Chronic atrophic rhinitis, or simply atrophic rhinitis, is a chronic

inflammation Inflammation (from la, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or irritants, and is a protective response involving immune cells, blood vessels, and molec ...

of the

nose A nose is a protuberance in vertebrates that houses the nostrils, or nares, which receive and expel air for respiration alongside the mouth. Behind the nose are the olfactory mucosa and the sinuses. Behind the nasal cavity, air next passes ...

characterised by atrophy of

nasal mucosa The nasal mucosa lines the nasal cavity. It is part of the respiratory mucosa, the mucous membrane lining the respiratory tract. The nasal mucosa is intimately adherent to the periosteum or perichondrium of the nasal conchae. It is continuous w ...

, 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. It can also be described as the empty nose syndrome.

Signs and symptoms

* It is most commonly seen in females. * It is 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 the nerve endings (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. 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 The nasal cavity is a large, air-filled space above and behind the nose in the middle of the face. The nasal septum divides the cavity into two cavities, also known as fossae. Each cavity is the continuation of one of the two nostrils. The nasal c ...

can occur. The nose may show a saddle-nose deformity. * Atrophic rhinitis is also associated with similar atrophic changes in the

pharynx The pharynx (plural: pharynges) is the part of the throat behind the mouth and nasal cavity, and above the oesophagus and trachea (the tubes going down to the stomach and the lungs). It is found in vertebrates and invertebrates, though its st ...

or larynx, producing symptoms pertaining to these structures. Hearing impairment can occur due to Eustachian tube blockage causing

middle ear The middle ear is the portion of the ear medial to the eardrum, and distal to the oval window of the cochlea (of the inner ear). The mammalian middle ear contains three ossicles, which transfer the vibrations of the eardrum into waves in the ...

effusion.

Etiology

Causes can be remembered by the mnemonic HERNIA: * Hereditary factors: the disease runs in families * Endocrine imbalance: the disease tends to start at puberty and mostly involves females *

Racial A race is a categorization of humans based on shared physical or social qualities into groups generally viewed as distinct within a given society. The term came into common usage during the 1500s, when it was used to refer to groups of variou ...

factors: white people are more susceptible than natives of equatorial Africa *

Nutrition Nutrition is the biochemical and physiological process by which an organism uses food to support its life. It provides organisms with nutrients, which can be metabolized to create energy and chemical structures. Failure to obtain sufficient ...

al deficiency: vitamins A or D, or iron *

Infection An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable dis ...

: ''

Klebsiella ''Klebsiella'' is a genus of Gram-negative, oxidase-negative, rod-shaped bacteria with a prominent polysaccharide-based capsule. ''Klebsiella'' species are found everywhere in nature. This is thought to be due to distinct sublineages developi ...

ozaenae'', diphtheroids, ''

Proteus vulgaris ''Proteus vulgaris'' is a rod-shaped, nitrate-reducing, indole-positive and catalase-positive, hydrogen sulfide-producing, Gram-negative bacterium that inhabits the intestinal tracts of humans and animals. It can be found in soil, water, and ...

'', ''E. coli'', etc. *

Autoimmune In immunology, autoimmunity is the system of immune responses of an organism against its own healthy cells, tissues and other normal body constituents. Any disease resulting from this type of immune response is termed an "autoimmune disease". ...

factors: viral infection or some other unidentified insult may trigger antigenicity of the nasal mucosa.

Secondary atrophic rhinitis

Specific infections, such as syphilis,

leprosy Leprosy, also known as Hansen's disease (HD), is a long-term infection by the bacteria ''Mycobacterium leprae'' or ''Mycobacterium lepromatosis''. Infection can lead to damage of the nerves, respiratory tract, skin, and eyes. This nerve damag ...

and rhinoscleroma, may cause destruction of the nasal structures leading to atrophic changes. Atrophic rhinitis can also result from long-standing purulent

sinusitis Sinusitis, also known as rhinosinusitis, is inflammation of the mucous membranes that line the sinuses resulting in symptoms that may include thick nasal mucus, a plugged nose, and facial pain. Other signs and symptoms may include fever, head ...

or radiotherapy of the nose, or as a complication of surgery of the

turbinates In anatomy, a nasal concha (), plural conchae (), also called a nasal turbinate or turbinal, is a long, narrow, curled shelf of bone that protrudes into the breathing passage of the nose in humans and various animals. The conchae are shaped like ...

. The United Kingdom

National Health Service The National Health Service (NHS) is the umbrella term for the publicly funded healthcare systems of the United Kingdom (UK). Since 1948, they have been funded out of general taxation. There are three systems which are referred to using the " ...

has stated that "Most cases of atrophic rhinitis in the UK occur when the turbinates are damaged or removed during surgery". Some authors refer to as Atrophic rhinitis secondary to sinus surgery as the

empty nose syndrome Empty may refer to: ‍ Music Albums * ''Empty'' (God Lives Underwater album) or the title song, 1995 * ''Empty'' (Nils Frahm album), 2020 * ''Empty'' (Tait album) or the title song, 2001 Songs * "Empty" (The Click Five song), 2007 * ...

Unilateral atrophic rhinitis

Extreme deviation of nasal septum may be accompanied by atrophic rhinitis on the wider side.

Pathology

* 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 and periarteritis causing decreased blood supply, hence the supplying area atrophies. * Arrested development of paranasal sinuses.

Diagnosis

Diagnosis is based on clinical history and examination. Examination is clinical, via anterior rhinoscopy and fibreoptic, using nasendoscopy. A CT scan can be used to confirm the diagnosis and review disease extent.

Treatment

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 nasal solutions. * 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 Vitamin D is a group of fat-soluble secosteroids responsible for increasing intestinal absorption of calcium, magnesium, and phosphate, and many other biological effects. In humans, the most important compounds in this group are vitamin D3 (c ...

₂ . * Estradiol spray for regeneration of seromucinous glands and vascularization of mucosa. * Systemic streptomycin (1g/day) against Klebsiella organisms. * Oral

potassium iodide Potassium iodide is a chemical compound, medication, and dietary supplement. It is a medication used for treating hyperthyroidism, in radiation emergencies, and for protecting the thyroid gland when certain types of radiopharmaceuticals are u ...

for liquefaction of secretion. * Placental extract injected in the submucosa. * Rifampicin 600 mg once daily for 12 weeks. Surgical interventions include: * Young's operation. * Modified Young's operation. * Narrowing of nasal cavities, submucosal injection of Teflon paste (William's operation), section and medial displacement of the lateral wall of the nose. * Transposition of parotid duct to maxillary sinus or nasal mucosa (Wittmack's operation) * Complete inversion of mucoperiosteum of maxillary antrum to create a neoturbinate (Raghav Sharan's operation) * Repeated Stellate ganglion block (Sardana's operation) * Vestibuloplasty

History

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 Egyptian medical papyri are ancient Egyptian texts written on papyrus which permit a glimpse at medical procedures and practices in ancient Egypt. These papyri give details on disease, diagnosis, and remedies of disease, which include herbal re ...

. In the Edwin Smith Papyrus (1700 BC) it was prescribed a treatment based on wine and breast milk to cure this disease. The ancient Greek and Indian civilizations were aware of atrophic rhinitis.

References

External links

{{Respiratory pathology Inflammations Nose disorders ja:臭鼻症