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Atrophic rhinitis (Ozaena): causes, symptoms and treatment

Synonyms: dry rhinitis, rhinitis sicca, empty-nose syndrome, or ozaena.
Definition: chronic non-specific rhinitis characterized by progressive atrophy of the nasal mucosa along with the underlying bones of turbinates.

Etiology (Causes):

Primary atrophic rhinitis: (HERNIA)

  • Hereditary factors: the disease runs in families.
  • Endocrine imbalance: the disease tends to start at puberty and mostly involves females.
    Atrophic-Rhinitis-Ozaena
  • Racial factors: whites are more susceptible than natives of equatorial Africa.
  • Nutritional deficiency: vitamins A or D, or iron.
  • Infection: Klebsiella ozaena.
  • Autoimmune factors: viral infection or some other unidentified insult may trigger antigenicity of the nasal mucosa.

Secondary atrophic rhinitis: most frequent type nowadays.

  • Specific infections (granulomas) such as syphilis (Treponema), and rhinoscleroma.
  • Radiotherapy of the nose
  • Complication of surgery of the Turbinates.

Pathology:

  • Squamous metaplasia of the epithelium of nasal mucosa.
  • Atrophy of mucosa, turbinal bones and seromucinous glands due to obliterative endarteritis.

Incidence: more common in females at the age of puberty.

Symptoms:

  • Nasal obstruction despite the roomy nasal cavity, which can be caused either by the obstruction produced by the discharge in the nose, or as a result of sensory loss due to atrophy of nerves in the nose, so the patient is unaware of the air flow.
  • Nasal discharge: greenish crusts with foul smelling, though the patients may not be aware of this, because the associated merciful anosmia.
  • Epistaxis, may occur when the dried discharge (crusts) are removed.
  • Hyposmia.

Signs:

  • Atrophic nasal mucosa and turbinates.
  • The nasal cavities become roomy and are filled with foul smelling crusts.

Treatment of atrophic rhinitis:

First, treatment of the cause: e.g., nasal granulomas, then:

Medical treatment:

  • Nasal irrigation and removal of crusts using alkaline nasal solutions.
  • 25% glucose in glycerin can be applied to the nasal mucosa to inhibit the growth of proteolytic organisms which produce foul smell.
  • Local antibiotic spray.
  • Estradiol spray for regeneration of seromucinous glands.
  • Oral potassium iodide for liquefaction of secretion.
  • Placental extract injected in the submucosa.
  • Iron and vitamin A.

Surgical interventions:

  • Aims at narrowing of nasal cavity till the mucosa regenerates.
  • Young's operation: Closure of the nasal cavity affected with atrophic rhinitis by creating mucocutaneous flaps (6m-2y). (Obsolete)
  • Submucosal augmentation using bone, cartilage, or Teflon paste.

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