Chronic atrophic rhinitis
|Chronic atrophic rhinitis|
|Classification and external resources|
Chronic atrophic rhinitis is a chronic inflammation of nose characterised by atrophy of nasal mucosa, including the glands, turbinate bones and the nerve elements supplying the nose. Chronic atrophic rhinitis may be primary and secondary. Special forms of chronic atrophic rhinitis are rhinitis sicca anterior and ozaena.
Primary atrophic rhinitis
This disorder was known since the time of ancient Egypt, almost 4,000 years ago, and descriptions of it are found in the historical medical papyri. In the papyrus of Edwin (1700 BC) it was prescribed a treatment based on wine and breast milk to cure this disease. Even the ancient Greek civilization and the Indian were aware of atrophic rhinitis.
- Heredity factors: the disease runs in families
- Endocrine 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: vitamins A or D, or iron
- Infection: Klebsiella ozaenae, diphtheroids, Proteus vulgaris, E. coli, etc.
- Autoimmune: viral infection or some other unidentified insult may trigger antigenicity of the nasal mucosa.
The ciliated columnar epithelium of the nasal mucosa is replaced by stratified squamous epithelium. Atrophy of mucosa, turbinal bones and seromucinous glands tends to occur, due to obliterative endarteritis causing decreased blood supply, hence the supplying area atrophies.
The disease is most commonly seen in females, is reported among patients from lower socioeconomic groups and tends to appear during puberty. It can occur, however, as early as 12 months of age. 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. 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. In the case of the second cause, the sensation of obstruction is subjective. 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. Atrophic rhinitis is also associated with similar atrophic changes in the pharynx or larynx, producing symptoms pertaining to these structures. Hearing impairment can occur due to Eustachian tube blockage causing middle ear effusion.
Permanent loss of smell and impairment of taste may also be a result of this disease, even after the symptoms are cured.
Secondary atrophic rhinitis
Specific infections, such as syphilis, lupus, leprosy and rhinoscleroma, may cause destruction of the nasal structures leading to atrophic changes. Atrophic rhinitis can also result from long-standing purulent sinusitis, radiotherapy of the nose or excessive surgical removal of turbinates.
Unilateral atrophic rhinitis
Extreme deviation of nasal septum may be accompanied by atrophic rhinitis on the wider side.
Treatment of atrophic rhinitis can be either medical or surgical.
Medical measures include:
- Nasal irrigation using normal saline
- Nasal irrigation and removal of crusts using alkaline solutions
- 25% glucose in glycerine can be applied to the nasal mucosa to inhibit the growth of foul-smelling proteolytic organisms
- Local antibiotics, such as chloramphenicol (Kemicetine)
- Estradiol and vitamin D2
- Estradiol spray
- Systemic streptomycin
- Oral potassium iodide
- Placental extract injected in the submucosa
Surgical interventions include:
- Young's operation
- Modified Young's operation
- Narrowing of nasal cavities, submucosal 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
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