ATROPHIC RHINITIS or OZAENA

 §  Atrophy of nasal mucosa and turbinates

Types:

Atrophic rhinitis is a chronic inflammation of nose characterized by atrophy of nasal mucosa, including the glands, turbinate bones and the nerve elements. Atrophic rhinitis may be primary or secondary

1. Primary atrophic rhinitis

The primary pathology is inflammation and atrophy of the nose. Generally, atrophic rhinitis refers to primary atrophic rhinitis. Causes are : –

1. Hereditary
2. Endocrinal pathology – Starts at puberty. Stops after menopause
3. Racial factors – Seen more in Whites and Yellow races
4. Nutritional deficiency – Deficiency of vitamin A, D, E and iron may be responsible for it.
5. Infective – Klebsiella ozanae, Diphtheriods, P. vulgaris, E.coli, Staphylococci, Streptococci.
6. Autoimmune process – Causing destruction of nasal, neurovascular and glandular elements may be the cause.
7. Secondary atrophic rhinitis

Specific infections, such as syphilis, lupus, leprosy, and rhinoscleroma, may cause destruction of the nasal structures leading to atrophic changes. Can also results from long standing purulent sinusitis , radiotherapy of nose, excessive surgical removal of the turbinate and as complication of DNS on the root side of nose.

Clinical features of atrophic rhinitis

• The disease is mostly seen in females and tends to appear during  puberty.
• The disease is always bilateral except in case of DNS where it is seen on the wider side.
• There is foul smell from the nose making the patient a social outcast though patient himself is unaware of the smell due to marked anosmia (merciful anosmia).
• Patient complains of nasal obstruction inspite of unduly wide nasal chambers. This is due to large crusts filling the nose.
• Epistaxis may occur when the crusts are removed.
• Nasal cavities are roomy and full of foul-smelling crusts
• Ciliated columnar epithelium is replaced by stratified squamous type.

Medical treatment – nasal irrigation and removal of crusts, local antibiotics, oestradiol spray, submucosal placental extract injection

 Surgery – Young’s operation

Exam Question

Klebsiella ozanae causes Primary Atrophic rhinitis

Secondary  Atrophic rhinitis are due  to Specific infections, such as syphilis, lupus, leprosy, and rhinoscleroma.

• Can also result from long standing purulent sinusitis ,
• radiotherapy of nose,
• excessive surgical removal of the turbinate and 
• as complication of DNS on the root side of nose.

Clinical features of atrophic rhinitis:         

• The disease is mostly seen in females and tends to appear during  puberty.
• There is foul smell from the nose making the patient a social outcast though patient himself is unaware of the smell due to marked anosmia (merciful anosmia).