Atrophic Rhinitis

What is atrophic rhinitis? Atrophic rhinitis is a chronic nasal condition that is characterised by the formation of thick dry crusts in the nasal cavity. It results from progressive wasting away or decreasing in size (atrophy) of the mucous nasal lining (mucosa) and its underlying bone. It also affects the glands and turbinate bones. Special forms of chronic atrophic rhinitis are rhinitis sicca anterior and ozaena. Etiology • Hereditary factors • Endocrinal 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 in vitamins A , D or iron • Autoimmune factors - viral infection may trigger antigenicity of the nasal mucosa Symptoms • Most commonly seen in females • Reported among patients from lower socioeconomic groups • The nasal cavities become roomy and are filled with foul smelling crusts which are black or dark green and dry, making expiration painful and difficult. • Microorganisms are known to multiply and produce a foul smell from the nose, though the patients may not be aware of this, because their elements (responsible for the perception of smell) have become atrophied. This is called merciful anosmia. • 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 the patient is unaware of the air flow. • 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. The nose may show a saddle-nose deformity. Management Treatment of atrophic rhinitis can be either medical or surgical. Medical measures include: • Nasal irrigation using normal saline • Removal of crusts using alkaline nasal solutions prepared by dissolving a spoonful of powder containing one part sodium bicarbonate, one part sodium biborate and two part sodium chloride. • 25% glucose in glycerine can be applied to the nasal mucosa to inhibit the growth of proteolytic organisms which produce foul smell • Local antibiotics, such as chloromycetine • Vitamin D(Kemicetine) • Systemic streptomycin (1g/day) against Klebsiella organisms. Surgical interventions include: • Modified Young's operation • Narrowing of nasal cavities, sub-mucosal injection of Teflon paste, section and medial displacement of the lateral wall of the nose • Transposition of parotid duct to maxillary sinus or nasal mucosa