Atrophic Rhinitis is a chronic inflammatory nasal disease characterized by progressive atrophy of the mucosa, and underlying bone of the turbinates. There is a viscid secretion in the nose which rapidly dries and forms crusts which emits a characteristic foul odour called ozaena and the patient himself suffers from anosmia. It is also termed as Ozaena. Types: Atrophic rhinitis is of two types:
- Hereditary factors: The disease runs in family.
- Endocrinal disturbance: The disease usually starts at puberty. It involves females more than males. It tends to cease after menopause. These factors have raised the possibility of disease being an endocrinal disorder.
- Racial factors: White and yellow races are more susceptible than natives of equatorial Africa.
- Nutritional deficiency: Due to deficiency of vitamin A, D or iron or some other dietary factors.
- Infective: Organisms involved includes Klebsiella ozaenae, Diphtheroids, Proteus vulgaris, Escherichia coli, staphylococci and streptococci.
- Autoimmune process.
- Infections like syphilis, leprosy, tuberculosis, Lupus vulgaris.
- Extensive surgery.
- Klebsiella ozaenae
- Proteus vulgaris
- Escherichia coli
Histopathology: There is a metaplasia of columnar or ciliated epithelium to squamous epithelium with decrease in the number of compound alveolar glands. Histopathologically, there are 2 types of atrophic rhinitis:
- Type I: Characterized by endarteritis and periarteritis, which may be as a result of chronic infection. These patients may benefit by vasodilator effect of oestrogen therapy.
- Type II: Characterized by vasodilation of capillaries which may become worse by oestrogen therapy.
- Nose emits foul smell.
- Anosmia- There is foul smell from nose which patient himself is unaware of it due to marked anosmia (merciful anosmia) which accompanies degenerative changes.
- Blocking of nose.
- There is atrophy of nerves as well, hence the patient loses sensation of smell.
- External Nose: Bridge of the nose appears depressed due to atrophy of the nasal septum.
- Anterior rhinoscopy reveals roomy nostrils with crusts, occasionally with septal perforation.
- Posterior rhinoscopy shows crusts.
- VDRL test to rule to out syphilis.
- Nasal smear for tuberculosis and leprosy.
- X-ray paranasal sinuses may reveal sinusitis.
- CT scan PNS shows atrophy of turbinate and mucosa.
Local Conservative treatment:
Local Conservative treatment:
- Glucose in glycerin nasal drops: 25% glucose in glycerin, inhibits the growth of proteolytic organisms.
- Kemicetine antiozoenal solution containing chloramphenicol 90 mg, vitamin D2 and Oestradiol di-propionate.
- Alkaline nasal douche: In 280 ml warm water the following are added:a. Sodium bicarbonate 28.4 gm for loosening the crusts. b. Sodium diborate 28.4 gm. c. Sodium Chloride for isotonicity 56.7 gm.
Surgical: Numerous surgical attempts have been made to narrow the nasal passage. Various surgical procedures are:
- Inspection of Teflon strips, polythene, cartilage in the mucoperichondrial flap.
- Stellate ganglion blocks.
- Young’s surgery: Young in 1967 invented a procedure to close the nostril which is later re-opened after varying periods ranging from 6 months to 1 year.
- Modified Young’s closure: This is similar to Youngs closure but the anterior nares are partially closed, permitting minimal breathing for the patient.
- Raghav Sharan’s operation: This includes implantation of maxillary sinus mucosa in the nostril.
- Wittmack’s surgery: Implantation of the Stenson’s duct (parotid duct) into the maxillary antrum.
- Lautenslager’s Surgery: The lateral wall of the nose is medialized to narrow the nasal cavity.