
The alkaline solution loosens the crusts and removes thick tenacious discharge.
Hard crusts need to be removed with forceps or suction.
b) 25% glucose in glycerin:
The application of this paint, after the removal of crusts, inhibits the growth of proteolytic organisms responsible for foul smell.
c. Antibiotics:
Spraying or painting antibiotics may eliminate secondary infection.
- Kemicetine antiozaena solution, which contains Chloromycetin, estradiol and vitamin D2 has been found useful.
- Systemic use of streptomycin (effective against Klebsiella), 1 g/day for 10 days, reduces crusting and bad odor.
d) Estradiol nasal spray:
It is said to increase the vascularity of nasal mucosa and regenerate seromucous glands.
e) Placental extract:
This submucosal intranasal injection provides symptomatic relief.
f) Potassium iodide:
This oral preparation has been shown to promote and liquefy nasal secretions.
B. Surgical
1. Young’s operation:
In this surgery, both nostrils are completely closed within the nasal vestibule with flaps.
Nasal mucosa may revert to normal, and crusting is reduced.
The nostrils are opened again after about 6 months or later.
2. Modified Young’s operation:
The nostrils are partially closed that avoids the discomfort of nasal obstruction.
3. Narrowing the nasal cavities:
Narrowing of the nasal airway helps in decreasing the crusting.
The techniques include —
1) Submucosal intranasal injection of Teflon paste.
2) Fat, Cartilage, Bone, or Teflon grafts
These grafts are put under the mucoperiosteum of the floor, and lateral wall of the nose, and the mucoperichondrium of the septum.
3) Medial displacement of lateral nasal wall.
Secondary Atrophic Rhinitis
1. Syphilis, lupus, leprosy, and rhinoscleroma
These diseases cause atrophic changes and destruction of the nasal structures.
2. The long-standing purulent rhinosinusitis
3. Radiotherapy, and
4. Excessive surgical removal of the turbinates
5. Marked deviation of the nasal septum (DNS).
Unilateral atrophic changes in the broader side nasal cavity are sometimes seen in cases of marked or gross DNS patients
Preventive Measures
While atrophic rhinitis may not always be preventable, there are steps you can take to minimize the risk and manage the condition effectively-
- Maintain good nasal hygiene by gently cleaning the nasal passages
- Avoid exposure to environmental irritants such as dust, smoke, and chemical fumes
- Stay hydrated to keep the nasal mucosa moist
- Follow a healthy diet rich in vitamins and minerals to support immune function
- Seek prompt treatment for any nasal infections or trauma
By adopting these preventive measures, you can reduce the frequency and severity of atrophic rhinitis symptoms.
THANK YOU
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