Atrophic means Degeneration and Rhinitis meaning Inflammation of mucous membrane inside nose. Atrophic Rhinitis, also name as Ozaena, is a chronic inflammation of nose with atrophy of nasal mucosa and turbinate bones.

Atrophic Rhinitis is of two types, namely, Primary Atrophic Rhinitis and Secondary Atrophic Rhinitis which occurs following another cause such as infections.

Primary Atrophic Rhinitis

Definition

Primary Atrophic Rhinitis occurs as a primary disease following no secondary cause.

Causes

Mnemonic – HERNIA

1. Hereditary factors- Multiple incidences in same family.

2. Endocrinal disturbances- F>M, appears more at puberty and ceases around menopause.

3. Racial factors- Whites and Yellow races>Equatorial african natives.

4. Nutritional deficiency- Vitamin A, D or iron relations.

5. Infections- Kelbsiella ozaenae, Proteus vulgaris, E.coli, Staphylococcus and Streptococci, Diptheroids relations.

6. Autoimmune process- Viral infections or some other unidentified agents may trigger antigenicity of the nasal mucosa.

Pathology

Ciliated columnar lost and replaced by stratified squamous type.

Recall as ARES:

-Atrophy of seromucinous glands, venous blood sinusoids and nerve elements.

-Resorption of turbinate bones leading to widening of nasal chambers

-Endarteritis of arteries in mucosa, periosteum and bone.

-Small paranasal sinuses due to arrested development.

Clinical Features

Symptoms

Symptoms with which patients present :-

1. Foul smell from the nose

2. Nasal obstruction due to large crusts filling the nose

3. Epistaxis (bleeding from nose) as these crusts are removed

Signs

Upon examination, following signs are revealed :-

1. Nasasl cavity is filled with greyish/greenish black dry crusts

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2. Nasal mucosa – Pale

3. Septal perforation and dermatitis of nasal vestibule

4. Nasal saddle deformity may be present

Related features

1. Cough and hoarseness of voice due to Atrophic laryngitis

2. Hearing problems due to obstruction of eustachian tube and middle ear effusion

3. Small underdeveloped paranasal sinuses

Treatment

Treatment regime can be either Medical or Surgical as follows:

Medical

1. Nasal irrigation and removal of crusts – Warm nasal saline helps in loosening crusts and removing tenacious discharge.

2. 25% glucose in glycerine – Following nasal irrigation, this helps in inhibiting growth of proteolytic organisms which cause foul smell.

3. Local antibiotics – Kemicetine helps in eliminating secondary infection.

4. Oestradiol spray – Helps in increasing mucosal vascularity and regeneration of seromucinous glands.

5. Placental extract – Provides relief from condition.

6. Systemic Streptomycin – Helps in reducing crusts and odour.

7. Potassium iodide – Promotes nasal secretion.

Surgical

1. Young’s operation – Nostrils closed for 6 months by raising flaps, which results in reduced crusts and normal mucosa.

Modified Young’s Operation – Partial closure done instead of complete.

2. Nasal Cavity Narrowing – Since nasal chambers are very wide in atrophic rhinitis due to which high air current can dry up secretions causing Crusting (We discussed this in Deviated Nasal Septum). Therefore, narrowing of the nasal airway size helps in relieving the symptoms, especially frequent Epistaxis. For this, techniques such as Teflon submucosal injection.

Secondary Atrophic Rhinitis

Atrophic Rhinitis following secondary infections is what we call Secondary Atrophic Rhinitis.

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Some causes of Secondary Atrophic Rhinitis are:

1. Syphilis
2. Leprosy
3. Rhinoscleroma
4. Purulent Sinusitis (long-standing case)
5. Radiotherapy
6. Turbinate surgical removal

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