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Rhinitis Atrophicans: Causes, Symptoms and Treatment
Rhinitis atrophicans is a chronic nasal condition characterized by progressive atrophy of the nasal mucosa and underlying bone, leading to crusting and an enlarged nasal cavity.
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Rhinitis atrophicans is a chronic nasal condition characterized by progressive atrophy of the nasal mucosa and underlying bone, leading to crusting and an enlarged nasal cavity.
What is Rhinitis atrophicans?
Rhinitis atrophicans (also known as ozena) is a rare, chronic disease of the nose in which the mucous membrane lining and the underlying bone and cartilage of the nasal cavity gradually waste away (atrophy). This tissue loss causes pathological widening of the nasal passages and the formation of characteristic, foul-smelling crusts. The condition occurs worldwide but is more prevalent in tropical and subtropical regions, as well as in socioeconomically disadvantaged populations.
Causes
The exact causes of rhinitis atrophicans are not fully understood. Two main forms are distinguished:
- Primary rhinitis atrophicans (ozena): The cause is unknown (idiopathic). Genetic predisposition, hormonal influences, and infection with bacteria such as Klebsiella ozaenae have been discussed as contributing factors.
- Secondary rhinitis atrophicans: Develops as a consequence of other conditions or interventions, such as extensive nasal surgery (sometimes referred to as empty nose syndrome), radiation therapy, chronic nasal inflammation, granulomatous diseases (e.g., granulomatosis with polyangiitis), or nasal trauma.
Additional contributing factors include malnutrition, poor hygienic conditions, and a weakened immune system.
Symptoms
Rhinitis atrophicans presents with a range of characteristic symptoms:
- Crust formation inside the nose with a characteristic, unpleasant odor (foetor)
- Cacosmia (subjective perception of foul odors) and anosmia (loss of the sense of smell)
- Sensation of dryness and spaciousness inside the nose despite reduced effective airflow
- Chronic nasal obstruction and difficulty breathing through the nose
- Recurrent epistaxis (nosebleeds)
- Headaches and general malaise
- In severe cases: spread to the sinuses, throat, and middle ear
Diagnosis
Diagnosis is usually made by an ear, nose, and throat (ENT) specialist and involves the following steps:
- Medical history: Assessment of symptoms and clinical background
- Rhinoscopy / Endoscopy: Direct visualization of the nasal cavity; typical findings include widened nasal passages with crusting and atrophied mucosa
- Bacteriological swabs: Detection of pathogens such as Klebsiella ozaenae
- Imaging: CT or MRI of the paranasal sinuses to assess the extent of atrophy and bone resorption
- Histological examination: Tissue biopsy to rule out other conditions such as tumors or granulomatous diseases
Treatment
A complete cure for primary rhinitis atrophicans is currently not possible. Treatment focuses on relieving symptoms and slowing disease progression.
Conservative Treatment
- Nasal irrigation with isotonic or mildly hypertonic saline solution to loosen crusts and moisturize the nasal lining
- Topical application of nasal ointments or oils (e.g., dexpanthenol, sesame oil) to keep the mucosa hydrated
- Antibiotics (topical or systemic) for confirmed bacterial infection, e.g., with Klebsiella ozaenae
- Supplementation with vitamins (especially vitamin A and vitamin D) where deficiencies are identified
- Regular ENT follow-up and professional crust removal
Surgical Treatment
- Narrowing of the nasal passages through surgical procedures (e.g., implants or tissue augmentation) to normalize airflow and reduce mucosal dryness
- Temporary closure of the nostrils using the Young procedure to allow mucosal regeneration
Prognosis
Rhinitis atrophicans follows a chronic course and can significantly impact quality of life. However, consistent treatment can substantially reduce symptoms. Notably, the condition may spontaneously stabilize or improve during puberty or middle age in some patients.
References
- Hildenbrand T, Weber RK, Brehmer D. Rhinitis sicca, dry nose and atrophic rhinitis: a survey of the literature. Eur Arch Otorhinolaryngol. 2011;268(1):17-26. doi:10.1007/s00405-010-1391-3.
- Tos M. Atrophic rhinitis. In: Scott-Brown's Otorhinolaryngology: Head and Neck Surgery. 7th ed. Hodder Arnold, London, 2008.
- Bhalla RK, Jones TM, Freeland AP. Empty nose syndrome: an overview of a debilitating condition. J Laryngol Otol. 2004;118(6):429-433. doi:10.1258/002221504323219557.
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