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Article on "Atrophic Rhinitis"  

Atrophic Rhinitis

Summary

Atrophic Rhinitis (Ozaena) is a chronic condition which affects the nose or the nasal cavity. The nasal cavity or passages in the nose become wider. It occurs due to the thinning of the membranes and walls surrounding the nasal cavity. The inside of the cavity becomes dry and crusts may form on the walls and the membranes. There may also be foul smell from the nose, and reduced sense of smell. 

Depending on the cause, Atrophic Rhinitis may be of two types:

  • Primary (more common): The exact cause is not known. Symptoms usually appear in adolescence or in puberty. The condition is more common in females.

  • Secondary: It may occur due to an infection, after nose surgery, or due to exposure to radiation exposure. This can happen at any age.

Quick Points About the Disease/Condition

Chronic, can be infectious, can be genetic, non-contagious.

Your Body Part or System That it Affects

It affects the nose or the nasal cavities. The membranes and walls surrounding the nasal cavity become thin. There will be reduced sense of smell.

Causes of Atrophic Rhinitis

Depending on the cause, Atrophic Rhinitis may be primary or secondary.

Primary Atrophic Rhinitis (more common)

The exact cause is not known. However, the potential causes are:

  • Genetic: Atrophic Rhinitis is more common in people whose close relatives or parents have/had the condition. This probably is because of inheriting certain defective genes from the parents. However, no such exact genes have been identified yet.

  • Hormonal: Atrophic Rhinitis is more common in females. It commonly starts during puberty (when certain hormone levels increase) and regress after menopause (when the menses stop in females). This suggests a role of the hormones in Primary Atrophic Rhinitis. However, more details are not known at present.

  • Nutritional Deficiency: The condition is more common in poor people compared to the rich. This may be because of certain nutrients in the diet that prevent the conditions. Deficiency of vitamins A, D, or of iron may increase the chances of developing Atrophic Rhinitis.

  • Infection: Several bacteria such as klebsiella are present in the nose in people with Atrophic Rhinitis. These bacteria cause damage to the cells lining the nasal cavity and are responsible for producing foul smell. However, whether the bacteria cause the condition or infect the nose after the condition develops is not clear.

  • Autoimmune Causes: Primary Atrophic Rhinitis may occur due to damage to the tissues of the nose by the immune cells of its own body. This is referred to as autoimmune causes.

Secondary Atrophic Rhinitis 

It may occur due to:

  • Infection or Inflammation: Chronic (long term) infection may result in inflammation of the nasal structures. Inflammation is the accumulation of immune cells in the infected area. The inflammation results in thinning of the walls and nasal membranes, which is called Atrophy. This widens the nasal passages resulting in Atrophic Rhinitis. The infection can be due to organisms that cause conditions such as Syphilis, Leprosy or Rhinoscleroma. Other than that, Chronic Sinusitis or radiation treatment that may be taken to treat conditions such as nose cancer, may also result in long term inflammation. 

  • Surgery: Surgeries done on the nose such as rhinoplasty may result in Atrophic Rhinitis.

  • Deviated Nasal Septum: Nasal septum is a thin membrane that lies between the two sides of the nasal cavity. In some people, the septum deviates or shifts to one side. As a result, the nose cavity on the other side becomes wider. Nasal membranes on the wider side frequently get dry predisposing them to damage.

Symptoms of Atrophic Rhinitis

The usual symptoms in a person having Atrophic Rhinitis are foul smell from the nose, loss of smell and nosebleeds (Epistaxis). The nasal passages are wider. The walls of the nose passages may be covered with thick, greyish-black crusts. 

In some people, the voice may become rough and thick or becomes hoarse. There may also be frequent coughing due to associated damage to the throat and larynx (voice box) region. There may be mild hearing loss due to any associated ear infection.

Tests and Diagnosis of Atrophic Rhinitis

The diagnosis may start with verifying the medical and family history of the person. Any associated symptoms and history of any injury to the nose is also considered.  

Nasal examination is done using a bright light and a nasal speculum, which helps to spread open the nostrils. All the sides inside the nose are examined. This helps to confirm the diagnosis and assess the extent of Atrophic Rhinitis.

No further testing is usually needed.

Treatments for Atrophic Rhinitis

The aim of treatment is to relieve the symptoms, maintain nasal hygiene, and to reduce formation of crusts.

General Measures

The nasal cavity is irrigated with a warm saline solution for 2 to 3 times a day. The solution softens the crusts sticking to the walls of the nose, and helps in removing them easily. It also removes any discharge that blocks the nasal passages. The crusts that are not washed away by irrigation may be removed by forceps. 

Medication

  • A solution containing glycerine and glucose is applied on the walls of nose after removing the crusts. The solution prevents drying and formation of further crusts. It also cures the microbial infection of the nose that causes foul smell. 

  • Antibiotics are given orally or through nasal drops to kill or reduce the growth of microbes inside the nose.

  • Estrogen or placental extract may be applied inside the nose. These medications increase blood circulation to the nose and help in rebuilding of the nose tissues. 

Surgery

Surgery may be done if symptoms are not relieved by medications. The aim of surgery is to reduce crust formation and to reform the normal nasal passages. 

  • The nostrils may be closed completely or partially by a flap of the skin and re-opened after six months. The aim of this procedure is to give time for proper healing of the nasal walls.  

  • Surgery may be done to reduce the width of the nasal passages. It may be done by inserting of substances such as fat or synthetic material (Teflon, for example) into the walls of the nasal cavity.

Side-effects and Complications

  • Due to damage and thinning of the walls of the cavity of the nose, perforation (hole) of the nasal septum and depression of the nose (saddle nose) may occur.
  • Atrophic Rhinitis may result in Chronic Sinus infection. This causes pain in the face region and headache. In some cases, severe bleeding from the nose may occur.

  • People having Atrophic Rhinitis may be disturbed because of the foul smell coming from their noses. The person himself or herself may not able to smell the foul because of the reduced sense of smell, but other people may avoid company due to the foul smell.        

Self-care and Important Considerations

  • One may prevent Atrophic Rhinitis by taking the following measures:
  • One should take regular balanced diet with all the required nutrients and in adequate amounts.

  • Washing hands after coming from outside and avoiding contact with any person having a nose or throat infection, reduces the chances of nose infection.

  • Proper and early treatment of nose infections or deviated nasal septum reduces helps.

  • Anyone who has Atrophic Rhinitis should not put his or her fingers into the nose.

  • Crusts sticking to the walls of nose cavity should be removed gently. Rough and callous removal of crusts may cause bleeding.     

This article is developed by our team of Doctors/Experts. Last updated in 20th December,2010. Please see our Editorial board for details.
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