Atrophic rhinitis

Atrophic Rhinitis also called as Ozaena, it is a chronic inflammation of nose characterised by atrophy of nasal mucosa including the glands, turbinate bones, and the nerve elements supplying the nose.

Atrophic Rhinitis is of two types: primary and secondary.

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Primary Atrophic Rhinitis

Aetiology

• Heredity factors: Disease runs in families
• Endocrine Imbalance: Disease tends to start at puberty and mostly involves females
• Racial factors: White and yellow races
• Nutritional deficeincy: Vit A, D or iron
• Infection: Klebsiella ozaenae, diphtheroids, P.vulgaris, E.coli etc.
• Autoimmune: Viral infection or some other unidentified insult may trigger antigenicity of nasal mucosa

Pathology

Ciliated columnar epthelium of the nasal mucosa is replaced by stratified squamous epithelium. Atrophy of mucosa, turbinal bones, seromucinous glands tend to occur. This is due to obliterative endarteritis causing decreased blood supply hence the supplying area atrophies.

Clinical manifestations

Disease is most commonly seen in females and tends to appear during puberty. The nasal cavities become roomy and are filled with foul smelling crusts which are black and dry. Microorganisims are known to multiply and this produces a foul smell from the nose, though patient is not aware of this because his/her nerve aliments (responsible for the perception of smell) have become atrophied. Patients usually complain of 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 that the patient is unaware of the air flow. In the case of the second cause, the sensation of obstruction is subjective. Bleeding from the nose, also called epistaxis may occur when the dried discharge (crusts) are removed. Septal perforation and dermatitis of nasal vestibule can occur. Nose may show a saddly nose deformity. Atrophic rhinitis is also associated with similar atrophic changes in the pharynx, larynx producing symptoms pertaining to these structures. Hearing impairment can occur due to Eustachian tube blockage causing middle ear effusion.

Prognosis

Disease has a tendency to recover spontaneously by middle age.

Treatment options

Treatment of Atrophic Rhinitis can be either medical or surgical.

Medical measures include:

• Nasal irrigation and removal of crusts using alkaline nasal douches
• 25% glucose in glycerine can be applied to nasal mucosa, this inhibits growth of foul smelling proteolytic organisms
• Local antibiotics like Kemicetine (Chloramphenicol) Ostradiol and Vit D2
• Ostradiol spray
• Systemic streptomycin
• Oral potassium iodide
• placental extract injected in the submucosa

Surgical Interventions include

• Young's operation
• Modified Young's operation
• Narrowing of nasal cavities, submucosal injection of Teflon paste, section and medial displacement of lateral wall of nose
• Transposition of parotid duct to maxillary sinus or nasal mucosa.