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.
- 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.